Urine For Bile pigments

What sample of urine is needed for the Bile pigments?

1. Bile salt can be checked on random urine.
2. Bile pigmetns also include bilirubin and biliverdin.

What are the indications of urine for bile pigments?

1. This is because bile pigments in the urine indicate liver dysfunction.
2. The presence of bile pigments in the urine helps to diagnose the increased production of bilirubin.

What are the precautions for bile pigments?

1. There may be a false positive reagent strip.
2. In case of increased pH.
3. Some drugs, like sulfonamides, procaine, and 5-hydroxy indoleacetic acid, may interfere with the result.

How will you discuss the pathophysiology of the bile and bile pigments?

1. Bile acid and bile salts are used as synonyms.
2. Bile is a fluid synthesized by the liver and consists of the following:
   1. Conjugated bile salts.
   2. Bilirubin diglucuronide.
   3. Cholesterol.
   4. Phospholipids.
   5. Electrolytes.
   6. Water.
3. Bile is alkaline due to the presence of bicarbonate.
4. The bile color is golden-brown to greenish-yellow and has a bitter taste.

Urine For Bile pigments: Bile acids and bile salt metabolism

How will you discuss the biosynthesis of Bile acids and Bile salts?

4. Bile acids are synthesized in the hepatocytes from cholesterol. These are excreted into the bile and then pass into the duodenum.
   1. The primary bile acids are:
      1. Cholic acid.
      2. Chenodeoxycholic acid.
   2. These primary bile acids pass into the duodenum (intestine), and the bacterial action converts to secondary bile acids.
   3. Secondary bile acids are:
      1. Deoxycholic acid.
      2. Lithocholic acid.
   4. The bile acid can conjugate with glycine and taurine and form bile salts.

Urine For Bile pigments: Bile salt (bile acids) formation and functions

5. Bile salts help stimulate the bile flow and are a potent antibacterial.

Urine For Bile pigments: Bile salt cycle

6. The primary bile pigments due to catabolism of the hemoglobin are:
   2. Bilirubin. is orange or yellow in color.
   3. Biliverdin is green in color.
   4. Urobilinogen (Urobilin).
7. The leading site of the formation of bile pigments is the liver.
8. Ultimately, these leave the body in feces and a small amount in the urine.
9. Human bile contains:
   1. Cholate conjugate = 38%.
   2. Chenodeoxycholate conjugate = 34%.
   3. Deoxycholate conjugate = 28%.
   4. Lithocholate = 1 to 2%.
10. The hepatic bile contains 5% to 15% of the solids; the major components are bile acids.

How Bilirubin in the urine is excreted?

1. Normally, conjugated bilirubin in the urine is not detected.
2. Bilirubin in the urine appears in:
   1. Biliary tract obstruction is like extrahepatic obstruction of the common bile duct.
   2. Biliary tract obstruction may be intrahepatic, like cholestatic liver cell injury in active cirrhosis and viral hepatitis.

How is Urobilinogen in the urine excreted?

1. Urobilinogen is produced from conjugated bilirubin by the metabolic activity of the bacteria in the intestine, followed by absorption into the blood circulation.

How will you detect Bile salt and bilirubin?

1. Bile pigments (Bilirubin) give the urine a greenish-yellow, yellow, or brown color.
2. The Fouchet test:
   1. It detects bile pigments (Bilirubin).
3. Sulfur granules test:
   1. It detects bile salts.

 How will you perform Fouchet’s test?

1. It will detect the bilirubin in the urine.
2. Reagents are:
   1. Barium chloride 10%.
   2. Fouchet’s reagents consist of:
      1. Trichloracetic acid = 25 grams.
      2. Ferric chloride (FeCl3) 10% = 10 mL
      3. Distle water = 100 mL
3. The procedure of Fouchet’s test:
   1. Take 5 ml of the urine; if the urine is alkaline, then add one to 2 drops of glacial acetic acid (concentrated).
   2. Take 5 mL of urine and add barium chloride (BaCl2 10%) 2.5 mL.
   3. Mix well.
   4. The sample will become cloudy.
   5. Filter or centrifuge to obtain the precipitate, which contains bilirubin.
      1. A precipitate of sulfates appears to which bilirubin is bound (barium-sulfate-bilirubin complex).
   6. To the filtrate on the paper (precipitate), add one drop of Fouchet’s reagent (Ferric chloride).
   7. When ferric chloride is added to urine in trichloroacetic acid, it oxidizes bilirubin to green color biliverdin.
   8. Immediately, a blue-green color develops, indicating a positive for bilirubin.

Fouchet’s modified reaction

Procedure for Fouchet’s reaction in urine:

How will you perform the Foam test for bilirubin?

Urine is kept in a small vial and vigorously shaken. The bile pigments will stain the resulting foam.

1. There is yellowish foam in the case of urine bilirubin.
2. In normal urine, the foam will be white.

How will you perform the Sulfur granule test for bile salts:?

4. Carefully sprinkle the sulfur granules over the surface of the urine.
5. Also, it can run water as the control.
6. In the case of bile salts, sulfur will settle in the bottom.
7. In the case of negative urine, sulfur granules will remain on the surface.

Urine bile salt test

What is normal urine Bile pigments?

• Normally, bile pigments and bile salt are absent in normal urine.

What are the causes of increased urine urobilinogen?

1. It is increased in hemolytic anemia with absent urine bilirubin.
2. In case of hemorrhage into the tissue, like pulmonary infarction and severe bruises.
3. In case of severe hepatic cell damage in acute viral hepatitis, drugs and toxins.
4. In patients with cholangitis.

What are the causes for absent urine urobilinogen?

• When there is complete biliary obstruction and stool is pale or clay-colored.

Questions and answers: