Patient presents with icterus, urine urobilinogen is absent. This indicates?
Urobilinogen is formed by bacterial metabolism in the gut from conjugated bilirubin. Following secretion into bile, conjugated bilirubin reaches the duodenum and passes down the GIT without reabsorption by the intestinal mucosa. Hence it is absent in urine in obstructive jaundice. Urinary Urobilinogen is increased in haemolytic jaundice and decreased in hepatitis. Absence indicates post hepatic cause which from the above four choices is peri-hepatic obstruction. Normal Haemolytic jaundice Hepatitis Obstruction Urine urobilinogen 0-4 mg/ 24 hrs Increased Decreased Absent Urine bilirubin Absent Absent Present in case of micro-obstruction present
Hemolysis
Hepatitis
Liver failure
Peri-hepatic obstruction
Hereditary Hyperbilirubinemia & Jaundice