Pathway for bilirubin metabolism

Free or unconjugated bilirubin is lipid soluble, and does not undergo glomerular filtration and does not appear in the urine as a result. Bilirubin is processed in the liver according to the following sequence: Tight and reversible binding to albumin of unconjugated bilirubin allows transport in the plasma.

Bilirubin is taken up by hepatocytes by a process of facilitated (carrier-mediated) diffusion that requires inorganic anions.

Intracellular storage of bilirubin is achieved by binding to cytosolic proteins: ligandins and Z protein.

Conjugation with glucuronic acid of one or both propionic acid carboxyl groups. This is mediated by uridine diphosphate-glucuronyl transferase to form a diglucuronide and a monoglucuronide. Conjugation makes bilirubin water soluble.

Active transport across the bile canalicular membrane, which is formed by the apical membranes of the hepatocytes.

Bilirubin undergoes degradation by intestinal bacteria into urobilinogen and related compounds.

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