In a patient with obstructive jaundice, what is the possible explanation for a bilirubin level of 40 mg/dL?
Malignant obstruction
Complete obstruction of common bile duct
Renal failure
Liver failure
Ans: C. Renal failure(Ref Zakim and Boyer s Hepatologv (2016)/p109; Bailey 25/e p1128, Textbook of hepatologv 6/e p20t).High bilirubin content:Causes of cholestatic jaundice (malignant obstruction, complete CBD obstruction).Presence of concomitant renal failure a Very high bilirubin beyond 30 mg/dL.Conjugated hyperbilirubinemia:Results from impaired intrahepatic bilirubin excretion or extrahepatic obstruction.Due to continued urinary excretion, maximum serum bilirubin levels plateau at approximately 500 mmol/L (30 Ing/dL) even with complete bile duct obstruction.Extreme hyperbilirubinemia:Levels higher than 500 mmol/L (30 mg/dL).Commonly indicates severe parenchymal liver disease in association with hemolysis (as in sickle cell anemia) or renal failure.