2. Bilirubin
! Bilirubin
○yellow breakdown product of haeme
metabolism.
! Formation: breakdown of haeme present in
haemoglobin, myoglobin, cytochromes, catalase,
peroxidase and tryptophan pyrrolase.
3. Transportation
! 2 forms:
○ Unconjugated bilirubin: Insoluble
in water, can be toxic, tightly
bound to serum albumin.
○ Conjugated bilirubin: Soluble in
water, non-toxic, loosely bound to
albumin.
! Unconjugated bilirubin
! Bloodstream
! Liver
! Conjugated bilirubin
! Excreted in bile/urine
4. Bilirubin
! Normal bilirubin levels
○ Total bilirubin: 2-17 µmol/L
○ Conjugated bilirubin: 0-5 µmol/L
! High levels of bilirubin Jaundice
! Common causes of jaundice
○ Increased destruction of RBCs, with rapid
release of bilirubin into the blood (haemolytic
jaundice).
○ Obstruction of the bile ducts (obstructive
jaundice).
5. Mr P.’s total bilirubin level: 90 µmol/L
Conjugated bilirubin level: 70 µmol/L
! Pancreatic cancer
○ Symptoms; White stools,
dark urine, jaundice,
fatigue, nausea, pruritis
○ Enlarged pancreatic
head blocks bile
duct bile builds
up increased level of
bilirubin jaundice
6. Treatment and Prognosis
! Treatment – dependent on stage
○Surgery
○Chemotherapy or radiotherapy (or combination)
! Prognosis
○Surgery cure
○Metastasis tumour cannot be removed no
cure, chemotherapy can extend life
7. - EXPLANATIONS
- SUPPORT FOR HERSELF
- MEDICATION
- REFERRAL TO A
- Psychologist / Psychiatrist
Expectations of the partner
8. Psychologist Psychiatrist
! Psychotherapy:
○ Individual therapy
○ Family therapy
○ Support groups
! Mindfullness training
! $
! Med-checkups
! Prevention
! $$$
What’s the difference?
9.
10.
11.
12.
13.
14. References
! Kumar et al: Robbins and Cotran Pathologic Basis of Disease 8E
! http://www.uptodate.com.proxy-ub.rug.nl/contents/bilirubin-
metabolism?source=preview&language=en-
US&anchor=H1&selectedTitle=3~150#
! http://www.nlm.nih.gov/medlineplus/ency/article/003479.htm
! http://www.nlm.nih.gov/medlineplus/ency/article/000236.htm
