Bilrubin and Bile

- Hemoglobin broken down to bilirubin; Bilirubin conjugated by glucuonyl transferase in liver and secreted in bile; conjugated bilirubin broken down by bacteria in terminal ileum to urobilinogen and reabsorbed in blood and excreted in urine (thus high levels will turn urine cola dark)
- Bile composed of bile salts, lecithin, cholesterol and bilirubin; Primary bile acids: cholic acid and chenodeoxycholic acid and Secondary bile acids: deoxycholic and lithocholic acids formed by anaerobic bacteria in the intestine
QUESTION: What increases bile acid synthesis?
ANSWER: ileal resection, by-pass, bile acid absorption inhibitors (Cholestyramine)