A 50-year-old male arrives at the doctor with jaundice and a painful distended abdomen. His urine...

A 50-year-old male arrives at the doctor with jaundice and a painful distended abdomen. His urine is tea colored and bile salts are detected. Further assessment reveals the presence of bruises and mark on his arm indicative of IV drug use. What is the diagnosis? Why are there bile salts in his urine? Why is he jaundiced?

Solutions

Expert Solution

Most probable diagnosis is Hepatitis B infection

Reason: there is jaundice, andominal pain and dark coloured urine which are indicative of a liver infection. The patient has history of iv drug abuse. It increases the risk of getting hepatitis B which can be transmitted by the usage of unclean needles.

Reason for bile salts in urine

Examples for bile salts are

Sodium glycocholate.
Sodium taurocholate.

Most of the bile salt gets absorbed in the terminal ileum and return to liver through the portal circulation for resecretion.The recycling of bile salts is called enterohepatic circulation.

Bile salts appear in urine when there is any obstruction to the biliary tract and bile increase in blood.

Here due to the liver damage bile acids and bile salts enter the bloodstream and it reaches kidney which then excreted via urine. So, there will be presence of bile salts in urine.

Reason for jaundice

In hepatits, liver gets damaged.
insoluble bilirubin is unconjugated bilirubin, it moves to the liver through the blood, bound to albumin. In the liver, the bilirubin gets conjugated with glucuronic acid to give bilirubin diglucuronide, conjugated bilirubin, which is the water soluble form of bilirubin that can be excreted.

This conjugated bilirubin leaves the liver and enters the biliary tree and cystic ducts and stored in gall bladder as part of bile.
Bacteria in the intestine convert the bilirubin into urobilinogen.
This urobilinogen is either converted into stercobilinogen and excreted through feces, or gets reabsorbed by the intestinal cells(enterohepatic circulation) and taken to the kidneys via the blood to be excreted in the urine.

when liver is damaged, conjugation process not taking place properly which causes more amount of unconjugated bilirubin in blood. It causes yellowish discoloration of skin and sclera.
This is how jaundice develops in hepatitis

Sydney Mullin answered 10 months ago

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