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Sample

Indications

  1. Bile salts are detected in the urine to diagnose various conditions of liver diseases (Jaundice).
  2. To diagnose obstructive jaundice.

Pathophysiology

  1. Bile acid is generated from an amino acid, Glycine, and Taurine.

  1. Definition of bile salts:
    1. Bile acids conjugated with taurine or glycine in the liver. Sodium or potassium conjugates of these bile acids are called bile salt.
      1. Primary bile acids are synthesized in the liver.
      2. Secondary bile acids are produced in the colon by the bacterial action.
    2. Bile salts are formed when an acid is neutralized by a base.
      1. Bile salt consists of:
        1. Sodium glycocholate.
        2. Sodium taurocholate.
        3. Potassium and calcium bile salts are also common.
  2. Bile salts are made in the liver from cholesterol and these help in the fat absorption.They make them more soluble.

  1. Bile salts appear in the urine when there is an obstruction to the biliary tract and that will leads to increase in the bile acids in the blood.
  2. Bile salts are positive in urine in other liver diseases.
  3. Cholestasis, retention of bile and bile salts leads to Itching (Pruritus).
  4. The level of bile salts correlates with itching.
  5. This cholestatic itching may be seen in:
    1. Primary biliary cirrhosis.
    2. Primary sclerosing cholangitis.
    3. Intrahepatic cholestasis of pregnancy.
    4. Hereditary cholestatic syndrome.

Normal

Procedure to detect bile salts in urine

  1. Bile salts reduce the surface tension of liquids.
  2. On this principle, HAY’s test is done.
    1. Sulfur powder is sprinkled over the surface of urine and it sinks if bile salts are present.
    2. Sulfur will remain on the surface when bile salts are absent.

Positive bile salt test is seen in:

  1. Obstructive jaundice.
  2. Liver diseases with the appearance of jaundice.

 


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