This now water-soluble bilirubin is moved into the gallbladder where it is combined with bile. Only when the bilirubin molecule is bound to glucuronic acid, not albumin, is it considered to be in the conjugated form. 3 The albumin is then removed and bilirubin is conjugated with one or two molecules of glucuronic acid This makes it again water soluble. 3 This complex reaches the liver where it is taken up by hepatocytes. As such, bilirubin is released from monocytes into the blood as a complex with albumin. 2 Bilirubin is not water-soluble and cannot be excreted alone into the blood stream. ![]() 1,2 At the end of its life cycle, the RBC is taken up by monocytes where the heme group is eliminated, first by being converted to biliverdin and then later to bilirubin. Red blood cells contain hemoglobin made up of two alpha chains and two beta chains, each containing a heme group. More specifically, jaundice indicates an excess of bilirubin in the bloodstream, typically greater than 2.5mg/dL. 1,2 Scleral icterus is most often the initial presenting sign of jaundice, which in this case was the result of alcohol induced liver cirrhosis. The diagnosis in this issue is scleral icterus secondary to systemic jaundice. Can his history aid in his diagnosis?Īdditional testing included photodocumentation of the presentation for reference and a close inspection of the eyelids to rule out lipid and cholesterol deposition (xanthelasma). This 34-year-old male patient presented with yellowed eyes and skin, but 20/20 vision in both eyes. The dilated fundus examination was within normal limits with normal cupping measuring 0.2/0.2 and quiet peripheries.ĭoes this case require any additional tests? What does this patient’s history and clinical findings tell you about his likely diagnosis? How would you manage this patient? What’s the patient’s likely prognosis? The biomicroscopic examination of the anterior segment was unremarkable and Goldmann applanation tonometry measured 15mm Hg OU. The pertinent external findings are documented in the photograph. His best corrected entering visual acuities were 20/20 OD and 20/20 OS at distance and near. The patient was not currently taking medication and denied any drug allergies. The remainder of his surgical and medical histories were non-contributory. His medical history was positive for alcohol-induced cirrhosis of the liver. The patient reported no ocular or visual complaints and had an unremarkable ocular history. A 34-year-old white male was admitted to the hospital after being referred for an ophthalmic consult by his internal medicine team.
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