BillirubinJaundice Causes and Billirubin In UrineBillirubin levels in blood samples is another measure of liver status. Why is that important and what does it tell us? As a Veterinarian I'll give you the best answers to those questions. Billirubin (or "BIL" as I am going to use as well) is a product coming from breakdown of mainly hemoglobin. Hemoglobin is the oxygen carrying part of the red blood cells and therefore very important. After the red blood cell dies, it will separates in different components. 
Some components are recycled, such as Iron (Fe). Other bits - like the Heme part (see picture)- are connected to albumin in the blood and transported to the liver cells. When it binds to albumin it ts called conjugated. In the liver cells billirubin connects to glucuronic (GLU) acid and this BIL-GLU molecule goes to the bile, and leaves the body. You can actually both measure conjugated and non conjugated BIL in the blood. In practice the total amount of BIL is measured. No distinction is made between conjugated and non conjugated BIL. Increased LevelsFrom two reasons:
Too much production or to less removal. In practice, rule out the possibility of anemia, hemolysis or hemorrhage, before you can point increased level of BIL to a liver disease. But you don't have to worry about this. Its my job. In general if liver disease is a major suspicion the amount of conjugated BIL should get increased. If blood is the primary concern the non conjugated Billirubin is increased Causes of JaundiceSymptoms of jaundice (ikterus) in dogs are not that complex. If the liver can't clear blood from red blood cell end products they will enter connective tissue instead. The skin will become yellow. Everything will have a yellow tone. The white in the eyes is yellow as well. This is where I tend to look first to check for colour changes.
Photo courtesy of Mike Baird In humans you can see the increased level of BIL in the skin can cause sensitivity to the sun. This is because of photo chemical reactions happening to the BIL molecule. This causes skin irritations and skin rashes. In dogs this is rare. Rare because of the pigmentation of the skin and all the hair giving protection against the sun. And In the UrineSome conjugated BIL can go to the kidneys and into the urine. If its a lot, the urine will change clour to more darkish. Be avare though, its perfectly normal to find small amounts of Bil in the urine. Especially if the urine is very concentrated. But if the urine is verty dilute and thin, you should only find traces of BIL on a urine stiks. Larger amounts is a sign of some kind of liver problem. To sum it upYou have to compare blood BIL to other liver blood tests to judge liver health. Not only one sample can do the job. Often you take samples more the once. Thereby you can see the development of the disease. Find out if the treatment is sufficient or not. See if there is any sign of liver recovery. This can take days or sometime weeks to get the final result. This waiting can be a big challenge for you! Related Pages
Hepatic Encephalopathy
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