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Yellow pigmentation of tissues and body fluids due to hyperbilirubinemia, usually present at levels of >2.5 mg/dL
- Unconjugated (indirect) hyperbilirubinemia: Unconjugated bilirubin is the direct breakdown product of heme, is water insoluble, and is measured as indirect bilirubin:
- Excessive production of unconjugated bilirubin
- Decreased hepatobiliary excretion of bilirubin by:
- Defective uptake (drugs, Crigler–Najjar syndrome)
- Defective conjugation (Gilbert syndrome drugs)
- Defective excretion of bilirubin by the liver cell (drugs, Dubin–Johnson syndrome)
- Conjugated (direct) hyperbilirubinemia:
- Conjugated bilirubin is water soluble and measured as direct bilirubin.
- In conjugated hyperbilirubinemia, bilirubin is returned to the bloodstream after conjugation in the liver instead of draining into the bile ducts.
- Hepatocellular dysfunction:
- Tumor invasion
- Toxic injury
- Intrahepatic (nonobstructive) cholestasis
- Extrahepatic (obstructive) cholestasis
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