The composition and concentration of substances dissolved in urine reflect the course of all types of metabolism. Unnecessary metabolic products are excreted from the body in the urine if the size of their molecules allows them to pass through the kidney filter. The rest are sent to the intestines.
Bile pigments are present in urine in very small quantities. They are the ones that color urine yellowish. It is impossible to identify this minimum using conventional laboratory methods, and is not considered necessary.
If the color of urine darkens to a “beer shade,” a suspicion arises of an increase in the concentration of bile pigments caused by their increased content in the blood. Conducting a urine test with qualitative and quantitative reactions allows you to make a correct diagnosis.
What bile pigments end up in urine?
There are 2 types of bile pigments found in urine:
- bilirubin;
- urobilinogen.
Accordingly, such conditions can be called bilirubinuria and urobilinogenuria.
What is bilirubin?
The breakdown of red blood cells causes an increased release of hemoglobin. It is from this that bilirubin is formed in the liver. The substance can be present in the blood in two states:
- free bilirubin (unconjugated) – does not pass through the barrier of the renal membrane, which means it is not normally found in urine, despite the increased level;
- bound (conjugated) - reacts with glucuronic acid, becomes a soluble compound and is excreted into the urine, bile, and with it into the intestines.
Transformations occur in liver cells. Bilirubinuria is caused by an increased level of conjugated bilirubin in the blood.
The formation of bilirubin is associated with the process of breakdown of red blood cells
How is urobilinogen formed?
Urobilinogen is a product of the subsequent processing of bilirubin in the intestine by:
- mucosal enzymes;
- bacteria.
More modern data indicate the presence of urobilinogen bodies, which include derivatives:
- mesobilirubinogen,
- i-ypobilinogen,
- urobilinogen IX a,
- d-urobilinogen,
- "third" urobilinogen.
The last two types and stercobilinogen are synthesized in fairly small quantities and are of no diagnostic value.
The formation of urobilinogen from conjugated bilirubin occurs in the upper part of the small intestine and the beginning of the large intestine. Some researchers believe that it is synthesized by cellular dehydrogenase enzymes in the gallbladder with the participation of bacteria.
A small part of urobilinogen is absorbed through the intestinal wall into the portal vein and returns to the liver, where it is completely broken down. The other is processed into stercobilinogen.
Further, through the hemorrhoidal veins, these substances can enter the general bloodstream and are excreted into the urine by the kidneys. Most of the stercobilinogen in the lower intestine is transformed into stercobilin and excreted in the feces. This is the main pigment that provides color to feces.
The normal level in urine is considered to be no more than 17 µmol/l. If urine is briefly exposed to air, urobilinogen is oxidized by oxygen and converted into urobilin. This can be seen by color:
- urobilinogen is a colorless substance, fresh urine has a straw-yellow tint;
- after some time, due to the formation of urobilin, it darkens.
Jaundice in newborns is associated with increased breakdown of red blood cells and the transition to their own hematopoiesis
What do urine pigments “tell”?
Taking into account the biochemical transformations and properties of bile pigments, their determination can be considered a reliable sign of liver damage and the inability to cope with the disposal of red blood cell breakdown products.
When bilirubinuria is detected, 2 variants of pathology should be assumed:
- disruption of the functioning of liver cells (inflammation, loss of number due to replacement by scar tissue, compression by edema, dilated and overcrowded bile ducts), this process is confirmed by checking the content of aspartic and alanine transaminases, alkaline phosphatase, and total protein in the blood;
- accumulation in the blood of an increased content of hemoglobin from destroyed erythrocyte cells; for clarification, a study of the hematopoiesis process and analysis of bone marrow punctate will be required.
When is the level of bilirubin in urine impaired?
Unconjugated bilirubin appears in the blood in liver diseases:
- viral hepatitis;
- toxic hepatitis due to poisoning with toxic substances (medicines);
- severe consequences of allergies;
- cirrhosis;
- oxygen hypoxia of liver tissue in heart failure;
- metastatic damage to cancer cells from other organs.
But it does not pass into urine due to the impossibility of filtration. Only in the case of renal and hepatic failure with destruction of the nephron membrane can it be detected in urine.
These same diseases are accompanied by the accumulation of conjugated bilirubin. Its level in the blood determines the degree of damage to the liver tissue. The “renal threshold” for bilirubin is considered to be a level of 0.01-0.02 g/l.
If the liver function is not impaired, but the outflow of bile into the intestines is hampered, then a significant amount of bound bilirubin enters the blood and its excretion in the urine increases accordingly. This variant of pathology develops when:
- cholelithiasis;
- compression of the bile duct by a tumor of the head of the pancreas or swelling in acute pancreatitis.
Impaired bile outflow leads to high levels of bilirubin in urine
Bilirubinuria occurs as a result of a slow flow of bile in the interlobular ducts (cholestasis), leakage of bile into the blood vessels. The patient is expressed in yellowness of the skin and sclera. The type of jaundice (mechanical or parenchymal, subhepatic or hepatic) is determined by the ratio of free - bound bilirubin in the blood and urine.
An important distinguishing feature of hemolytic conditions is the absence of bilirubinuria.
What is judged by the content of urobilinogen?
In diagnosis, both increased and decreased levels of pigment in the urine are important. The growth of the upper normal level is possible due to:
- Damage to the liver parenchyma, but maintaining the flow of the bulk of bile into the intestine. The part of the pigment returned through the portal vein is not processed by hepatocytes due to their functional inferiority. Therefore, urobilinogen is excreted into the urine.
- Activation of hemolysis (destruction of red blood cells) - increased synthesis of urobilinogen bodies and stercobilin occurs in the intestine. In this case, the returning part of urobilinogen is broken down by the working liver into the final product (pentediopente), and stercobilin goes through the hemorrhoidal veins into the general bloodstream, the kidneys and is excreted in the urine.
- Intestinal diseases - which are accompanied by increased reabsorption of stercobilinogen through the affected wall (prolonged constipation, enterocolitis, chronic intestinal obstruction, cholangitis).
The mechanism of hemolysis is characteristic of diseases such as:
- malaria;
- Addison-Beermer anemia;
- lobar pneumonia;
- Infectious mononucleosis;
- Werlhof's disease;
- some types of hemorrhagic diathesis;
- sepsis.
Massive hemolysis is caused by:
- complication of massive internal bleeding;
- transfusion of incompatible blood group;
- resorption of large hematomas.
Parenchymal failure is secondary to circulatory disorders after myocardial infarction and the development of cardiac weakness. Treatment of liver cirrhosis by applying a shunt to eliminate portal hypertension can be complicated by renal vein thrombosis.
A decrease in urobilinogen concentration indicates:
- blockage of the biliary tract due to stones or compression by a tumor;
- inhibition of bile formation up to complete cessation in severe hepatitis and toxic liver damage.
Methods for qualitative and quantitative determination of pigments in urine
Qualitative samples can identify a substance, but do not indicate its mass. Tests for bilirubin are based on the ability to form a green compound (biliverdin) when oxidized with iodine or nitric acid. An iodine-containing solution (Lugol's, potassium iodide, alcohol tincture) is added layer by layer into a test tube with 5 ml of urine.
Bilirubinuria is indicated by the formation of a green ring at the border
To detect urobilin, bilirubin, which interferes with the reaction, is removed from urine with a solution of calcium chloride and ammonia, then various tests are carried out:
- with copper sulfate - urine is combined with copper sulfate, then with a chloroform solution, after shaking, an intense pink color appears;
- using a spectroscope – the blue-green part of the spectrum remains.
Depending on the intensity of the color, the following may be marked in conclusion:
- (+) – the reaction is weakly positive;
- (++++) – sharply positive.
A detailed determination of the amount of bile pigments in urine is carried out using biochemical reagents in special clinics. The fact is that the study of bile pigments is more indicative of the results of blood tests rather than urine tests.
When is it necessary to check a urine test for bile pigments?
Qualitative tests for bile pigments are included in the mandatory list of standard urine tests. Therefore, if the patient complains of:
- dyspeptic disorders;
- vague pain in the hypochondrium on the right;
- yellowness of the sclera, skin;
- darkening of urine and light-colored stool;
- It is necessary to exclude diseases of the liver and gall bladder.
When choosing a method of treating a patient, the doctor must not harm the human organs and systems, so the analysis is needed to exclude the toxic effect of the drug on the liver.
The appearance of jaundice requires examination for bile pigments
Poisoning with various toxic substances is accompanied by damage to kidney and liver function. By identifying bile pigments, the degree of disorder can be tentatively assumed.
In severe myocardial diseases, a positive test indicates the involvement of liver tissue in the formation of general hypoxia.
Are there any specific features of collecting urine for analysis?
When collecting urine, general requirements should be met:
- mandatory hygiene of the external genitalia;
- Only the average portion of morning urine is suitable for research;
- the container with urine should not be stored for more than two hours, there is no need to leave the transparent jar in the light;
- 50 ml is enough for analysis.
Bile pigments in urine are involved in the metabolism of important organs and the hematopoietic system. Their determination in urine plays a significant role in diagnosis.
There are 2 types of bile pigments found in urine:
- bilirubin;
- urobilinogen.
Accordingly, such conditions can be called bilirubinuria and urobilinogenuria.
What is bilirubin?
The breakdown of red blood cells causes an increased release of hemoglobin. It is from this that bilirubin is formed in the liver. The substance can be present in the blood in two states:
- free bilirubin (unconjugated) – does not pass through the barrier of the renal membrane, which means it is not normally found in urine, despite the increased level;
- bound (conjugated) - reacts with glucuronic acid, becomes a soluble compound and is excreted into the urine, bile, and with it into the intestines.
Transformations occur in liver cells. Bilirubinuria is caused by an increased level of conjugated bilirubin in the blood.
The formation of bilirubin is associated with the process of breakdown of red blood cells
How is urobilinogen formed?
Urobilinogen is a product of the subsequent processing of bilirubin in the intestine by:
- mucosal enzymes;
- bacteria.
More modern data indicate the presence of urobilinogen bodies, which include derivatives:
- mesobilirubinogen,
- i-ypobilinogen,
- urobilinogen IX a,
- d-urobilinogen,
- "third" urobilinogen.
The last two types and stercobilinogen are synthesized in fairly small quantities and are of no diagnostic value.
The formation of urobilinogen from conjugated bilirubin occurs in the upper part of the small intestine and the beginning of the large intestine. Some researchers believe that it is synthesized by cellular dehydrogenase enzymes in the gallbladder with the participation of bacteria.
A small part of urobilinogen is absorbed through the intestinal wall into the portal vein and returns to the liver, where it is completely broken down. The other is processed into stercobilinogen.
Further, through the hemorrhoidal veins, these substances can enter the general bloodstream and are excreted into the urine by the kidneys. Most of the stercobilinogen in the lower intestine is transformed into stercobilin and excreted in the feces. This is the main pigment that provides color to feces.
The normal level in urine is considered to be no more than 17 µmol/l. If urine is briefly exposed to air, urobilinogen is oxidized by oxygen and converted into urobilin. This can be seen by color:
- urobilinogen is a colorless substance, fresh urine has a straw-yellow tint;
- after some time, due to the formation of urobilin, it darkens.
Jaundice in newborns is associated with increased breakdown of red blood cells and the transition to their own hematopoiesis
What do urine pigments “tell”?
Taking into account the biochemical transformations and properties of bile pigments, their determination can be considered a reliable sign of liver damage and the inability to cope with the disposal of red blood cell breakdown products.
When bilirubinuria is detected, 2 pathologies should be assumed:
- disruption of the functioning of liver cells (inflammation, loss of number due to replacement by scar tissue, compression by edema, dilated and overcrowded bile ducts), this process is confirmed by checking the content of aspartic and alanine transaminases, alkaline phosphatase, and total protein in the blood;
- accumulation in the blood of an increased content of hemoglobin from destroyed erythrocyte cells; for clarification, a study of the hematopoiesis process and analysis of bone marrow punctate will be required.
When is the level of bilirubin in urine impaired?
Unconjugated bilirubin appears in the blood in liver diseases:
Causes of increased bilirubin in urine 
- viral hepatitis;
- toxic hepatitis due to poisoning with toxic substances (medicines);
- severe consequences of allergies;
- cirrhosis;
- oxygen hypoxia of liver tissue in heart failure;
- metastatic damage to cancer cells from other organs.
But it does not pass into urine due to the impossibility of filtration. Only in the case of renal and hepatic failure with destruction of the nephron membrane can it be detected in urine.
These same diseases are accompanied by the accumulation of conjugated bilirubin. Its level in the blood determines the degree of damage to the liver tissue. The “renal threshold” for bilirubin is considered to be a level of 0.01-0.02 g/l.
If the liver function is not impaired, but the outflow of bile into the intestines is hampered, then a significant amount of bound bilirubin enters the blood and its excretion in the urine increases accordingly. This variant of pathology develops when:
- cholelithiasis;
- compression of the bile duct by a tumor of the head of the pancreas or swelling in acute pancreatitis.
Impaired bile outflow leads to high levels of bilirubin in urine
Bilirubinuria occurs as a result of a slow flow of bile in the interlobular ducts (cholestasis), leakage of bile into the blood vessels. The patient is expressed in yellowness of the skin and sclera. The type of jaundice (mechanical or parenchymal, subhepatic or hepatic) is determined by the ratio of free - bound bilirubin in the blood and urine.
An important distinguishing feature of hemolytic conditions is the absence of bilirubinuria.
What is judged by the content of urobilinogen?
In diagnosis, both increased and decreased levels of pigment in the urine are important. The growth of the upper normal level is possible due to:
- Damage to the liver parenchyma, but maintaining the flow of the bulk of bile into the intestine. The part of the pigment returned through the portal vein is not processed by hepatocytes due to their functional inferiority. Therefore, urobilinogen is excreted into the urine.
- Activation of hemolysis (destruction of red blood cells) - increased synthesis of urobilinogen bodies and stercobilin occurs in the intestine. In this case, the returning part of urobilinogen is broken down by the working liver into the final product (pentediopente), and stercobilin goes through the hemorrhoidal veins into the general bloodstream, the kidneys and is excreted in the urine.
- Intestinal diseases - which are accompanied by increased reabsorption of stercobilinogen through the affected wall (prolonged constipation, enterocolitis, chronic intestinal obstruction, cholangitis).
The mechanism of hemolysis is characteristic of diseases such as:
- malaria;
- Addison-Beermer anemia;
- lobar pneumonia;
- Infectious mononucleosis;
- Werlhof's disease;
- some types of hemorrhagic diathesis;
- sepsis.
Massive hemolysis is caused by:
- complication of massive internal bleeding;
- transfusion of incompatible blood group;
- resorption of large hematomas.
Parenchymal failure is secondary to circulatory disorders after myocardial infarction and the development of cardiac weakness. Treatment of liver cirrhosis by applying a shunt to eliminate portal hypertension can be complicated by renal vein thrombosis.
A decrease in urobilinogen concentration indicates:
- blockage of the biliary tract due to stones or compression by a tumor;
- inhibition of bile formation up to complete cessation in severe hepatitis and toxic liver damage.
Methods for qualitative and quantitative determination of pigments in urine
Qualitative samples can identify a substance, but do not indicate its mass. Tests for bilirubin are based on the ability to form a green compound (biliverdin) when oxidized with iodine or nitric acid. An iodine-containing solution (Lugol's, potassium iodide, alcohol tincture) is added layer by layer into a test tube with 5 ml of urine.
Bilirubinuria is indicated by the formation of a green ring at the border
To detect urobilin, bilirubin, which interferes with the reaction, is removed from urine with a solution of calcium chloride and ammonia, then various tests are carried out:
- with copper sulfate - urine is combined with copper sulfate, then with a chloroform solution, after shaking, an intense pink color appears;
- using a spectroscope – the blue-green part of the spectrum remains.
Depending on the intensity of the color, the following may be marked in conclusion:
- (+) – the reaction is weakly positive;
- (++++) – sharply positive.
A detailed determination of the amount of bile pigments in urine is carried out using biochemical reagents in special clinics. The fact is that the study of bile pigments is more indicative of the results of blood tests rather than urine tests.
Bilirubin in a general urine test - characteristics and norms
During normal functioning of the body, the substance in question is excreted through the liver. When there is an excess of bilirubin in the blood, the function of its extraction is partially performed by the kidneys, which ensures the presence of this component in the urine.
Should there be bilirubin in the urine in children and adults?
In the absence of any pathologies in the functioning of the body, urine testing in children and adults should not show the presence of bilirubin in it.
Causes of bilirubin in urine in children and adults
The presence of the substance in question in the urine indicates a malfunction of the liver/kidneys.
The most common causes of bilirubin in urine are:
When is it necessary to check a urine test for bile pigments?
Qualitative tests for bile pigments are included in the mandatory list of standard urine tests.
Therefore, if the patient complains of:
- dyspeptic disorders;
- vague pain in the hypochondrium on the right;
- yellowness of the sclera, skin;
- darkening of urine and light-colored stool;
- It is necessary to exclude diseases of the liver and gall bladder.
When choosing a method of treating a patient, the doctor must not harm the human organs and systems, so the analysis is needed to exclude the toxic effect of the drug on the liver.
The appearance of jaundice requires examination for bile pigments
Poisoning with various toxic substances is accompanied by damage to kidney and liver function. By identifying bile pigments, the degree of disorder can be tentatively assumed.
In severe myocardial diseases, a positive test indicates the involvement of liver tissue in the formation of general hypoxia.
Treatment
Before starting therapy, it is necessary to reliably establish the cause of the appearance or increase of bile products in the blood. Collecting complaints, medical history, and diagnostic test results will help determine the type of disorder as accurately as possible.
Basically, correction of hepatobiliary tract disorders is carried out using traditional methods:
- A therapeutic diet is mandatory; alcohol and smoking are contraindicated.
- Viral hepatitis is treated using special algorithms.
- Detoxification and plasma blood purification are carried out.
- Hepatoprotectors and choleretic agents are prescribed.
- Supportive (glucose, vitamins) and immunostimulating therapy is used.
Tumors, stones and other mechanical obstacles are subject to surgical removal. The optimal method is selected depending on the type of intervention and failure of conservative therapy.
Unconventional methods of treatment are acceptable in the presence of pathological bile pigments in urine. Usually special infusions of herbs with hepatoprotective properties or aimed at enhancing biliary function are used. Before starting to use traditional methods of therapy, it is necessary to consult with a specialist in order to avoid cross-effects of drug interactions.
Rules for collecting urine for analysis
The result of a urine test is influenced by the correct collection of the necessary material. If the rules are not followed, the result may be inaccurate. Accordingly, the prescribed therapy will also be incorrect.
When collecting urine, it is important to follow several rules.
Among them:
- The night before collecting material for analysis, it is necessary to perform a thorough external toilet of the genital organs.
- Collect urine in a special container in the morning. The container may not be sterile, but it must be clean.
- Remove the collected material to a dark place. Bile pigments are destroyed in light. Therefore, if it is not possible to immediately submit urine to a laboratory, it is better to put the material in the refrigerator. Here urine can be stored for no more than 2 hours.
- It is enough to collect 30-50 milliliters for research.
It is important to promptly detect the presence of bile pigments. Any violations or deviations from the norm can cause the development of serious diseases and complications.
Pigments and their role in the human body
The normal level of bile pigments is the key to ensuring that the body functions normally. The role of pigments in the human body is that they are products of metabolism and can indicate the onset of pathologies before they have yet produced clear symptoms. There are several main pigments.
Hemoglobin
Hemoglobin pigment is a respiratory blood pigment found in red blood cells. It is responsible for transporting oxygen from the lungs to the tissues.
In essence, it is not a bile pigment, but it is closely related to them, because they emerge from it. One of the main ones that manifests itself against the background of hemoglobin breakdown is bilirubin.
Bilirubin: features
In the urine of a healthy person, bilirubin is contained in small quantities, so it is not determined during the analysis. Therefore, it is believed that it is absent in urine. If its amount begins to increase, they say that the person develops bilirubinuria.
Bilirubin can change the color of the liquid - to the so-called beer shade. Bilirubin is formed during the breakdown of red blood cells. It cannot dissolve in water and is called free, which does not penetrate the kidney filter. Therefore, it does not appear in the urine, even if its amount is exceeded. But in the liver, such an element binds to glucuronic acid, resulting in the formation of conjugated bilirubin. But it can just be excreted in the urine. First, it passes through the ducts of the digestive organs, and then moves on.
If bound bilirubin begins to appear in the urine, the doctor may understand that some kind of pathology of the liver or biliary tract is occurring in the human body, for example:
- viral hepatitis;
- cirrhosis;
- metastases from cancer of the digestive system.
Urobilinogen
Urobilinogen can also be found in small amounts in the urine. When urine sits, it oxidizes and turns into urobilin, which is yellow. Therefore, during stagnation, the urine darkens due to accumulated urobilin. This also happens when dehydration is noted.
Normally, this substance should be contained in the analysis no more than 17 µmol per liter. If this amount increases, then a pathological condition such as urobilinogenuria develops.
Urobilinogen is the result of the interaction of bilirubin and bacterial enzymes, cells of the intestinal mucosa, which enter here with bile. With the development of certain pathologies, the formation of such a substance can increase and intensify. At the same time, there are situations when everything happens exactly the opposite, and the amount of pigment decreases.
An increase in urobilinogen in the urine indicates any diseases that occur against the background of destruction and breakdown of red blood cells. These include:
- malaria;
- hemolytic jaundice;
- bleeding of internal organs;
- lobar pneumonia, etc.
It is not so difficult to recognize the presence of urobilinogen in your tests - it is indicated by crosses on the analysis card. If the reaction is weakly positive, there will be one cross. If it is strongly positive, 4 crosses will be written on the form.
Urobilin
Another pigment that is formed during the breakdown of hemoglobin. This pigment is indirectly related to gallstones. At the same time, it indicates how the human urinary-excretory system works.
Biliverdin
Sometimes they can talk about the discovery of a pigment such as biliverdin. This is the green pigment of bile. It is essentially an intermediate product of the breakdown of hemoglobin. When it breaks down, globin and iron are released. When enzymes act on it, it is reduced back to bilirubin. 
Ketone bodies in general urine analysis - characteristics and norms
The formation of these substances occurs due to the decomposition of fatty acids. There are several types of ketone bodies: acetone, acetoacetic acid, hydroxybutyric acid.
Detection of the substances in question in urine is important for timely diagnosis and treatment of diabetes mellitus.
With inadequate drug treatment of diabetes mellitus, the level of ketone bodies in the urine will increase, which will indicate a deterioration in the functioning of the central nervous system.
How many ketone bodies should be in the urine of children and adults according to standards?
The presence of these substances in the urine of adults and children, even in small doses, is a sign of pathology.
Why do ketone bodies appear in urine in children and adults - reasons
The detection of these substances in urine may indicate the following pathologies:
Reasons for appearance
In the normal state, bile in the urine is contained in minimal concentrations, which can fluctuate throughout the day, but do not exceed permissible limits. Normally, only urobilin is excreted in urine. The appearance of bound soluble bilirubin indicates pathology. In this case, the substance itself is always elevated in the blood; the value of the indirect fraction may vary.
The absence of urobilin occurs with inflammation, tumor blockage of the bile ducts, impaired urination, and terminal liver lesions.
Video: All about bilirubin
Bilirubin
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In adults
In practice, doctors more often encounter disturbances in the excretion of heme breakdown products in the working population. Reasons that cause the appearance of bilirubin in urine:
- GSD, cholestasis;
- infections;
- intoxication, poisoning;
- hepatitis, Botkin's disease;
- cirrhosis;
- tumors of the hepatobiliary tract;
- removed gallbladder;
- intestinal obstruction;
- disorders of the heart and blood vessels leading to hypoxia of the parenchyma;
- hypothyroidism
Urobilin increases under the following conditions:
- Diseases of the liver parenchyma, when reuptake of bilirubin does not occur and high concentrations of pigments remain in the blood, exceed the renal filter and are found in the urine.
- Increased hemolysis of red blood cells. In addition to the physiological increase during menstruation and the neonatal period, it occurs with malaria, pneumonia, bleeding of various locations, disorders of the coagulation system, and sepsis.
- Gastrointestinal pathologies with increased absorption of hemoglobin breakdown products: chronic constipation, intestinal obstruction.
In children
Urobilin in infants is often elevated. The phenomenon is associated with physiological adaptation: the replacement of fetal hemoglobin is accompanied by an increase in the breakdown of red blood cells, and newborn jaundice occurs. It is important to monitor the dynamics of the condition: a rapid increase in the concentration and appearance of bilirubin in urine indicates a disruption of the natural process and the appearance of pathology.
At an early age, the cause of the appearance of pigments in urine is:
- genetic damage to the enzymatic transformation of bilirubin - Rotor, Crigler, Dubin-Johnson syndrome;
- disorders of the blood system (hemorrhagic diathesis, Werlhof's disease);
- hemolytic jaundice;
- intussusception followed by intestinal obstruction.
During pregnancy
At the time of gestation, the load on all organs and systems increases. Even in healthy women, an increase in urobilinogen can be detected in the urine. In this case, patients complain of darkening of the urine. In cases where there is pathology of the biliary system before pregnancy, the condition may worsen. Additionally, increased work of the heart and kidneys plays a role, contributing to an increase in the volume of blood volume and the concentration of absorbed substances.
Monitoring the level of bile pigments allows you to indicate the onset of an exacerbation. In a patient in an interesting position, it is necessary to exclude cholecystitis, viral hepatitis, pyelonephritis, and coagulation system disorders.
The color, consistency, and even smell of urine can indicate the presence of certain health problems. Therefore, you should be attentive to the appearance of unusual signs and immediately consult a doctor. If bile pigments are detected in the urine, the doctor will explain what this all means.
A change in the amount of pigments in urine indicates disturbances in the dissolution of bilirubin, as well as the filtration of urobilinogen. Usually failures occur after removal of the gallbladder or as a result of the development of liver disease. In addition, violations may indicate that the process of removing stones from the biliary system was carried out incorrectly.
Therefore, a urine test for the presence of bile pigments is prescribed for the following patient complaints:
- presence of dyspeptic disorders;
- the appearance of unclear pain from the right hypochondrium;
- the skin and mucous membranes acquire a yellow tint;
- urine becomes dark in color and stool becomes light.
The doctor must make sure that the patient has not been exposed to toxic poisoning, for example, from drugs. Under their influence, the kidneys and liver fail faster than other organs. Conducting a urine test for the presence of bile pigments will help the doctor draw a conclusion about the degree of the disorder and prescribe the correct treatment.
Diagnostics
Isolated slight darkening of urine is usually not a cause for concern. However, if you notice the following signs, you should consult a specialist:
- dark brown urine;
- discolored stool;
- fever, weakness;
- dyspeptic disorders (nausea, vomiting, stool disorders)
- skin itching;
- urinary disturbance;
- icterus of the skin, mucous membranes;
- pain in the right hypochondrium;
- the appearance of spontaneous hematomas.
First of all, you need to visit a therapist to prescribe standard urine tests to detect bile pigments. If violations are detected, the doctor determines the probable cause of the condition. With this in mind, it becomes clear which specialist to turn to for help. Blood diseases are corrected by a hematologist. Hepatitis is treated by an infectious disease specialist. Hepatobiliary tract disorders – gastroenterologist, surgeon if necessary.
For diagnosis the following is prescribed:
- Complete blood count to determine anemia due to increased breakdown of red blood cells.
- Blood biochemistry allows you to determine the concentration of fractions of bilirubin, alkaline phosphatase, protein, and get an idea of the functioning of the liver.
- Hemotest - analysis of stool for hidden blood if gastrointestinal bleeding is suspected.
- Determination of markers of viral hepatitis during blood sampling.
- Ultrasound of the abdominal organs.
The main way to identify pigments is a qualitative study of various environments of the body (urine, blood, feces). Special tests are carried out for the presence of urobilinogen: Florence, Gmelin, Rozin, Bogomolov. For reactions, iodine, nitric and hydrochloric acids are used, which combine with the components of bile to form a specific color. Depending on the intensity of the resulting shade, the laboratory technician in conclusion indicates the type of reaction: from weak (+) to strongly positive (++++).
Test systems with Ehrlich's reagent and the fluorescence method help to quantitatively establish bile pigments.
Bile pigments may be present in human urine due to the following reasons:
- The appearance of stones that began to form in the kidneys and urinary tract.
- The development of blood diseases in which red blood cells are quickly destroyed. This happens, for example, with malaria.
- The presence of bleeding in various internal systems and organs. Most often this occurs in the gastrointestinal tract, uterus and lungs.
- Hemorrhagic diathesis.
- Congestion in the rectal area.
- Infections enter the gallbladder, as well as the ducts of the organ.
- Progression of liver diseases. Among them are cirrhosis and various types of hepatitis.
In addition, deviations from the norm of bile pigments can be caused by poor nutrition, in particular, abuse of saturated carbohydrates. In a healthy person, the level of urobilinogen ranges from 5 to 10 mg/l.
A decrease in the indicator may occur for the following reasons:
- blockage of the bile ducts;
- liver dysfunction, which occurs due to the development of hepatitis A;
- excessive fluid intake;
- imbalance of bacterial flora;
- lack of the enzyme glucuronyl transferase.
Due to these factors, the following pathologies and diseases may develop:
- Stones in the gallbladder or its ducts.
- Tumors of bile-forming organs.
- Cholangitis.
- Suprahepatic jaundice.
- Various poisonings and intoxications.
- Hepatitis.
- Cirrhosis.
- Filatov's disease.
- Enteritis.
- Constipation.
If there are no urobilinogen compounds in the urine, this means that the patient suffers from a severe form of hepatitis, which is viral in nature. The second cause of deviations is toxic damage to liver tissue.
When bilirubin enters the urine, it takes on an unusual color. It is dark brown. If you notice changes in your urine, you need to see a doctor and get tested. This will help determine why there is bile in the urine.
Dark-colored urine is often observed in people who have had their gallbladder removed. In addition, changes in the color of urine can be a prerequisite for the development of bilirubinuria.
Bilirubin does not dissolve in water. Therefore, the pigment is present in urine pure. The bound compound of hepatic glucuronic acid enters the urine. If the level of this bile pigment begins to increase in the blood, the excess is excreted through the kidneys into the urine. This usually occurs due to progressive diseases of the liver and bile ducts.
Pathologies of the liver and biliary tract can lead to the formation of congestion. Immobilized bile promotes the active formation of cholesterol and bilirubin. They precipitate and crystallize. The process is accompanied by the fouling of cholesterol and pigment particles with calcium salts. This becomes the main reason for the formation of stones.
The presence of bilirubin in the blood and its absence in a urine test indicates hemolytic jaundice. The kidneys were unable to properly filter the pigment, so it could not pass into the urine.
The main reasons that lead to the development of bilirubinuria are:
- Formation of stones in the kidneys and urinary tract.
- Unhealthy diet, which is dominated by foods enriched with carbohydrates.
- Blood diseases that lead to its rapid destruction.
If any deviations are found, you should seek advice. This will help to diagnose a developed disease in a timely manner and avoid the development of complications.
Why is pigment analysis needed?
A change in the concentration of bile pigments in urine indicates the presence of a pathology that disrupts the process of dissolution of bilirubin pigment and filtration of urobilinogen.
In this way, it is possible to diagnose complications due to a removed gallbladder, liver disease, and determine how well the stones were removed from the biliary system.
It is important to carry out the most accurate and correct diagnostic measures in order to refute or confirm the pathology. To do this, you need to examine your urine for the presence of pigments. The analysis will help identify substances contained in the urine.
Bilirubin can be detected by oxidation of the starting material with iodine or nitric acid. If a pigment substance is present, the urine turns green during the reaction. For analysis, you need to take a sterile test tube and add 5 milliliters of urine. Then the solution containing iodine is added layer by layer.
- As the last one take:
- Lugol;
- potassium iodide;
To check urobilin levels, you need to remove bilirubin from the urine. The pigment will interfere with the reaction carried out with a solution of calcium chloride and ammonia.
After eliminating bilirubin, you can begin various tests:
- Copper sulfate. It is combined with urine by adding a chloroform solution. The “cocktail” is shaken. The solution should turn intense pink.
- Spectroscope. The decoding will show the remainder of the blue-green part of the spectrum.
The color intensity of the solution during testing is marked with crosses. One will mean a weakly positive reaction, and 4 plus signs will mean a strongly positive reaction.
Determination of the level of bile pigments can only be carried out in special laboratories and clinics where biochemical reagents are available.
Bile acids (pigments) in general urine analysis - characteristics and norms
The most common representatives of this group of substances are bilirubin and urobilinogen. Excretion of the components in question occurs through feces, less often through urine.
A distinctive feature of bile pigments when present in urine is its non-standard color: dark yellow, with a green tint.
What should be the normal level of bile pigment in urine in children and adults?
Bile pigments are regularly formed in the body under the influence of enzymes in the intestines. Often the main share of such substances (more than 97%) is excreted along with feces, in other cases through urine.
The permissible norm of the pigments in question in the urine of adults and children cannot exceed 17 µmol/l. An increase in this indicator is associated with serious diseases.
Causes of occurrence (increase) of bile pigment in urine in children and adults
The reasons causing an increase in the concentration of bile pigments when testing urine can be of a different nature:
Glucose in a general urine test - characteristics and norms
Often, the increase (occurrence) of glucose in the urine occurs due to the inability of the kidneys to reabsorb glucose.
How much glucose should there be in the urine of children and adults according to the norms?
The substance in question may normally be present in urine, but its permissible concentration is limited: no more than 0.8 mmol/l. If, when testing urine, the glucose level exceeds the specified norm, a blood glucose test is prescribed at the same time.
Reasons for the increase (occurrence) of urine glucose in children and adults
The detection of this substance in the urine requires further, more thorough research, which will help establish the exact cause of this pathological phenomenon.
The most likely factors that cause the appearance of glucose in the urine in children and adults are the following:
Indican in general urine analysis - characteristics and norms
The substance in question is formed as a result of protein decay in the cavity of the small intestine. An increase in the level of indican concentration in the urine does not always indicate pathological conditions: this may be associated with poor nutrition (the predominance of meat foods in the diet).
What should be the normal content of indican in urine in children and adults?
This substance may be present in the urine of healthy people and children, but its amount is limited: 0.005-0.02 g/day. If there is an excess of indigan, the urine will have a blue tint, and the patient will complain of abdominal pain and diarrhea.
Reasons for increased urine indican levels in children and adults
Factors that provoke an increase in the level of indican concentration in the urine are often associated with errors in the functioning of the gastrointestinal tract:
- Inflammatory, purulent phenomena in the intestines: colitis, peritonitis, intestinal obstruction, chronic constipation, abscesses/abscesses in the intestines.
- Malignant formations in the stomach, intestines, liver.
- Diabetes.
- Gout.
Hemoglobin in a general urine test - characteristics and norms
This substance is formed during the destruction of the structure of red blood cells, after which the blood masses are replenished with a considerable amount of hemoglobin. The liver is responsible for removing the main part of hemoglobin; the kidneys take part in this process partially.
BALL PIGMENTS
The source of formation of bile pigments in the human body is hemoglobin (the respiratory pigment of the blood).
Hemoglobin – chromoprotein (complex protein), consisting of a protein part – globin and prosthetic (non-protein) part - heme.
Heme consists of 4 pyrrole rings connected by methine bridges (- CH =). In the center of the porphyrin ring, formed by pyrrole rings, there is an ion Fe2+.
Hemoglobin is found in red blood cells. The lifespan is 90-120 days, after which they disintegrate. When they die, hemoglobin is released. This process is actively happening in RES cells (reticuloendothelial system - liver, spleen, red bone marrow).Hemoglobin disintegrates into its component parts: globin hydrolyzes to amino acids, which are absorbed into the blood, heme is oxidized into hematin and excreted in feces, i.e. not used by the body. The hemoglobin released in this case is adsorbed in the blood by haptoglobin (Hp) and transported to the liver, where it breaks down.
The mechanism of hemoglobin breakdown in cells
With the participation of enzymes, hemoglobin is oxidized by heme oxidase. Fe 2+ as part of hemoglobin it is oxidized to Fe 3+ and hemoglobin is converted into methemoglobin . Then the destruction of the tetrapyrrole ring of heme begins. Forms a green pigment - verdoglobin. Verdoglobin (spontaneously) breaks down into its constituent parts: globin(hydrolyzes to amino acids), iron(captured by transferrin and delivered to the liver in the blood, where it is stored as a reserve) and heme. A green pigment is formed - biliverdin.
Biliverdin is enzymatically reduced to bilirubin (red-yellow (orange) pigment), which is a water-insoluble and toxic substance. Therefore, it is quickly eliminated from the cells and enters the blood, where it is adsorbed by blood plasma albumin (as a result of which it does not pass through the intact renal filter). A complex is formed bilirubin-albumin (which is already water soluble and non-toxic). This bilirubin does not react directly with diazo reagents and is therefore called unconjugated (indirect or free). This complex is transported to the liver, where, upon reaching the liver cells, it loses albumin and combines with two molecules glucuronic acid (conjugates) and turns into a complex bilirubin diglucuronide . This complex is non-toxic, water soluble and is called - conjugated (direct or related) bilirubin . Conjugated bilirubin accumulates in liver cells (hepatocytes), which enters the gallbladder and is part of bile pigments. The content of conjugated bilirubin in the blood should not exceed 34 mmol/l (0.01-0.02 g/l) – renal bilirubin threshold .
As part of bile, conjugated bilirubin enters the small intestine through the bile duct, where, under the influence of enzymes from microorganisms, it is converted into mesobilinogen . A small part of mesobilinogen is absorbed into the blood and returns through the portal vein system to the liver, where it is completely broken down (up to dipyrroles), and most of it remains in the intestines.
In the large intestine, mesobilinogen is further exposed to intestinal microflora, turning into stercobilinogen (pigment in stool that gives it a brown color). In the lower parts of the colon, some of the stercobilinogen is absorbed into the blood and through the system of hemorrhoidal veins is absorbed into the general bloodstream (systemic circulation), and then excreted in the urine in the form urobilinogen .Urobilinogen in urine is oxidized in air and converted into urobilin. The other part of stercobilinogen is excreted in feces, oxidizing in air to stercobilin.
PATHOLOGY OF BALL PIGMENT METABOLISM:
Impaired metabolism of bile pigments is accompanied by hyperbilirubinemia and bilirubinuria, urobilinogenuria and jaundice.There are several pathogenetic mechanisms of these disorders:
- Damage to the liver parenchyma (any etiology)
- Obstruction of the bile ducts or bile duct
- Congenital (hereditary) and acquired defects in the metabolism of bile pigments.
Enhanced mainly intracellular destruction of red blood cells
TYPES OF JAUNDICE
The following types are distinguished: jaundice : hemolytic, parenchymal and mechanical (obstructive).
Hemolytic jaundice – occurs with increased hemolysis of red blood cells in the bloodstream(occurs in toxicosis, burns and transfusion of incompatible blood). At the same time, the level in the blood increases sharply , which in the liver is converted into conjugated bilirubin (arises - hyperbilirubinemia ), and from there it enters the intestines as part of bile. Kali urine becomes almost black due to the increased content of stercobilin (in the intestines) and urobilin (in the urine). It is observed in the blood - urobilinogenemia and as a consequence - urobilinogenuria .
Bilirubin is not detectable in urine .
Parenchymal jaundice – is based on damage to liver cells (hepatocytes) and is observed in liver inflammation (hepatitis). In this case, the liver cannot cope with the neutralization of unconjugated bilirubin (converting it into conjugated), and the level in the blood increases unconjugated bilirubin . Also in the liver, the integrity of cell membranes is disrupted and capillary permeability increases. Conjugated bilirubin from bile penetrates into the blood. In this case, there arises - hyperbilirubinemia and as a consequence - hyperbilirubinuria . Thus, bilirubin enters the urine, which takes on the color of “beer” and a yellow foam appears.
If the process has gone far, then the liver cannot cope with the returning meso- and urobilinogen. arise urobilinogenemia And urobilinogenuria . The test for urobilin in the urine becomes positive.
At very severe liver damage, stool may become lighter in color.
Mechanical (obstructive) jaundice – occurs when there is a violation of the outflow of bile into the duodenum and the entry of conjugated bilirubin into the intestine, due to blockage (tumor, stone) or spasm of the common bile duct. In the common bile duct, bile pressure increases, which leads to the penetration of bile into the capillaries. The amount in circulating blood increases conjugated bilirubin - hyperbilirubinemia , as a result of which there arises - bilirubinuria .Feces become colorless (since bile does not enter the intestines due to a mechanical barrier) – acholic stool . Test for stercobilin– negative. Obstructive jaundice is preceded by a picture of hepatic colic (acute pain in the right hypochondrium, radiating to the right scapula).
Acids from liver secretions help process them. There are situations when a person experiences bile stagnation. This may occur due to disruption of the internal organs. Acids do not go to work, but accumulate, beginning to have a negative effect on the body. Excess bile is diagnosed. Treatment required.
What can stagnation of bile lead to?
In order for fats to be absorbed, it is necessary not only to expose them to gastric juice, but also to bile acids and salts. If there is stagnation of liver secretion, it stops entering the duodenum. There is a decrease in enzyme activity. Fats are no longer completely absorbed and partially enter the blood. Cholesterol levels increase. This can lead to the development of atherosclerosis.
In addition, stagnation of bile can cause inflammation of the gallbladder or cholelithiasis.
Your doctor will tell you how to remove bile.
If the pathology is not treated:
- sand forms in the bubble, and then stones;
- the functioning of the digestive system is disrupted;
- An acute form of inflammation of the bile and secretion ducts develops.
Cholecystitis sometimes progresses to cirrhosis of the liver, as inflammation promotes the development of bacterial microflora.
Prolonged stagnation of bile provokes the release of bilirubin into the patient’s bloodstream. This is a pigment responsible for the disposal of used red blood cells. Bilirubin is brownish. Excess pigment in tissues leads to intoxication of the body. Externally, it is expressed in yellowing of the sclera of the eyes and skin. Bilirubin colors them, “overlapping” the natural pigment of the integument, melanin.
Methods for removing bile
If there is prolonged stagnation of bile, pain appears on palpation of the liver and compaction in the area of the organ. Not only the color of the skin changes, but also the color of the urine. The liquid becomes dark.
The main signs of impaired bile outflow are:
- Frequent attacks of nausea and vomiting.
- Bad breath.
- Stool clarification.
If a spasm of the gallbladder occurs, liver secretions spill into the upper esophagus. This is the cause of heartburn and bitterness in the mouth.
How to remove bile from the body must be determined by the attending physician.
There are several methods:
- medicinal;
- using medicinal herbs;
- diet (eating choleretic products);
- gymnastics.
In severe cases, if conservative methods do not bring results, experts prescribe a surgical method for removing bile.
Medication
The basis for treating stagnation of liver secretions with medications is the prescription of drugs that include ursodeoxycholic acid. It is also contained in bile produced by the human body. The substance neutralizes the toxic effects of other bile acids, reduces cholesterol levels and prevents its penetration into the intestines.
Treatment of bile stagnation with medications is long-term. The course of therapy can be prescribed for one and a half, two years.
The dosage of drugs is determined by the attending physician. The prescription depends on the patient’s weight and state of health.
Thus, drugs containing ursodeoxycholic acid are not prescribed if the patient:
- Liver cirrhosis.
- Calcium formations in the gallbladder.
- Acute cholecystitis.
- Failure of internal organs.
Often, when deciding how to expel bile, doctors prescribe medications containing herbal ingredients. They prevent the accumulation of bile and stimulate its removal from the body. We are talking about Allohol, Khofitol. Their components have a beneficial effect on the condition of the liver. The herbal nature of the medicine eliminates multiple side effects.
Physiotherapy
The method is effective, but has a number of contraindications.
Physiotherapy should not be used if:
- The patient has a fever.
- An acute inflammatory process develops.
- A person has been diagnosed with a tumor.
To remove bile from the body using physiotherapy, the following methods are used:
- magnetic therapy;
- paraffin baths;
- pine baths;
- electrophoresis using medicinal herbs;
- directed currents to the gallbladder area.
The choice of method is influenced by the results of the patient's examination. For example, he may be prescribed a sanatorium-resort treatment based on mud therapy, general strengthening of the body, and the use of mineral waters.
Gymnastics
Physical activity is the basis for the treatment of bile stagnation. The movement of fluid will not “start” outside of general human activity. Moderate loads tone the muscles. Blood flow is restored. The muscles contract and fluids in the body move through the “arteries.”
Doing therapeutic exercises is especially important for those leading a sedentary lifestyle and suffering from excess weight.
Therapeutic exercises aimed at weight loss will help:
- improve overall well-being;
- reduce cholesterol;
- normalize blood pressure.
As a result, bile is removed from the body. Daily two-hour walks contribute to this. As a rule, patients refuse transport on the way to and from work.
Diet
In the treatment of stagnation of liver secretions, diet plays an important role. The patient's diet should contain bile-discharging products. These include foods rich in vegetable fats. In the process of consuming bile products, secretion production in the liver is normalized. Its composition is also normalized. Without excess cholesterol, bile does not form clots that threaten to harden into stones.
Oils with a choleretic effect include:
Olive oil is considered the most beneficial. It helps solve the problem of how to remove excess bile from the body. The secretion will no longer be excessive if you use the oils “raw”, for example, dressing salads.
You can effectively remove excess bile from the body with the help of vitamin C, which is found in fruits. Not only is the outflow of liver fluid restored, but immunity is also increased. At the same time, the general condition of the body improves.
The most useful are:
Vegetables should become an integral part of the daily menu. Consuming them in the required quantity helps normalize digestion. It is best to eat vegetables raw.
Meals should be organized in fractions, in small portions 5-6 times a day. You should not eat food that is too hot or, conversely, too cold. When you break the rules, it is difficult to feel the bile coming out. It is excreted naturally in the feces. Vigor appears, pain and yellowness of the skin go away.
Traditional methods
Removing bile from the body is a task within the capabilities of traditional medicine. St. John's wort is considered the mildest remedy. It can be used by both sick people and healthy people for the purpose of prevention.
To prepare a decoction of St. John's wort, you need to take 10 grams. herbs and brew it with a glass of boiling water. The product should sit for half an hour. After this, the broth should be cooled and diluted with half a glass of cold water. St. John's wort should be taken 70 ml 3 times a day. The course of treatment is 2 months.
Herbal teas that remove bile from the body also include a duet of wormwood and horsetail. Dried herbs are mixed in equal proportions. To prepare the product, take one teaspoon per glass of water. You need to drink one cup of the decoction in the morning on an empty stomach.
Surgery
When conservative treatment is unsuccessful, surgical intervention is prescribed. There are different operational methods:
- Complete removal of the gallbladder.
- Excision of a tumor or node that has become an obstacle to the removal of bile.
- Stents are installed in the bile ducts - these are special expanders.
- Balloon dilation of the ducts.
- Drainage of the common bile duct.
Most often, the operation is performed using the puncture method. This allows the patient to recover quickly. There is no need to apply stitches.
It is important to begin treatment for bile stagnation at an early stage. Otherwise, the phenomenon becomes chronic and leads to serious consequences.
Bile pigments in urine
Urine contains mainly water, electrolytes, organic matter, and is a product of material metabolism and filtration of blood in the kidneys. The composition of urine is constantly changing and depends on the intensity of glomerular filtration, the level of reverse absorption of water and biologically active substances from primary urine and/or renal excretion. Assessing the composition of urine allows one to judge the functional capabilities of the kidneys, the stability of metabolic processes in the body, the presence of pathologies, and the effectiveness of the applied treatment tactics. Normally, bilirubin metabolic products should not be present in urine. Bile pigments are quantified by special tests.
What are bile pigments?
Bile pigments are products that are formed from hemoglobin, which contains red blood cells. The cells are destroyed to produce bilirubin in a free, unbound state. After entering the liver, this substance reacts with glucuronic acid and a bound pigment is formed. In this form, it enters the bile, and with it into the intestines.
When reacting with intestinal microflora and enzymes, urobilinogen is obtained. This compound is partially absorbed into the blood and then excreted in the urine. With pathologies of the bile-forming system, such as a removed gallbladder, an inflamed liver, bilirubinuria and urobilinogenelia develop.
Types of pigments
Urine may contain 2 types of bile substances: bilirubin, urobilinogen, which are formed during the division of red blood cells. If there are no pathologies in the body, urine should normally not contain bilirubin pigment. The concentration of urobilinogen throughout the day can vary within different limits, without exceeding the norm. Over time from the moment of collection of the material, urobilinogen in the urine is converted into urobilin.
Bilirubin pigment
The substance should not be detected in urine by classical laboratory tests, such as general and biochemical analysis. Normally, this metabolic product should be removed from the body. When its limit in urine is increased, bilirubinuria develops. Urine turns dark brown. The phenomenon often occurs when the gallbladder has been removed.
The free substance is insoluble in water, so it is not found in urine. The property of solubility is endowed with a compound bound by hepatic glucuronic acid. When the pigment is elevated in the blood, the excess is excreted from the kidneys into the urine. Increased bilirubin is observed against the background of progression of liver and biliary tract diseases. As a result of stagnation, rapid formation of cholesterol and bilirubin pigment occurs. They form a sediment in the bile with gradual crystallization, which becomes overgrown with calcium salts and other components, which leads to the formation of stones.
If jaundice of the skin appears, but there is no pigment in the urine, hemolytic jaundice is diagnosed. In this case, increased bilirubin is found in the blood. As a result of such hemolysis, indirect bilirubin pigment is not filtered by the kidneys, which means it is not excreted in the urine. The causes of bilirubinuria are:
- stone formation in the kidneys and urinary tract;
- failures in the diet with a large amount of carbohydrates;
- pathologies that cause rapid destruction of red blood cells, for example, blood diseases, malaria, sickle cell anemia, chemical intoxication.
Urobilinogen
The substance is formed from bilirubin pigment when it reacts with intestinal enzymes. A small concentration of colorless urobilinogen should be in the urine. This substance is oxidized to form yellow urobilin. If its content is exceeded, the urine becomes dark.
Urobilinogen is created at a specific rate, so it is regularly excreted in feces and partially in urine. An increase in the rate of its formation is provoked by various diseases. In some cases, the rate drops, then the pigment is not detected in the urine. Exceeding the concentration is usually associated with pathologies that cause intense breakdown of red blood cells, which provokes an increase in the amount of free hemoglobin, which is a source of excess bilirubin, and therefore urobilinogen.
Reasons for excess urobilin in urine:
- malaria;
- bleeding from the gastrointestinal tract, lungs, female genital organs;
- Werlhof's disease;
- Biermer's anemia or hemolytic jaundice;
- lobar pneumonia;
- hemorrhagic diathesis;
- liver diseases;
- severe biliary tract infections;
- cardiac dysfunctions;
- stagnation in the intestines.
If urobilinogen is not in the urine, then you need to check the bile duct for blockage. For this reason, the passage of bile with bilirubin substance is disrupted.
Why is pigment analysis needed?
A change in the concentration of bile pigments in urine indicates the presence of a pathology that disrupts the process of dissolution of bilirubin pigment and filtration of urobilinogen. In this way, it is possible to diagnose complications due to a removed gallbladder, liver disease, and determine how well the stones were removed from the biliary system.
Preparing to submit urine for testing
- Urine is given in the morning.
- 30-50 ml of material is enough.
- The collected material is stored in the dark and in a tightly closed container.
- Storage in the refrigerator is allowed.
- Urine must be donated no later than 2 hours from the moment of collection.
Norm and pathology
In the absence of bilirubin pigment, a person is healthy, his liver functions normally. If it is detected in the urine, additional blood tests and ultrasound of the liver and gall bladder are prescribed. A positive result indicates the risk of developing viral hepatitis, cirrhosis of the liver, blockage of the bile ducts, and tumor formations in the pancreas.
The concentration of urobilinogen ranges from 5 to 10 mg/l. Clinical symptoms of pathologies can be exceeding or decreasing the specified limits. When the concentration of a substance decreases, there is a risk of:
- blockage of the bile ducts with a stone or tumor;
- development of cholangitis, suprahepatic jaundice;
- intoxication or infection with hepatitis;
- development of cirrhosis, Filatov's disease;
- enteritis, constipation.
The absence of the compound in urine indicates a severe form of viral hepatitis or toxic damage to liver tissue.
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What do bile pigments in urine mean?
The composition and concentration of substances dissolved in urine reflect the course of all types of metabolism. Unnecessary metabolic products are excreted from the body in the urine if the size of their molecules allows them to pass through the kidney filter. The rest are sent to the intestines.
Bile pigments are present in urine in very small quantities. They are the ones that color urine yellowish. It is impossible to identify this minimum using conventional laboratory methods, and is not considered necessary.
If the color of urine darkens to a “beer shade,” a suspicion arises of an increase in the concentration of bile pigments caused by their increased content in the blood. Conducting a urine test with qualitative and quantitative reactions allows you to make a correct diagnosis.
What bile pigments end up in urine?
There are 2 types of bile pigments found in urine:
What is bilirubin?
The breakdown of red blood cells causes an increased release of hemoglobin. It is from this that bilirubin is formed in the liver. The substance can be present in the blood in two states:
- free bilirubin (unconjugated) – does not pass through the barrier of the renal membrane, which means it is not normally found in urine, despite the increased level;
- bound (conjugated) - reacts with glucuronic acid, becomes a soluble compound and is excreted into the urine, bile, and with it into the intestines.
Transformations occur in liver cells. Bilirubinuria is caused by an increased level of conjugated bilirubin in the blood.
The formation of bilirubin is associated with the process of breakdown of red blood cells
How is urobilinogen formed?
Urobilinogen is a product of the subsequent processing of bilirubin in the intestine by:
More modern data indicate the presence of urobilinogen bodies, which include derivatives:
- mesobilirubinogen,
- i-ypobilinogen,
- urobilinogen IX a,
- d-urobilinogen,
- "third" urobilinogen.
The formation of urobilinogen from conjugated bilirubin occurs in the upper part of the small intestine and the beginning of the large intestine. Some researchers believe that it is synthesized by cellular dehydrogenase enzymes in the gallbladder with the participation of bacteria.
A small part of urobilinogen is absorbed through the intestinal wall into the portal vein and returns to the liver, where it is completely broken down. The other is processed into stercobilinogen.
Further, through the hemorrhoidal veins, these substances can enter the general bloodstream and are excreted into the urine by the kidneys. Most of the stercobilinogen in the lower intestine is transformed into stercobilin and excreted in the feces. This is the main pigment that provides color to feces.
The normal level in urine is considered to be no more than 17 µmol/l. If urine is briefly exposed to air, urobilinogen is oxidized by oxygen and converted into urobilin. This can be seen by color:
- urobilinogen is a colorless substance, fresh urine has a straw-yellow tint;
- after some time, due to the formation of urobilin, it darkens.
Jaundice in newborns is associated with increased breakdown of red blood cells and the transition to their own hematopoiesis
What do urine pigments “tell”?
Taking into account the biochemical transformations and properties of bile pigments, their determination can be considered a reliable sign of liver damage and the inability to cope with the disposal of red blood cell breakdown products.
When bilirubinuria is detected, 2 pathologies should be assumed:
- disruption of the functioning of liver cells (inflammation, loss of number due to replacement by scar tissue, compression by edema, dilated and overcrowded bile ducts), this process is confirmed by checking the content of aspartic and alanine transaminases, alkaline phosphatase, and total protein in the blood;
- accumulation in the blood of an increased content of hemoglobin from destroyed erythrocyte cells; for clarification, a study of the hematopoiesis process and analysis of bone marrow punctate will be required.
When is the level of bilirubin in urine impaired?
Unconjugated bilirubin appears in the blood in liver diseases:
- viral hepatitis;
- toxic hepatitis due to poisoning with toxic substances (medicines);
- severe consequences of allergies;
- cirrhosis;
- oxygen hypoxia of liver tissue in heart failure;
- metastatic damage to cancer cells from other organs.
But it does not pass into urine due to the impossibility of filtration. Only in the case of renal and hepatic failure with destruction of the nephron membrane can it be detected in urine.
These same diseases are accompanied by the accumulation of conjugated bilirubin. Its level in the blood determines the degree of damage to the liver tissue. The “renal threshold” for bilirubin is considered to be a level of 0.01-0.02 g/l.
If the liver function is not impaired, but the outflow of bile into the intestines is hampered, then a significant amount of bound bilirubin enters the blood and its excretion in the urine increases accordingly. This variant of pathology develops when:
- cholelithiasis;
- compression of the bile duct by a tumor of the head of the pancreas or swelling in acute pancreatitis.
Impaired bile outflow leads to high levels of bilirubin in urine
Bilirubinuria occurs as a result of a slow flow of bile in the interlobular ducts (cholestasis), leakage of bile into the blood vessels. The patient is expressed in yellowness of the skin and sclera. The type of jaundice (mechanical or parenchymal, subhepatic or hepatic) is determined by the ratio of free - bound bilirubin in the blood and urine.
What is judged by the content of urobilinogen?
In diagnosis, both increased and decreased levels of pigment in the urine are important. The growth of the upper normal level is possible due to:
- Damage to the liver parenchyma, but maintaining the flow of the bulk of bile into the intestine. The part of the pigment returned through the portal vein is not processed by hepatocytes due to their functional inferiority. Therefore, urobilinogen is excreted into the urine.
- Activation of hemolysis (destruction of red blood cells) - increased synthesis of urobilinogen bodies and stercobilin occurs in the intestine. In this case, the returning part of urobilinogen is broken down by the working liver into the final product (pentediopente), and stercobilin goes through the hemorrhoidal veins into the general bloodstream, the kidneys and is excreted in the urine.
- Intestinal diseases - which are accompanied by increased reabsorption of stercobilinogen through the affected wall (prolonged constipation, enterocolitis, chronic intestinal obstruction, cholangitis).
The mechanism of hemolysis is characteristic of diseases such as:
- malaria;
- Addison-Beermer anemia;
- lobar pneumonia;
- Infectious mononucleosis;
- Werlhof's disease;
- some types of hemorrhagic diathesis;
- sepsis.
Massive hemolysis is caused by:
- complication of massive internal bleeding;
- transfusion of incompatible blood group;
- resorption of large hematomas.
Parenchymal failure is secondary to circulatory disorders after myocardial infarction and the development of cardiac weakness. Treatment of liver cirrhosis by applying a shunt to eliminate portal hypertension can be complicated by renal vein thrombosis.
A decrease in urobilinogen concentration indicates:
- blockage of the biliary tract due to stones or compression by a tumor;
- inhibition of bile formation up to complete cessation in severe hepatitis and toxic liver damage.
Methods for qualitative and quantitative determination of pigments in urine
Qualitative samples can identify a substance, but do not indicate its mass. Tests for bilirubin are based on the ability to form a green compound (biliverdin) when oxidized with iodine or nitric acid. An iodine-containing solution (Lugol's, potassium iodide, alcohol tincture) is added layer by layer into a test tube with 5 ml of urine.
Bilirubinuria is indicated by the formation of a green ring at the border
To detect urobilin, bilirubin, which interferes with the reaction, is removed from urine with a solution of calcium chloride and ammonia, then various tests are carried out:
- with copper sulfate - urine is combined with copper sulfate, then with a chloroform solution, after shaking, an intense pink color appears;
- using a spectroscope – the blue-green part of the spectrum remains.
Depending on the intensity of the color, the following may be marked in conclusion:
A detailed determination of the amount of bile pigments in urine is carried out using biochemical reagents in special clinics. The fact is that the study of bile pigments is more indicative of the results of blood tests rather than urine tests.
When is it necessary to check a urine test for bile pigments?
Qualitative tests for bile pigments are included in the mandatory list of standard urine tests. Therefore, if the patient complains of:
- dyspeptic disorders;
- vague pain in the hypochondrium on the right;
- yellowness of the sclera, skin;
- darkening of urine and light-colored stool;
- It is necessary to exclude diseases of the liver and gall bladder.
The appearance of jaundice requires examination for bile pigments
Poisoning with various toxic substances is accompanied by damage to kidney and liver function. By identifying bile pigments, the degree of disorder can be tentatively assumed.
In severe myocardial diseases, a positive test indicates the involvement of liver tissue in the formation of general hypoxia.
Are there any specific features of collecting urine for analysis?
When collecting urine, general requirements should be met:
- mandatory hygiene of the external genitalia;
- Only the average portion of morning urine is suitable for research;
- the container with urine should not be stored for more than two hours, there is no need to leave the transparent jar in the light;
- 50 ml is enough for analysis.
Bile pigments in urine are involved in the metabolism of important organs and the hematopoietic system. Their determination in urine plays a significant role in diagnosis.
ATTENTION! All information on the site is for informational purposes only and does not claim to be absolutely accurate from a medical point of view. Treatment must be carried out by a qualified doctor. By self-medicating you can harm yourself!
Methods for removing bile from the body
Bile is a physiological fluid that is involved in the digestion of food. With its help, proteins, fats and carbohydrates are broken down in the duodenum. Bile is produced by the liver and sent to the gallbladder, where it is accumulated, stored, and released into the intestine during meals. With the development of internal pathology of the digestive organs, stagnation may occur, which will lead to negative consequences. How to remove bile from the body without harm to health?
Why stagnation of bile is dangerous
The accumulation and concentration of bile in the bladder leads to functional disruptions in the gastrointestinal tract and the development of inflammatory diseases.
If bile does not enter the intestines in the required volume during meals, then this disrupts the process of initial breakdown and breakdown of foods. Next, a negative chain mechanism develops. When moving through the intestines, insufficiently digested food is not absorbed by the mucous membrane of the small intestine, and useful microelements and vitamins are removed from the body along with feces. Consequences of functional digestive disorder:
- systematic diarrhea;
- hypovitaminosis;
- chronic exhaustion of the body;
- weight loss;
- dyspeptic disorders - flatulence, putrefactive and fermentative processes in the intestines;
- development of chronic fatigue syndrome.
If bile is not naturally removed from the bladder and accumulates, then over time this leads to acute or chronic inflammatory diseases of the gastrointestinal tract:
- cholecystitis;
- cholangitis – inflammation of the ducts;
- pancreatitis;
- duodenitis;
- gastritis - inflammation of the stomach due to the reflux of bile;
- enteritis.
Stagnation promotes the formation of gallstones.
Who is indicated for the removal of bile and the use of medications?
Removal of bile from the body is indicated for patients diagnosed with biliary dyskinesia. This is a pathology in which the physiological outflow is disrupted or complicated. Cleansing is also prescribed for chronic inflammatory processes in the liver.
Choleretic drugs are mandatory for people after cholecystectomy - surgical removal of the gallbladder, so that it is not deposited in the liver.
It is strictly forbidden for patients who have stones in the bladder to expel bile on their own. A sharp outflow of fluid can provoke active advancement of stones, which will lead to blockage of the ducts. This condition is dangerous, and if it occurs, it requires emergency surgery.
To effectively expel bile from the body, medications, diet and traditional medicine are simultaneously prescribed.
Choleretic agents
Cleansing preparations help get rid of many negative symptoms. They relieve nausea, bitterness and unpleasant taste in the mouth. Medicines relax the smooth muscles of the bile ducts and relieve their spasm, which helps relieve pain symptoms. After taking the drugs, digestion processes improve and appetite increases.
- Allochol is a product based on dry bile, activated carbon, garlic and nettle. Stimulates the motor activity of the ducts, enhances the production of gastrointestinal enzymes, inhibits fermentation and putrefaction in the large and small intestines.
- Cholenzym – the basis of the drug – is dry bile. Promotes its removal from the liver, improves the functioning of the entire gastrointestinal tract.
- Hologon – irritates liver cells and stimulates the formation of bile. Has a pronounced choleretic effect.
- Ursoliv is a choleretic agent that partially dissolves stones in the bladder and removes cholesterol from the liver and intestines. Indicated for reflux of bile into the stomach.
- Urdoxa - reduces the concentration of cholesterol in bile, stimulates its evacuation from the bladder.
- Choludexan - reduces the secretion of cholesterol, gradually dissolves stones, promotes the outflow of bile.
Plant-based choleretic agents:
- Berberis plus is a homeopathic medicine based on berberis.
- Datiscan – Datiscan hemp extract.
- Solaren – curcuma longa extract.
- Travochol - immortelle, tansy, licorice, mint, bird cherry, currant, rosehip.
- Phytohepatol is a herbal mixture that includes marigold, tansy, mint, and chamomile.
- Holagol – turmeric root, mint, eucalyptus.
- Tanacehol is a drug based on tansy flowers.
- Urolesan – urolesan extract, wild carrot fruits, hop cones, oregano, fir and mint oil.
Removing bile at home
At home, bile can be driven away using a special diet. To do this, you need to adjust your diet. There are products with a choleretic effect, the daily use of which will prevent stagnation, increase outflow, and improve digestion processes:
- Vegetables: tomatoes, carrots, corn, cabbage, olives.
- Greens: dill, parsley, cilantro, spinach, rhubarb, celery, lettuce, artichokes.
- Fruits: citrus fruits (lemon, tangerine, orange, grapefruit), berries (gooseberries, blackberries), avocado, ginger, figs, dried apricots.
- Nuts: peanuts, walnuts.
By consuming these foods, bile is removed from the body quickly and without negative health consequences.
Foods that reduce cholesterol - bran (oatmeal, corn), whole grain bread - help to cope well with the problem.
Drinking fresh squeezed juices also has a beneficial effect on the condition of the bile ducts and intestines. The following types of juices are recommended: beetroot, cucumber, orange, grapefruit, carrot, berry, apple (sour, green fruit).
Herbal teas, green loose leaf tea, and hibiscus are also suitable drinks.
You can add liquid May honey (forbs) to dishes with bran, cereals, fruit salads, and drinks. It promotes the evacuation of bile from the bladder. Patients with stones should eat honey with caution, as this product can provoke their motor activity.
The outflow of bile increases with the consumption of spices, seasonings, herbs. These products affect the receptors and secretory function of the digestive system. Therefore, they are choleretic and can be added to main dishes when cooking - ginger, curry, mint, turmeric, chicory.
- You need to eat often and in small portions.
- Reduce the amount of salt, sugar, fat.
- Avoid fried and smoked foods.
- Food should be served warm. During the diet, it is not recommended to eat too cold or hot food.
- Limit consumption of chicken eggs.
- Don't eat at night.
At home, you can also prepare decoctions and infusions from medicinal herbs yourself, but only after the recommendations of your doctor. The following plants have a choleretic effect:
During the course of treatment with drugs and diet, it is important to maintain a water regime. A large amount of liquid reduces the concentration of bile, making it more watery, which improves excretion. Water softens stones and reduces the risk of duct blockage.
The optimal daily amount of water is from 1.5 to 2 liters. It can be partially replaced with rosehip decoctions or slightly sweetened teas. Before meals, to improve bile flow, you can drink water with apple cider vinegar.
Before starting the process of cleaning the gallbladder, you need to consult a doctor and also undergo some examinations. An ultrasound of the abdominal organs is required to rule out the presence of gallstones. Only after this they begin the procedure of cleansing the body of bile.
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Urine contains mainly water, electrolytes, organic matter, and is a product of material metabolism and filtration of blood in the kidneys. The composition of urine is constantly changing and depends on the intensity of glomerular filtration, the level of reverse absorption of water and biologically active substances from primary urine and/or renal excretion. Assessing the composition of urine allows one to judge the functional capabilities of the kidneys, the stability of metabolic processes in the body, the presence of pathologies, and the effectiveness of the applied treatment tactics. Normally, bilirubin metabolic products should not be present in urine. Bile pigments are quantified by special tests.
Pigments are formed from hemoglobin, which contains red blood cells.
What are bile pigments?
Bile pigments are products that are formed from hemoglobin, which contains red blood cells.
When reacting with intestinal microflora and enzymes, urobilinogen is obtained. This compound is partially absorbed into the blood and then excreted in the urine. With pathologies of the bile-forming system, such as a removed gallbladder, an inflamed liver, bilirubinuria and urobilinogenelia develop.
Types of pigments
The cells are destroyed to produce bilirubin in a free, unbound state. After entering the liver, this substance reacts with glucuronic acid and a bound pigment is formed. In this form, it enters the bile, and with it into the intestines.
Bilirubin pigment
Urine may contain 2 types of bile substances: bilirubin, urobilinogen, which are formed during the division of red blood cells. The substance should not be detected in urine by classical laboratory tests, such as general and biochemical analysis. Normally, this metabolic product should be removed from the body. When its limit in urine is increased, bilirubinuria develops. Urine turns dark brown. The phenomenon often occurs when the gallbladder has been removed.
The free substance is insoluble in water, so it is not found in urine. The property of solubility is endowed with a compound bound by hepatic glucuronic acid. When the pigment is elevated in the blood, the excess is excreted from the kidneys into the urine. Increased bilirubin is observed against the background of progression of liver and biliary tract diseases. As a result of stagnation, rapid formation of cholesterol and bilirubin pigment occurs. They form a sediment in the bile with gradual crystallization, which becomes overgrown with calcium salts and other components, which leads to the formation of stones.
If jaundice of the skin appears, but there is no pigment in the urine, hemolytic jaundice is diagnosed. In this case, increased bilirubin is found in the blood. As a result of such hemolysis, indirect bilirubin pigment is not filtered by the kidneys, which means it is not excreted in the urine. The causes of bilirubinuria are:
- stone formation in the kidneys and urinary tract;
- failures in the diet with a large amount of carbohydrates;
- pathologies that cause rapid destruction of red blood cells, for example, blood diseases, malaria, sickle cell anemia, chemical intoxication.
If there are no pathologies in the body, urine should normally not contain bilirubin pigment. The concentration of urobilinogen throughout the day can vary within different limits, without exceeding the norm. Over time from the moment of collection of the material, urobilinogen in the urine is converted into urobilin. When bilirubin increases, the urine turns dark brown. The formation of urobilinogen is provoked by various diseases. The substance is formed from bilirubin pigment when it reacts with intestinal enzymes.
Urobilinogen is created at a specific rate, so it is regularly excreted in feces and partially in urine. An increase in the rate of its formation is provoked by various diseases. In some cases, the rate drops, then the pigment is not detected in the urine. Exceeding the concentration is usually associated with pathologies that cause intense breakdown of red blood cells, which provokes an increase in the amount of free hemoglobin, which is a source of excess bilirubin, and therefore urobilinogen.
Reasons for excess urobilin in urine:
- malaria;
- bleeding from the gastrointestinal tract, lungs, female genital organs;
- Werlhof's disease;
- Biermer's anemia or hemolytic jaundice;
- lobar pneumonia;
- hemorrhagic diathesis;
- liver diseases;
- severe biliary tract infections;
- cardiac dysfunctions;
- stagnation in the intestines.
If urobilinogen is not in the urine, then you need to check the bile duct for blockage. For this reason, the passage of bile with bilirubin substance is disrupted.
