positive urobilinogen in urinalysis

Can be seen with diuretics and after exercise. Tulsa (OK): Saint Francis Health System; c2010. Nitrite: positive in most bacterial urinary tract infections; negative in urinary tract infections caused by Gram-positive organisms or Pseudomonas spp. Don't let the container touch your body. Proteinuria. Elsevier; 2022. https://www.clinicalkey.com. Fecal Urobilinogen; p. 295. WebUrinalysis is a series of tests on your urine, or pee. We analyzed 2,600 urine samples using the Arkray Semi-Automated Analyzer and using Aution Sticks 4EA strips with 10 parameters including glucose, protein, bilirubin, urobilinogen, pH, specific density, red blood cells, nitrite, and leukocytes, and then using the Nikon Eclipse E100 microscope to examine the urinary sediment . Overall sensitivities for both urine assays were 70% to 74% for serum bilirubin, but 43% to 53% for other LFTs; specificities were 77% to 87% for both urine screens. At IGL-India, we see that when you live in the way it is distinguished above, you are also leading, and the distinction between living and leading collapses. Identifying the specific etiology of hemolytic anemia begins with a peripheral blood smear for abnormal RBCs, such as spherocytes, schistocytes, or bite or blister cells1 (Figures 2 and 3). information submitted for this request. Testing for urobilinogen in urine is important since it shows how See permissionsforcopyrightquestions and/or permission requests. Gram negative rods such as E. coli are more likely to give a positive test. False-negative results using either methodology can be obtained when testing is delayed, since urobilinogen can be converted into urobilin, which is nonreactive. URINARY PH. Click here for an email preview. He came for a consultation with these symptoms. A random urine sample may be expected to contain 0.11mg/dL urobilinogen. Align your health hacks with your genes for optimal health & cognitive function. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Urinalysis may be positive for hemoglobinuria in hemolytic anemia despite no visible RBCs on microscopy. Sulfonamides may produce false-positive results, and degradation of urobilinogen to urobilin may yield false-negative results. Components of the dipstick urinalysis (urine urobilinogen and urine bilirubin) are often used by emergency physicians to screen for the need to obtain liver function tests in many clinical situations. Copyright 2023 American Academy of Family Physicians. Science, Eastern Wisdom And Generative Leadership, Achieving extra-ordinary results through communication, Creating Effective & Sustainable Leadership, Leadership Conversations For Possibilities, Managing Capacity, Managing Promises and Achieving Results, Creating a powerful growth strategy and making it work, Come with over two decades of business and leadership. Comment * document.getElementById("comment").setAttribute( "id", "a287a8b7458ae21c3e6172009085a529" );document.getElementById("a6cbe26769").setAttribute( "id", "comment" ); Save my name, email, and website in this browser for the next time I comment. Urobilinogen in Urine: Low & High Levels + Normal Range It can also help diagnose liver problems and many other medical conditions. Dr.Manuela Stoicescu, in Medical Semiology Guide of the Renal System, 2020. Bilirubin test; [cited 2022 Mar 13]; [about 5 screens]. Dysmorphic RBCs or RBC casts: glomerulonephritis. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Dark-colored urine (pee) and/or light-colored stool (poop), Heart palpitations (feeling that your heart is skipping a beat, fluttering, or beating too hard or too fast). Its mission is to train and support pathologists and senior scientists and to improve the use of pathology testing to achieve better healthcare. Blood: a positive test for blood may be due to red cells from inflammation, trauma, or tumour of the renal tract. Alcohol also decreases red blood cells, which may exacerbate anemia. Start urinating again, this time into the container. Treatment is discontinuation of the drug and supportive care. However, these values vary from lab to lab. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Spherocytes are caused by membrane deficits or repeated small membrane removals by macrophages. There is no known risk to having this test. The initial workup of hemolytic anemia begins with a complete blood count illustrating normocytic (mean corpuscular volume of 80 to 100 m3 [80 to 100 fL]) or macrocytic (mean corpuscular volume greater than 100 m3) anemia (Figure 1). Urinalysis: A Comprehensive Review | AAFP Hypoglycaemic coma may be present when urine shows glucosuria from earlier hyperglycaemia. Unable to load your collection due to an error, Unable to load your delegates due to an error. privacy practices. However, small quantities of urobilinogen are found in normal urine, where they contribute to the typical yellow colour of the specimen. Glucosuria is not a reliable indicator of gestational diabetes and the test should not be used for this purpose. what might cause this? Hyperbilirubinemia: An Urgent Care Approach The .gov means its official. Lynn D. Robertson, David Roper, in Dacie and Lewis Practical Haematology (Twelfth Edition), 2017. Both methods are affected by drugs and metabolites that mask the color of the test strip and lead to erroneous interpretations; these include phenazopyridine and drugs containing azo dyes. Recirculation of urobilinogen in an enterohepatic cycle (Approximately 20% of urobilinogen is recirculated and returned to the liver. Emerg Med Clin North Am. Donate online now using the button below. However, some diseases and conditions allow proteins to pass through the filters of your kidneys, causing protein in urine. Save time on interpreting lab results with the largest database of biomarkers online. 1. Weakness. In severe cases, it can cause hemolysis in the neonatal period but typically presents later as chronic hemolysis. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Understand and improve your laboratory results with our health dashboard. 8600 Rockville Pike Other names for it are urine test, urine analysis, and UA. Ketones: nitroprusside. A urobilinogen in urine test measures the amount of urobilinogen in your urine (pee). That inflammation can come from an injury, infection, or disease. LWW The site is secure. The mutations are largely autosomal dominant, making the family history important. Jaundice is a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin. but is for informational and educational purposes alone. When urine urobilinogen is low or absent in a person with urine bilirubin and/or signs of liver dysfunction, it can indicate the presence of hepatic or biliary obstruction. If your provider has ordered other urine or blood tests, you may need to fast (not eat or drink) for several hours before the test. WebNot all bacteria have this function. Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. We use cookies to help provide and enhance our service and tailor content and ads. At The Institute for Generative Leadership, we: Copyright 2020 Institute For Generative Leadership. Some of it enters your bloodstream and returns to your liver, where it's "recycled" into bile. The diet must also have sufficient nitrates for a nitrite test to be positive. Collect at least an ounce or two of urine into the container. Some is excreted in feces, and the rest is reabsorbed and excreted in the urine. Contains a comprehensive listing of all genes from the Human Gene Nomenclature Committee (HGNC) database alongside laboratories and tests available in the country. Thus, it is important for pharmacists to note this, since both the drugs, and bile pigments in urine can cause an orange discoloration. In other forms of jaundice, urobilinogen is increased. Mayo Foundation for Medical Education and Research; c19982022. This article updates a previous article on this topic by Dhaliwal, et al.3. A false positive urobilinogen reaction may occur with the dipstick method when substances known to react with Ehrlich's reagent such as sulfonamides and p-aminosalicylic acid are present in the urine. A positive leukocyte esterase test results from the presence of white blood cells either as whole cells or as lysed cells. Have a doctor or pharmacist review your medications to see if any could be harmful to the liver [, Timing (test is done later in the afternoon), Drugs that make the urine red, such as phenazopyridine (Pyridium), Oral contraceptives and hormone replacement therapy. This is commonly seen with drug reactions, hepatitis, as well as any type of liver disease. Urine concentration will affect the depth of the color. Treasure Island (FL): [last update 2021 Aug 20; cited 2022 Mar13]; [about 6 screens]. Urinary pH can range from 4.5 to 8 but normally is slightly acidic Inflammation in your body triggers the release of leukocytes. Urobilinogen is a byproduct of bilirubin that is eventually eliminated through the stool and urine. Lin SC, Hsu MY, Kuan CM, Tseng FG, Cheng CM. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. The water soluble bilirubin can now be excreted by the liver in bile and excreted into the small intestine through the common bile duct. WebUrobilinogen is a colorless pigment produced in the gut from the metabolism of bilirubin. The remaining urobilinogen (5%) is transported by the blood into the kidneys where it is converted into yellow urobilin and is excreted giving urine its characteristic yellow color. WebInflammation. Copyright 2023 RCPA. A urobilinogen in urine test alone cannot diagnose a specific condition. If lactic acidosis is also present, the ketone reaction may be inappropriately weak. information is beneficial, we may combine your email and website usage information with If you continue to use this site we will assume that you are happy with it. When bilirubin production increases because of red blood cell destruction (hemolysis) or liver disease, urobilinogen levels rise in the urine. Basic examination of urine. We use procedural, physical, and electronic security methods designed to prevent unauthorized people from getting access to this information. The diagnosis of this patient was unique kidney and acute renal failure after antibiotics. Q. Zhang, X. Chris Le, in Comprehensive Sampling and Sample Preparation, 2012. Then, if the test stick is positive, the doctor will perform a test to determine how much urobilinogen is in your urine. Swelling and/or pain in your abdomen (belly) Swelling in your ankles and legs. WebUrobilinogen is formed from bilirubin by intestinal bacteria in the duodenum (=the first part You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition. Bethesda, MD 20894, Web Policies SelfDecode does not treat, diagnose or cure any conditions, 90% of that is oxidized into Stercobilin. Another study of 620 people with malaria found that the presence of urobilinogen in the urine was associated with an increased risk of severe malaria with the following complications [30]: Factors that can lead to false-positive results include [8]: Address any underlying conditions that are causing low urobilinogen levels. In the absence of obstruction, urobilinogen levels generally rise with increased bilirubin production. Urinalysis in Clinical Laboratory Practice. ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. National Kidney Foundation' s Primer on Kidney Diseases, Contemporary Practice in Clinical Chemistry (Fourth Edition), Laboratory Methods Used in the Investigation of the Haemolytic Anaemias, Dacie and Lewis Practical Haematology (Twelfth Edition), Approach to the Patient with Jaundice or Abnormal Liver Tests, Goldman's Cecil Medicine (Twenty Fourth Edition), Extraction Techniques and Applications: Biological/Medical and Environmental/Forensics, Comprehensive Sampling and Sample Preparation. But how do you plan to do it? This can also be seen due to some sort of blockage of the bile ducts. However, rarely, has anyone looked at science & Eastern Wisdom, and brought forth leadership distinctions & practices. The unconjugated bilirubin builds up in the body giving liver failure patients their yellow glow. When anemia is identified, testing should include measurement of lactate dehydrogenase, haptoglobin, reticulocyte, and unconjugated bilirubin levels, as well as urinalysis (Table 3). All Rights Reserved. Positive bilirubin on urinalysis indicates a need for further investigation to rule out hepatobiliary disease. Available from: Labpedia.net [Internet].c.2014-2022. official website and that any information you provide is encrypted Simerville JA, Maxted WC, Pahira JJ. In the setting of a DAT-negative hemolysis and spherocytes on peripheral blood smear, an increased mean corpuscular hemoglobin concentrationtomean corpuscular volume ratio (greater than 0.35) should prompt consideration of hereditary spherocytosis and further testing with osmotic fragility and eosin-5-maleimide binding to confirm the diagnosis.29 Treatment is supportive, with splenectomy often required in moderate to severe hereditary spherocytosis. Simply attach an image or a file of your lab test results, and one of our qualified data entry team members will add the results for you. Urobilinogen: increased in haemolysis. A manual for the process of macroscopic dissection in Anatomical Pathology laboratories. WebWhat is it used for? Blockage of bile ducts: The bilirubin is not able to be excreted through bile into the small intestine and has increased numbers because of this physical obstruction. Urobilinogen levels also correlate with blood levels of liver enzymes (e.g. RCPA Foundation thanks you for your generous support. The urobilinogen test, by itself, is not enough to diagnose any condition. Some of the urobilinogen leaves your body in your stool (poop). Ketones: in a diabetic, positive ketones indicate ketoacidosis. Glucose: diabetes mellitus and other causes of hyperglycaemia. There is no limit on how many lab reports you can upload. Although plasma exchange is superior, fresh frozen plasma infusion is beneficial and should be started if transfer to a plasma exchangecapable center is delayed.11, Hemolytic uremic syndrome (HUS) is characterized by MAHA and acute kidney injury, and commonly thrombocytopenia and neurologic dysfunction. Today, SelfDecode has helped over 100,000 people understand how to get healthier using their DNA and labs. See our Privacy Policy for more details. Doctors use it to check for signs of common conditions or diseases. Extrinsic nonimmune causes include the thrombotic microangiopathies, direct trauma, infections, systemic diseases, and oxidative insults. Talk to your doctor about what your test results mean and how to manage any underlying health conditions [10]. The ADAMTS13 enzyme cleaves von Willebrand factor aggregations and, when it is not present or functional, large von Willebrand factor multimers form. In an observational study of 28k people, drinking more than 3 cups of coffee per day was associated with lower levels of liver enzymes (e.g. They are continually monitored by our internal peer-review process and if we see anyone making material science errors, we don't let them write for us again. Severe cholestasis, bile duct obstruction, or broad-spectrum antibiotics that reduce or eliminate bacterial conversion of bilirubin to urobilinogen markedly decrease the formation and urinary excretion of urobilinogen. SelfDecode is a personalized health report service, There are also certain factors (sunlight exposure to urine sample) or acidification through substances like vitamin c. Address the underlying condition. Overview of heavy proteinuria and the nephrotic syndrome. The etiologies of hemolysis are numerous (Table 1). As discussed previously, conjugated bilirubin is excreted with the bile into the duodenum, where the conjugated bilirubin is converted by bacteria into urobilinogen. What is bilirubin? 11. Urinalysis Interpretation | Hospital Handbook Unconjugated bilirubin and iron. It is increased in patients with a haemolytic anaemia. Email: evep@rcpa.edu.au, Rachel Johnson If we combine this information with your protected WBCs: PMNs=UTI; eosinophils (AIN with special Wright stain). Careers. Antibody-mediated hemolysis results in phagocytosis or complement-mediated destruction, and can occur intravascularly or extravascularly. Your kidneys filter waste products from your blood while keeping what your body needs including proteins. Urobilinogen in urine. Urobilinogen in the urine positive Many causes of AIHA are idiopathic; however, viral and bacterial infections, autoimmune conditions, connective tissue disorder, lymphoproliferative malignancies, blood transfusions, and transplantations have been associated with AIHA. A blockage in the ducts that carry bile from your liver or gallbladder to your intestines, A blockage in the blood flow through the liver. Rovin BH. Patients with hemolysis may present with acute anemia, jaundice, hematuria, dyspnea, fatigue, tachycardia, and possibly hypotension. Most of the urobilinogen is excreted in the feces, but some is reabsorbed into the blood and goes either into the liver for reexcretion in the bile, or the urine. HELLP syndrome is pregnancy related and shares many characteristics with TTP and HUS, both of which can also occur during pregnancy. 2005 Mar 15 [cited 2022 Mar 13]; 1;74(7):1096. Urobilinogen is normally eliminated in the stool after passing through the liver and gallbladder. Table of Contents What is Bilirubin? Iron studies (including serum iron, total iron-binding capacity, transferrin saturation, and serum ferritin) are valuable if an inappropriately low reticulocyte count and a microcytic anemia are present. One needs the presence of appropriate bacteria for the dipstick to register a positive nitrite. If no red cells are seen on microscopy, it indicates haemoglobinuria or myoglobinuria. STEC urinary tract infections can cause a diarrhea-negative STEC-HUS.13 Streptococcus pneumoniae, human immunodeficiency virus, and influenza have also been associated with HUS in rare cases, which presents without the classic prodrome. A positive (+) result of bilirubin in urine (bilirubinuria) is indicative of a liver problem or a bile obstruction. Normal urine urobilinogen excretion is 4mg/day or less. pH:inability to acidify urine may indicate distal renal tubular acidosis. At HealthMatters, we're committed to maintaining the security and confidentiality of your personal information. In a 2015 review, the overall incidence of drug-induced TMA was 5% of all MAHA cases.19 Another review found 78 medications suspected of causing drug-induced TMA. https://www.aafp.org/afp/2011/0315/p719.html, https://www.aafp.org/afp/2005/1001/p1277.html#afp20051001p1277-t3, https://www.aafp.org/afp/2015/1215/p1069.html, https://www.aafp.org/afp/2009/0815/p339.html. You start to live and lead your life in the true sense. The Ehrlich method is not specific for urobilinogen and will react with porphobilinogen, sulfonamides, procaine, indole, methyldopa, 5-hydroxyindoleacetic acid, and aminosalycylic acid metabolites. It includes many separate and diverse entities whose common clinical features can aid in the identification of hemolysis. Certain medicines and supplements can affect your results, so be sure to let your provider know what you are taking. This can reduce the production of urobilinogen, which leads to lower levels in the urine [1, 13]. Advertising revenue supports our not-for-profit mission. Hemolytic Anemia: Evaluation and Differential Diagnosis Classically, fava beans, sulfa drugs, and primaquine were the primary triggers of oxidative hemolysis, but the list of medications to avoid in persons with G6PD deficiency is extensive22,23 (see https://www.aafp.org/afp/2005/1001/p1277.html#afp20051001p1277-t3). Shu-Ling Fan, Shi Bai, in Contemporary Practice in Clinical Chemistry (Fourth Edition), 2020. Relevant UpToDate articles were also accessed to provide references. in Urine Urobilinogen is a colorless pigment produced from the breakdown of bilirubin by gut bacteria. Disseminated intravascular coagulation causes prolonged coagulation studies, positive d-dimer test results, and decreased fibrinogen levels.18, Drug-induced TMA occurs when a compound causes the formation of platelet microthrombi, resulting in MAHA through induced antibodies or direct toxicity. WebA positive reaction must be interpreted in light of SG, pH, and urine sediment examination. Eve Propper Decreased urobilinogen is associated with obstructive biliary disease and severe cholestasis (=a decrease in bile flow due to impaired secretion). LabCE [Internet]. A health care professional may give you a cleansing wipe, a small container, and instructions for how to use the "clean catch" method to collect your urine sample. The hallmark of AIHA is a positive DAT result (Figure 4).3 AIHA is organized into two primary subgroups based on binding temperatures, referred to as cold and warm agglutinins. Fatigue. Blood: inflammation, trauma, or tumour of renal tract, haemoglobinuria, myoglobinuria, coloured urine. Direct cellular destruction is caused by toxins, trauma, or lysis. Dark They should always be considered in the workup of a child with hemolysis, and have been reviewed in previous articles in American Family Physician30,31 (https://www.aafp.org/afp/2015/1215/p1069.html and https://www.aafp.org/afp/2009/0815/p339.html). This content does not have an English version. These include [4, 5, 6]: Urobilinogen levels can also be measured in the stool (although this is not done as often). Leucocyte esterase: urinary tract inflammation. Negative predictive values were 85% for both urine assays for serum bilirubin elevations, but lower for other LFTs. Short sleep duration and poor sleep quality significantly increased the incidence of non-alcoholic fatty liver disease (NAFLD) in an observational study of 69k people [19]. This results in methemoglobinemia (i.e., the denaturing of ferric hemoglobin into multimers, called Heinz bodies), leading to premature RBC destruction by phagocytosis. In addition, as conjugated bilirubin cannot be excreted into bile, it will be reabsorbed into the bloodstream and thus spilled into the urine, resulting in high levels of direct bilirubin in the blood.1 Nevertheless, false-positive results may occur in patients is taking phenazopyridine or phenothiazines. Urobilinogen is normally found in trace amounts in the urine (0.2 1.0 mg/dL) [7]. Protein in urine (proteinuria) Causes - Mayo Clinic Urinary urobilinogen levels were significantly lower in infants with biliary atresia (narrow, blocked, or absent bile ducts) compared to healthy infants in an observational study of 75 infants [13]. A urobilinogen in urine test may part of a urinalysis, a test that measures different cells, chemicals, and other substances in your urine. If your test results show too little or no urobilinogen in your urine, it may be a sign of: If your test results show a higher-than-normal level of urobilinogen, it may be a sign of: If your test results aren't normal, it doesn't always mean you have a medical condition that needs treatment. Figures 2 and 3 provided by Lyndon P. Bowden, MD, MPH, Department of Pathology, Womack Army Medical Center. Urobilinogen is also a product of hemoglobin metabolism and is formed by bacterial degradation of bilirubin in the colon. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The direct antiglobulin test further differentiates immune causes from nonimmune causes. https://www.uptodate.com/contents/search. Often, substances such as protein or glucose will begin to appear in the urine before patients are aware that they may have a problem. 1989 Jan;113(1):73-6. Urinalysis Accessed Feb. 14, 2022. Uroculture was positive >100,000UFC/mL Enterococcus spp. It has a yellow/orange color. For this reason, the patient first started a protocol of rehydration with saline solutions to decrease the level of urea and creatinine and then started antibiotic therapy conforming to the antibiogram for urinary tract infection. I have IgA nephrology. Unconjugated bilirubin ordinarily does not reach the gut except in neonates or by ill-defined alternative pathways in the presence of severe unconjugated hyperbilirubinemia (e.g., Crigler-Najjar type 1). Required fields are marked *. Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. TTP and HUS do not usually induce liver-associated enzyme elevations as in HELLP syndrome.16 A low lactate dehydrogenasetoaspartate transaminase ratio can aid in distinguishing HELLP syndrome, because the rate of hemolysis is higher in the other TMAs and hepatic involvement is higher in HELLP syndrome.17 Disseminated intravascular coagulation also can result in MAHA due to fibrin-rich microthrombi. This service is excellent whether you have a lot of reports to upload or are too busy to do the data entry yourself. Positive urine dipstick tests for bilirubin may be alarming in patients with rheumatoid arthritis on hepatotoxic drugs such as methotrexate, as this may indicate hepatic damage due to disease or iatrogenic effects. CRC Press. WebIf you had a chemical urine test, such as a glucose urine test or nitrite urine test, the The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. Our science team must pass long technical science tests, difficult logical reasoning and reading comprehension tests. Treatment of warm AIHA typically includes the use of glucocorticoids, management of the underlying condition, blood transfusion (if necessary), and supportive care.4. hemolytic anemia, pernicious anemia, intravascular hemolysis, congestive heart failure) raise bilirubin levels, which increases the production of urobilinogen in the gut [1, 27, 3]. Symptoms of high urobilinogen levels in your urine depend on the underlying cause. Urobilinogen in Urine: MedlinePlus Medical Test https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis/albuminuria-albumin-urine. Can you tell me what these blood results mean:Estimated GFR: 55 ALT/SGPT: 11 URINE HEMO: SMALL URINE PROTEIN: 43.4 URINE UROBILINOGEN EHRLICHS: POSITIVE URINE UROBILINOGEN: 2.O URINE SQUAMOS: 11-20 UR WebA negative test with red urine indicates presence of a coloured compound eg, beetroot, Waxy casts: most commonly seen in chronic kidney disease. Bilirubin is a breakdown product of red blood cells. Clinical Significance of Urobilinogen in Urine; [cited 2022 Mar 13]; [about 1 screen]. The hemoglobinopathies lead to splenic destruction and, in the case of sickle cell disease, likely multiple mechanisms of destruction. is a clickable link to peer-reviewed scientific studies. The urine must remain in the bladder for about four hours for bacteria to produce nitrites. Your provider will let you know if there are any special instructions to follow. There is an atypical HUS that also does not have the prodrome, is caused by complement dysregulation and not infection, and can be hereditary. Bilirubin in urine Liver disease5; [cited 2022 Mar 13]; [about 8 screens]. This site needs JavaScript to work properly. Urinalysis Urine Test Paul Berk, Kevin Korenblat, in Goldman's Cecil Medicine (Twenty Fourth Edition), 2012. It should be part of the differential diagnosis for any normocytic or macrocytic anemia. Hemolytic anemia is defined as the destruction of red blood cells (RBCs) before their normal 120-day life span. Will I need a kidney transplant? You may also have this test if you have symptoms of a liver disease or hemolytic anemia. - Review your medications with your healthcare practitioner as some can damage the liver. Accessibility Comparing the urinary bilirubin result with the urobilinogen result may assist in distinguishing between red cell hemolysis [=rupturing (lysis) of red blood cells], hepatic disease (=any disturbance of liver function that causes illness), and biliary obstruction (=a blockage of the bile ducts), as shown in the table below: -https://www.ncbi.nlm.nih.gov/pubmed/28106928, -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110573/, -https://www.ncbi.nlm.nih.gov/books/NBK302/, -https://www.aafp.org/afp/2005/0315/p1153.html, -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936984/, -https://www.ncbi.nlm.nih.gov/pubmed/3662182, -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245376/, -https://www.ncbi.nlm.nih.gov/pubmed/15633120, -https://www.ncbi.nlm.nih.gov/pubmed/23578884/, -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499388/, -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5658984/, -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654245/, -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917983/, -https://www.aafp.org/afp/2005/0315/p1105.html, -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119305/.

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