Wednesday 20 April 2016

Conjugated hyperbilirubinemia | Crack PGIMER 22 MAY 2016


Conjugated hyperbilirubinemia in seen in 

A. Rotors synd. 
B. Dubin Johnson syndrome
C. Gilbert’s syndrome
D. Breast milk jaundice 
E. CrigglerNajjar syndrome



The Answer is. A. Rotors synd.
Crigler-Najjar syndrome
There are actually two types of Crigler-Najjar, and both are they different clinically.
Type I CN
-    Rare
-    autosomal recessive disorder
-    Absent UGT1A1 activity. UGT1A1 is a liver enzyme that participates in bilirubin processing
-    The unconjugated bilirubin backs up into the blood, producing severe jaundice and icterus.
-    Usualy fatal in the neonatal period unless liver transplant is done
Type II CN
-    autosomal dominant disorder
-    Some UGT1A1 activity is seen (the enzyme is only capable of forming monoglucuronidated bilirubin).
-    Non fatal, good prognosis.
Gilbert syndrome
-    Common disorder, autosomal recessive
-    Decreased activity of UGT1A1 (but more than Type II Criggler najjar)
-    Unconjugated hyperbilirubinemia, with no clinical consequence
Dubin-Johnson syndrome
-    Autosomal recessive disorder
-    Conjugated bilirubin in the blood.
-    Caused by a defect in secretion of bilirubin glucuronides (which is already conjugated!) across the canalicular membrane (patients are missing a canalicular protein that transports bilirubin glucuronides into bile).
-    Liver biopsy: darkly pigmented because of coarse granules within the hepatocyte cytoplasm.
-    Most patients are asymptomatic (except for yellow skin)
Rotor syndrome
-    Autosomal recessive disorder
-    Conjugated bilirubin in the blood.
-    Unknown defect
-    Asymptomatic (except for mild jaundice)
Must remember:
1.       CD ROM (Conjugated – Dubin, Rotor)   |   Use CNG: (Unconjugated – Criggler Najjar, Gilbert)
All are AR except type II CN