Detoxi V1.Key

1,357 views

Published on

Aula de Bioquímica

Published in: Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,357
On SlideShare
0
From Embeds
0
Number of Embeds
13
Actions
Shares
0
Downloads
150
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Detoxi V1.Key

    1. 1. Detoxificação Hepática Zé Luiz - e-mail: joseluiz60@gmail.com
    2. 2. +
    3. 3. +
    4. 4. +
    5. 5. +
    6. 6. 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.
    7. 7. 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.
    8. 8. Direct Bilirubin - Conjugated
    9. 9. Direct Bilirubin - Conjugated
    10. 10. 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).
    11. 11. Jaundice
    12. 12. Jaundice
    13. 13. Jaundice
    14. 14. Jaundice
    15. 15. Jaundice Neonato
    16. 16. Jaundice Neonato
    17. 17. Jaundice Neonato
    18. 18. Jaundice Neonato
    19. 19. Jaundice Neonato X
    20. 20. Jaundice Neonato X
    21. 21. Jaundice Neonato X
    22. 22. Jaundice Neonato X
    23. 23. 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
    24. 24. 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
    25. 25. Obrigado!
    26. 26. 20
    27. 27. BLOOD CELLS KIDNEY reabsorbed INTESTINE into blood LIVER Figure 2. Catabolism of hemoglobin
    28. 28. BLOOD CELLS Hemoglobin Globin Heme KIDNEY reabsorbed INTESTINE into blood LIVER Figure 2. Catabolism of hemoglobin
    29. 29. BLOOD CELLS Hemoglobin Globin Heme KIDNEY O2 reabsorbed Heme oxygenase INTESTINE into blood CO Biliverdin IXα LIVER Figure 2. Catabolism of hemoglobin
    30. 30. 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
    31. 31. 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
    32. 32. 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
    33. 33. 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
    34. 34. 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
    35. 35. 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
    36. 36. Examples of hyperbilirubinemia
    37. 37. Examples of hyperbilirubinemia A. Hemolytic anemia excess hemolysis  unconjugated bilirubin (in blood)  conjugated bilirubin (released to bile duct)
    38. 38. 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)
    39. 39. 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)

    ×