[Bilirubin metabolism in liver cirrhosis]

The serum bilirubin concentration is a specific marker of liver disease but the sensitivity is low for detecting liver damage and remains within normal limits in many patients with compensated liver cirrhosis. In liver cirrhosis, portal blood flow is distorted accompanied by a decrease in hepatic clearance of bilirubin. In addition, portosystemic shunting as well as splenomegaly results in an increase in hemolysis and production of bilirubin. These together result in an increase in the concentration of unconjugated bilirubin in serum. In advanced cirrhosis, glucuronyl conjugation of bilirubin and biliary excretion of conjugated bilirubin are markedly impaired and jaundice appears. The concentration of bilirubin in serum thus become a good prognostic marker for patients with incompensated liver cirrhosis.