Question

What is the diagnosis in a case of a 30 year old male with jaundice, unconjugated bilirubinemia, increased urine urobilinogen, negative urine bilirubin, normal direct bilirubin, and normal alkaline phosphatase?

• A. Hemolytic jaundice
• B. Viral hepatitis
• C. Obstructive jaundice

Hint:

Raised unconjugated bilirubin with negative urine bilirubin points to hemolysis.

Answer 1

The Correct Option is A

Step 1: Understanding the Question:
A 30 year old man has jaundice with a raised unconjugated (indirect) bilirubin, increased urine urobilinogen, negative urine bilirubin, normal direct bilirubin, and normal alkaline phosphatase. We need to name the type of jaundice this pattern fits.

Step 2: Key Formula or Approach:
Jaundice is sorted into hemolytic, hepatocellular, and obstructive types by checking which bilirubin fraction is high, whether bilirubin appears in urine, and whether liver enzymes like alkaline phosphatase are raised. Unconjugated bilirubin is bound to albumin in blood and is not water soluble, so it never appears in urine, while conjugated bilirubin is water soluble and does spill into urine when raised.

Step 3: Detailed Explanation:
In this man, only the unconjugated bilirubin is high, while the direct (conjugated) bilirubin is normal. Since it is unconjugated bilirubin that is raised, and unconjugated bilirubin cannot pass into urine, the urine bilirubin is correctly negative.
More red cells are being broken down than usual, so more bilirubin is sent to the liver, processed, and excreted into the gut as normal, then turned by gut bacteria into more urobilinogen than usual, some of which is reabsorbed and shows up as increased urine urobilinogen.
Normal alkaline phosphatase argues against any blockage of bile flow, since obstruction to bile ducts raises alkaline phosphatase along with conjugated bilirubin, neither of which is seen here.
Viral hepatitis (hepatocellular jaundice) usually raises both conjugated and unconjugated bilirubin, since liver cells that both process and excrete bilirubin are damaged, so conjugated bilirubin and urine bilirubin would typically be raised too. This does not fit, since direct bilirubin here is normal.
Obstructive jaundice raises conjugated bilirubin and alkaline phosphatase, and produces a positive urine bilirubin with reduced urine urobilinogen, since bile cannot reach the gut. This is close to the opposite of the pattern seen here.
Hemolytic jaundice fits perfectly: raised unconjugated bilirubin, normal direct bilirubin, negative urine bilirubin, increased urine urobilinogen, and no bile duct blockage, so alkaline phosphatase stays normal.

Step 4: Final Answer:
This lab pattern, raised unconjugated bilirubin with negative urine bilirubin, increased urobilinogen, and normal direct bilirubin and alkaline phosphatase, is classic for hemolytic jaundice. \[ \boxed{\text{Hemolytic jaundice}} \]