Recomendados
Mais conteúdo relacionado
Destaque
Semelhante a Detoxi V1.Key
Semelhante a Detoxi V1.Key (18)
Último
Último (20)
Detoxi V1.Key
- 1. Detoxificação Hepática Zé Luiz - e-mail: joseluiz60@gmail.com
- 18. +
- 19. +
- 20. +
- 21. +
- 22. Indirect Bilirubin Unconjugated • Indirect-reacting (unconjugated) Bilirubin Free bilirubin (indirect-reacting or unconjugated). This is a relatively insoluble, nonpolar form requiring the addition of alcohol in the diazo reaction to allow color formation.
- 23. Indirect Bilirubin Unconjugated • Indirect-reacting (unconjugated) Bilirubin Free bilirubin (indirect-reacting or unconjugated). This is a relatively insoluble, nonpolar form requiring the addition of alcohol in the diazo reaction to allow color formation.
- 30. Direct Bilirubin - Conjugated
- 31. Direct Bilirubin - Conjugated
- 32. Direct Bilirubin - Conjugated • Direct-reacting (conjugated) Bilirubin Conjugated bilirubin (direct-reacting). This form reacts in the diazo reaction without the addition of alcohol. Increases in conjugated bilirubin indicate cholestasis but are not specific as to cause. As noted before (under the discussion for total bilirubin), hemolysis, liver disease and cholestasis will result in high conjugated bilirubin levels. Remember, that increased conjugated bilirubin in blood will produce bilirubinuria, which in all species, excluding the dog, is diagnostic for cholestasis. In horses, if conjugated bilirubin comprises > 25% of total bilirubin values, cholestasis likely exists (a concurrent bilirubinuria will be present). Extrahepatic bile duct obstruction produces the most marked increases in total bilirubin (20-30 mg/dL).
- 41. Jaundice
- 42. Jaundice
- 43. Jaundice
- 44. Jaundice
- 45. Jaundice Neonato
- 46. Jaundice Neonato
- 47. Jaundice Neonato
- 48. Jaundice Neonato
- 66. Table 2- Genetic Disorders of Bilirubin Metabolism Condition Defect Bilirubin Clinical Findings Crigler-Najjar severely defective Unconjugated Profound jaundice syndrome UDP-glucuronyltransferase bilirubin ⇑⇑⇑ Gilberts reduced activity of Unconjugated Very mild jaundice syndrome UDP-glucuronyltransferase bilirubin ⇑ during illnesses Dubin-Johnson abnormal transport of Conjugated Moderate jaundice syndrome conjugated bilirubin into the bilirubin ⇑⇑ biliary system
- 68. Referências Further Readings Bosma PJ: Inherited disorders of bilirubin metabolism. J Hepatol 38:107, 2003 [PMID: 12480568] Ferenci P: Wilson's disease. Clin Gastroenterol Hepatol 3:726, 2005 [PMID: 16233999] Fox IJ et al: Treatment of the Crigler-Najjar syndrome type I with hepatocyte transplantation. N Engl J Med 338:1422, 1998 [PMID: 9580649] Glasova H, Beuers U: Extrahepatic manifestations of cholestasis. J Gastroenterol Hepatol 9:938, 2002 Pratt DS, Kaplan MM: Laboratory tests, in Schiff's Diseases of the Liver, 9th ed, ER Schiff et al (eds). Philadelphia, Lippincott Williams & Wilkins, 2003 Trauner Met al: Molecular pathogenesis of cholestasis. N Engl J Med 339:1217, 1998 [PMID: 9780343] Bibliography Berg CL et al: Bilirubin metabolism and the pathophysiology of jaundice, in Schiff's Diseases of the Liver, 9th ed, ER Schiff et al (eds). Philadelphia, Lippincott Williams & Wilkins, 2003 Berk PD, Noyer C (eds): Bilirubin metabolism and the hereditary hyperbilirubinemias. Semin Liv Dis 14:321, 1994 [PMID: 7855625] Zimmerman HJ: Hepatoxicity: The Adverse Effects of Drugs and Other Chemicals on the Liver, 2d ed. Philadelphia, Lippincott Williams & Wilkins, 1999
- 69. Obrigado!
- 70. 20
- 71. BLOOD CELLS KIDNEY reabsorbed INTESTINE into blood LIVER Figure 2. Catabolism of hemoglobin
- 72. BLOOD CELLS Hemoglobin Globin Heme KIDNEY reabsorbed INTESTINE into blood LIVER Figure 2. Catabolism of hemoglobin
- 73. BLOOD CELLS Hemoglobin Globin Heme KIDNEY O2 reabsorbed Heme oxygenase INTESTINE into blood CO Biliverdin IXα LIVER Figure 2. Catabolism of hemoglobin
- 74. BLOOD CELLS Hemoglobin Globin Heme KIDNEY O2 reabsorbed Heme oxygenase INTESTINE into blood CO Biliverdin IXα NADPH Biliverdin reductase NADP+ Bilirubin (water-insoluble) LIVER Figure 2. Catabolism of hemoglobin
- 75. BLOOD CELLS Hemoglobin Globin Heme KIDNEY O2 reabsorbed Heme oxygenase INTESTINE into blood CO Biliverdin IXα NADPH Biliverdin reductase NADP+ Bilirubin Bilirubin (water-insoluble) (water-insoluble) LIVER via blood to the liver Figure 2. Catabolism of hemoglobin
- 76. BLOOD CELLS Hemoglobin Globin Heme KIDNEY O2 reabsorbed Heme oxygenase INTESTINE into blood CO Biliverdin IXα NADPH Biliverdin Bilirubin diglucuronide reductase (water-soluble) NADP+ 2 UDP-glucuronic acid Bilirubin Bilirubin (water-insoluble) (water-insoluble) LIVER via blood to the liver Figure 2. Catabolism of hemoglobin
- 77. BLOOD CELLS Hemoglobin Globin Heme KIDNEY O2 reabsorbed Heme oxygenase INTESTINE into blood CO Biliverdin IXα via bile duct to intestines NADPH Biliverdin Bilirubin diglucuronide reductase (water-soluble) NADP+ 2 UDP-glucuronic acid Bilirubin Bilirubin (water-insoluble) (water-insoluble) LIVER via blood to the liver Figure 2. Catabolism of hemoglobin
- 78. BLOOD CELLS Stercobilin excreted in feces Hemoglobin Globin Urobilinogen Heme formed by bacteria KIDNEY O2 reabsorbed Heme oxygenase INTESTINE into blood CO Biliverdin IXα via bile duct to intestines NADPH Biliverdin Bilirubin diglucuronide reductase (water-soluble) NADP+ 2 UDP-glucuronic acid Bilirubin Bilirubin (water-insoluble) (water-insoluble) LIVER via blood to the liver Figure 2. Catabolism of hemoglobin
- 79. BLOOD CELLS Stercobilin excreted in feces Urobilin excreted in urine Hemoglobin Globin Urobilinogen Heme formed by bacteria KIDNEY O2 reabsorbed Heme oxygenase INTESTINE into blood CO Biliverdin IXα via bile duct to intestines NADPH Biliverdin Bilirubin diglucuronide reductase (water-soluble) NADP+ 2 UDP-glucuronic acid Bilirubin Bilirubin (water-insoluble) (water-insoluble) LIVER via blood to the liver Figure 2. Catabolism of hemoglobin
- 82. Examples of hyperbilirubinemia A. Hemolytic anemia excess hemolysis unconjugated bilirubin (in blood) conjugated bilirubin (released to bile duct)
- 83. Examples of hyperbilirubinemia A. Hemolytic anemia B. Hepatitis excess hemolysis unconjugated bilirubin (in blood) unconjugated bilirubin conjugated bilirubin (in blood) (released to bile duct) conjugated bilirubin (in blood)
- 84. Examples of hyperbilirubinemia A. Hemolytic anemia B. Hepatitis C. Biliary duct stone excess hemolysis unconjugated bilirubin (in blood) unconjugated bilirubin unconjugated bilirubin conjugated bilirubin (in blood) (in blood) (released to bile duct) conjugated bilirubin conjugated bilirubin (in blood) (in blood)