Funny story behind Billirubin

2. Bilirubin metabolism

3. علاء الدين
Warning: Audience discretion is advised, what you are about to see is a true story about the miserable life of bilirubin.
Translated into English from an Arabic version from a King Saud University parody Lecture.

4. علاء الدين
•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 „.

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

6. علاء الدين
In 120 days

7. علاء الدين
hemolysis
•The villian called „‟ReteculoEndothelial System’’ sweeps off the house because it was over 120 days of age.

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And the life of the happy family changes

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And becomes sad =(

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Haemoglobin is cleaved into haem & Globin which is hydrolysed into free AA
•Globin asks for divorce to get back to her family house „‟ Amino acid pool‟‟.
طلقنى طلقنى
طلقنى..

11. علاء الدين
And every iron gets into his automobile „‟Transferrin‟‟ and travels far away.
Bye Daddy!!…
Iron is carried on transferrin to be reused

12. علاء الدين Dad becomes lonely and sad =(

13. علاء الدين
His colour changes to green and people called him „‟ Biliverden‟‟
Protoporpherin is then reduced into Biliverden

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Then his name changes to the infamous yellow colour called „‟Bilirubin‟‟
Then into Bilirubin

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His friends convince him to tie the knot again.
They propose Mademoiselle „‟ Albumin‟‟to him.

16. علاء الدين
Indirect bilirubin is water insoluble
•But Mademoiselle „‟ Albumin „‟ wanted to know him better before getting married.
I heard that you are ‘’ indirect’’, I wanna know ya more before we marry!.

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so it is carried on albumin and called haemobilirubinor indirect bilirbin
•So some people believe they got marriedDarling, people think we are married; tell them we are just „‟ engaged‟‟.

18. علاء الدين
Or unconjugatedbilirubin
They get called „‟haemobilirubin”
•“indirect bilirubin”
• “ unconjugated bilirubin ”

19. علاء الدين
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 it is toolarge.

20. علاء الدين
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, but Mrs. Albumin refuses.

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• They split upThe sad bilirubin enters the „liver‟
Farewell darling =(

22. علاء الدين
•In the liver; Bilirubin meets with two hawt blue ladies.
What are your names my blue angels? Glucuronic acidMarry me? Indirect bilirubin is conjugated in the liver with 2 glucuronic acid molecules

23. علاء الدين
Glucuronyl transferase
•The enzyme „‟Glucuronyl transferase „‟ wed them*.
•His name changes toDirect or Conjugated or Cholibilirubin
Now it is termed Direct or Conjugated or CholibilirubinEnzyme

24. علاء الدين
Conjuged bilirubin can be filtrated in urine if it is increased as in obstructive & hepatocellular jaundice
The cool thing about you girls; you are so cute and small we can enter the „‟ kidney‟‟ easily. We better go to the „‟ Small intestine‟‟ whaddaya think? I don‟t know the directions, I should ask one of my buds to lead me there.

25. علاء الدين
Ladies, this is Mr. „Bile Salts‟ Let‟s go fellows, Bile to go!!

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All of them went to the small intestines through But something unexpected happenedbile. Direct bilirubin (Bile pigment) is secreted into bile with bile salts

27. علاء الدين
Intestinal bacteria remove glucuronides and reduce bilirubin into stercobilirubin
•Bacteria attacks! Bilirubin lost their wives and became a widow called “stercobilinogen”

28. علاء الدين
•So Stercobilinogen decided to go back to blood and get absorbed with the nutrients. Some of it is reabsorbed and go to the liver

29. علاء الدين
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’’
•They give the stool its dark colour.

30. علاء الدين
•But the part that went to the liver divided into two groups

31. علاء الدين
A fraction of the absorbed part become excreted again into bile“Entero-hepatic Ciculation”
Some went again through bile in a circulation called ‘’ Entero-hepatic Circulation’’.

32. علاء الدين
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.

33. علاء الدين
This was the ending of bilirubin‟s life.

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stoolUrineBlood
Sterco
bilinogen
Summary
Entero- hepatic circulation

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UrinestoolBlood
Sterco
bilinogenHaemolyticjaundice

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Urine
stoolBloodStercobilinogen
Hepatocellular jaundice
indirect

37. علاء الدين
Urine
stool
Blood
Obstructive Jaundice