Bilirubin metabolism

Warning: Audience discretion is advised,

what you are about to see is a true story
about the miserable life of bilirubin.

‫عالء الدين‬
Translated into English from an Arabic version from a King Saud University parody
Lecture.
• Inside the vessels of a human

• In the bottom of heart

• There was a loving family called „‟
Hemoglobin‟‟ living.
• In a simple house called „ RBC „.

‫عالء الدين‬
• Consist of a father called „‟ ProtoPorphiren” who has a brownish colour.
• Madame „‟ Globin‟‟ who is from a protein origin ‫عالء الدين‬
• Four sons are called „‟ Iron „‟.
‫‪In 120 days‬‬ ‫عالء الدين‬
hemolysis

• The villian called „‟ReteculoEndothelial

System’’ sweeps off the house because
‫عالء الدين‬
it was over 120 days of age.
And the life of the happy family
‫عالء الدين‬
changes
And becomes sad =(
‫عالء الدين‬
Haemoglobin is cleaved into haem & Globin which is hydrolysed into free AA

‫طلقنى طلقنى‬
..‫طلقنى‬

• Globin asks for divorce to get back to ‫الدين‬

her‫عالء‬family
house „‟ Amino acid pool‟‟.
Iron is carried on transferrin to be reused

Bye Daddy!!…

And every iron gets into his automobile

‫عالء الدين‬
„‟Transferrin‟‟ and travels far away.
Dad becomes lonely and sad =(
‫عالء الدين‬
Protoporpherin is then reduced into Biliverden

His colour changes to green and people‫الدين‬

called
‫عالء‬
him
„‟ Biliverden‟‟
Then into Bilirubin

Then his name changes to the infamous yellow

‫عالء الدين‬
colour called „‟Bilirubin‟‟
His friends convince him to tie the knot again.
‫عالء الدين‬
They propose Mademoiselle „‟ Albumin‟‟ to him.
Indirect bilirubin is water insoluble

I heard that you are

‘’ indirect’’, I
wanna know ya
more before we
marry!.

• But Mademoiselle „‟ Albumin „‟ wanted

‫الدين‬to
‫عالء‬know
him better before getting married.
so it is carried on albumin and called haemobilirubin or indirect bilirbin

Darling, people think we are married;

tell them we are just „‟ engaged‟‟.

So some people believe they got married •

‫عالء الدين‬
Or unconjugated bilirubin

They get called „‟haemobilirubin”

“indirect bilirubin” • ‫عالء الدين‬
”unconjugated bilirubin“ •
Indirect bilirubin cannot be filtrated from the kidney even in it‟s exess so not present in urine in
haemolytic jaundice “acholuric”

• But Indirect billuribin cannot enter the kidney

even if it was in an ample quantities because
‫عالء الدين‬ it is
toolarge.
 ‫و‬

Whaddaya
think of dat
house dear?

Oh dear, I would never live in

such a house, it‟s a factory
not a house. So big!!

So Bilirubin decides to live in the liver, but‫الدين‬Mrs.

‫عالء‬
Albumin refuses.
 Farewell darling
=(

• They split up
‫عالء الدين‬
The sad bilirubin enters the „liver‟
Indirect bilirubin is conjugated in the liver with 2 glucuronic acid molecules

Glucuronic
acid
What are your
names my blue
angels?

Marry me?

• In the liver; Bilirubin meets with two hawt blue

‫عالء الدين‬
ladies.
Now it is termed Direct or Conjugated or Cholibilirubin

Glucuronyl
transferase

Enzyme

• The enzyme „‟Glucuronyl transferase „‟ wed them*.

‫عالء الدين‬
• His name changes to Direct or Conjugated or Cholibilirubin
Conjuged bilirubin can be filtrated in urine if it is increased as in obstructive & hepatocellular jaundice

I don‟t know the

directions, I should The cool thing about you
ask one of my buds girls; you are so cute and
to lead me there. small we can enter the „‟
kidney‟‟ easily.
We better go to the
„‟ Small intestine‟‟
whaddaya think?

‫عالء الدين‬
 Ladies, this is
Mr. „Bile Salts‟

Let‟s go fellows, Bile

to go!!

‫عالء الدين‬
Direct bilirubin (Bile pigment) is secreted into bile with bile salts

All of them went to the small intestines‫الدين‬

through
‫عالء‬
bile. But something unexpected happened
Intestinal bacteria remove glucuronides and reduce bilirubin into stercobilirubin

• Bacteria attacks! Bilirubin lost their wives and

‫عالء الدين‬
became a widow called “stercobilinogen”
Some of it is reabsorbed and go to the liver

• So Stercobilinogen decided to go back to blood and get

‫عالء الدين‬
absorbed with the nutrients.
While some remain and become oxidized to stercobilinogen

• Others were pessimist and decided to die by

oxidisation, so they went along the ‘’stool’’ and are
called ‘’Stercobilin’’ ‫عالء الدين‬
• They give the stool its dark colour.
• But the part that went to the liver divided into two
‫عالء الدين‬
groups
A fraction of the absorbed part become excreted again into bile“Entero-hepatic Ciculation”

Some went again through bile in a circulation

‫عالء الدين‬
called ‘’ Entero-hepatic Circulation’’.
Some go to the kidney and excreted as urobilinogen which is oxidized into urobilin

A group went to the kidney, excreted with urine as

Urobilinogen which oxidses into urobilin.‫عالء الدين‬
This was the ending of bilirubin‟s life.
‫عالء الدين‬
 Entero-
hepatic Blood
circulation

Sterco
bilinogen

Urine

stool

Summary ‫عالء الدين‬

 Blood

Sterco
bilinogen

Urine

stool

Haemolytic
‫عالء الدين‬
jaundice
 indirect

Blood

Sterco
bilinogen

Urine

stool

Hepatocellular
‫عالء الدين‬
jaundice
 Blood

Urine

stool

Obstructive
‫عالء الدين‬
Jaundice