Biochemistry

1. NUR IZZATUL NAJWA BINTI
SHARUPUDDIN
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NUR FARRA NAJWA BINTI AZMI
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RATTAPONG A/L BON LEE
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JAUNDICE

2. LEARNING OBJECTIVE
 ABLE TO DEFINE THE JAUNDICE
 ABLE TO UNDERSTAND THE COMMON
CAUSES OF JAUNDICE
 ABLE TO LIST THE TYPES OF JAUNDICE AND
THEIR CLASSIFICATION
 ABLE TO KNOW VAN DER BERGH REACTION

3. JAUNDICE

4. INTRODUCTION
 Refers to a yellowish discolouration of the
body tissues, including skin, sclera and mucous
membrane
 Due to large quantities of bilirubin in the
exctracellular fluid either, free bilirubin or
conjugated bilirubin.
 Normal plasma concentration of bilirubin is in the
range of 0.2-0.8 mg/dL
 Levels of bilirubin concentration
o > 1mg/dL (hyperbilirubinemia)
o > 2mg/dL (diffuse into tissue- JAUNDICE)

5. COMMON
CAUSES
Increased destruction
of RBC
LiverObstruction of
the bile ducts

6. TYPES OF JAUNDICE
PRE – HEPATIC
(HAEMOLYTIC
JAUNDICE)
HEPATIC
(HEPATOCELLULAR
JAUNDICE)
POST – HEPATIC
(OBSTRUCTIVE
JAUNDICE)

8. TYPES OF JAUNDICE
Hemolytic
jaundice
Hepatocellular
jaundice
Obstructive
jaundice
Blood, free bilirubin Increased Incerased Normal
Blood, conj. bilirubin Normal Increased Incresed
Blood, ALP Normal Increased Very high
Urine, bile salts Nil Nil Present
Urine, conj. bilirubin Nil Nil Present
Urine, bilinogens Increased Nil Nil
Fecal urobilinogen Increased Decreased Absent

9. CLASSIFICATION OF
JAUNDICE
TYPES OF
JAUNDICE
NATURE OF
HYPERBILIRUBINIMEA
FUNCTIONAL
DEFECT
PRE-HEPATIC
(HEMOLYTIC)
UNCONJUGATED RETENTION
HEPATIC
(HEPATOCELLULA
R)
CONJUGATED AND
UNCONJUGATED
RETENTION AND
REGURGITATION
POST-HEPATIC
(OBSTRUCTIVE)
CONJUGATED REGURGITATION

10. VAN DEN BERGH REACTION
 To determine the concentration of bilirubin
on body
 At ph5, the pigment is purple in colour
 Direct reaction- conjugated bilirubin, being
water soluble
 Indirect reaction- unconjugated ( free)
bilirubin, water insoluble. Need to be
extracted with alcohol

11. VAN DEN BERGH REACTION
 Direct reaction (soluble )
 Indirect reaction ( insoluble)
DIAZOTIZED
SULFANILIC
ACID
CONJUGATE
D BILIRUBIN
AZO BILIRUBIN
(REDDISH
PURPLE)
DIAZOTIZED
SULFANILIC
ACID
UNCONJUGATE
D BILIRUBIN
AZO BILIRUBIN
(NO COLOUR)
AZO BILIRUBIN
(REDDISH
PURPLE)
+
METHANOL*Test in presence of methanol = total
bilirubin

12. PROPERTIES OF CONJUGATED
BILIRUBIN AND FREE BILIRUBIN
PROPERTIES UNCONJUGATED
BILIRUBIN
CONJUGATED
BILIRUBIN
IN WATER INSOLUBLE SOLUBLE
IN ALCOHOL SOLUBLE SOLUBLE
VAN DEN BERGH
TEST
INDIRECT POSITIVE DIRECT POSITIVE

13. SUMMARY
1. Jaundice is characterised by pinky colour at the
body tissues, including the skin as well as the deep
tissues.
2.Jaundice is caused by hyperbilirubinemia
3. Obstructive jaundice is one type of jaundice
5. The normal range of bilirubin concentration in our
body is 1-2mg/dl
4. Van Den Bergh reaction is used to test the
concentration of red blood cell in our body

14. TAKE HOME MESSAGE
 Yellow -> skin, sclera and mucous membrane
 Hyperbilirubinemia
 Normal range
 3 types of jaundice and correlates bilirubin
 Van Den Bergh Reactions – direct and indirect

15. REFERENCE
 TEXTBOOK OF BIOCHEMISTRY, DM
VASUDEVAN, 7TH EDITION
 BIOCHEMISTRY, LIPPINCOTT’S ILLUSTRATED
REVIEW, 5TH EDITION