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Podcast - Unconjugated Chaos: Making Sense of High Bilirubin

Podcast - Unconjugated Chaos: Making Sense of High Bilirubin

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 The video version of this podcast can be found here: · https://youtu.be/ndAus37PfsEThe video on hepatitic pattern abnormal LFTs can be found here:· https://youtu.be/rIX46swVSfgThis episode refers to guidelines on the management of abnormal liver function tests by the British Society of Gastroenterology. Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by them. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I cover what to do when in respect of an isolated high bilirubin with otherwise normal liver function tests, always focusing on what is relevant in Primary Care only. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk My summary guide can be downloaded here:· https://1drv.ms/b/s!AiVFJ_Uoigq0mQ8MRxaNYnA1_pzh?e=H2U7rS The resources consulted can be found here:BSG- British Society of Gastroenterology:· bsg.org.uk/clinical-resource/guidelines-on-abnormal-liver-blood-tests· Guidelines on the management of abnormal liver blood tests (bsg.org.uk)o First published on:o BMJ article:o Guidelines on the management of abnormal liver blood tests | Gut (bmj.com)TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to cover what to do when we encounter an isolated high bilirubin with otherwise normal liver function tests, always focusing on what is relevant in Primary Care only. This episode is based on the British Society of Gastroenterology guidelines on abnormal Liver function tests. A link to it is in the episode description. Right, let’s jump into it.And let’s start by remembering that there are three common patterns of abnormal liver function tests or LFTs:An isolated raised bilirubin with otherwise normal liver tests, which is what we will concentrate on today.A cholestatic pattern, normally showing a high ALP and GGT.And a hepatitic pattern, with a raised ALT and AST indicating hepatocellular injury. By the way, if you are interested in finding out more about this particular type, make sure to watch the corresponding episode on this channel. The link is in the episode description.Let’s also remember that bilirubin is the by-product of the breakdown of haemoglobin. When red blood cells are broken down, bilirubin is produced and released into the bloodstream. It exists in two forms: unconjugated bilirubin and conjugated bilirubin. Unconjugated bilirubin is water-insoluble and travels to the liver bound to albumin. Once in the liver, it is converted into conjugated bilirubin, making it water-soluble so it can be excreted into bile.A high unconjugated bilirubin level is usually due to increased production, as in haemolysis, or reduced conjugation within the liver. A high conjugated bilirubin level, on the other hand, is normally due to liver disease or biliary obstruction, where the liver is unable to process or excrete ...
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