Hyperbilirubinemia with the absence of urobilinogen in urine is seen in:
Urobilinogen is formed from degradation of bile pigments by bacterial action. In case of obstruction to bile flow as happens in cholelithiasis or any kind of biliary obstruction,There will be no urobilinogen in urine. So, No formation of stercobilinogen and the patient passes clay colored stools. Option analysis: Hemolysis produces a lot of urobilinogen which is excreted in urine - option a and c are excluded. In hepatocellular jaundice, urobilinogen can be normal or reduced. The question specifically uses the word "absent" - options c is also excluded. Parameter Pre-hepatic Hepatocellular Obstructive Basic mechanism of raised bilirubin Hemolysis defective uptake, conjugation and excretion of bilirubin by hepatocytes defective excretion of bile due to the obstruction of biliary tract Type of serum bilirubin raised mainly unconjugated unconjugated + conjugated mainly conjugated (>50%) Urine bilirubin absent present present Urine urobilinogen present present absent Prototype example Hemolytic anaemia viral hepatitis common bile duct stone Prothrombin time normal abnormal; that is n't corrected by vitamin K inj. abnormal; that is corrected by the vitamin K inj. Additional features features of hemolysis on peripheral blood smear, reticuloytosis, low Hb, low haptoglobin Marked rise of serum ALT and ALP Marked rise of serum ALP (>3 times)
G6PD enzyme deficiency
Cirrhosis of liver
Paroxysmal Nocturnal Hemoglobinuria
Obstruction of the common bile duct
HAEM synth and porphyrias