How are Cholesterol and Jaundice Related to Bile Production?
The formation, structure, and effects of bile, a vital fluid produced by the liver.
The word "bile" in our language is understood to mean a burden that is unwanted, heavy to carry, and unacceptable. In maritime usage, it appears as an unnecessary weight that balances boats and can be jettisoned when necessary in Nevşehir's hot air balloons. This word, meaning yellow in Ottoman Turkish, is used as "bilis" in Latin, and it is thought that the name of the substance bilirubin, measured in the blood, comes from here. Although perceived as a difficult burden to carry, thanks to nature's magnificent organization, bile is a substance produced by the liver that provides incredible benefits to the body and whose absence can lead to major problems. In fact, it is considered an indispensable part of the system, produced from the waste materials generated by our body.
Looking at the composition of bile, it is seen to consist of three basic elements, the first of which is cholesterol. This is the cholesterol that when you visit an internist, they say "make sure not to raise your cholesterol, raise your good cholesterol." It is actually one of the most fundamental building blocks of the body and the gallbladder. Cholesterol, broken down within the liver, is divided into two elements called cholic acid and deoxycholic acid. These combine with taurine and glycine, also used by our body's neurovegetative system, to form bile salts. Bile salts, which form the basic building block of bile, are an indispensable component of fat metabolism. It is stated that if bile salts are not formed, fat metabolism will not occur, and therefore vitamins A, D, E, and K cannot be absorbed, which can lead to severe fatty diarrhea and serious systemic problems.
The third element that makes up bile is bilirubin. Bilirubin, remarkably, is actually a waste product. It is formed as a result of the breakdown of red blood cells (erythrocytes) in our blood, the essence of life, upon completing their average lifespan. When erythrocytes break down, they divide into two components: heme and siderin. Heme is an iron compound used by the body. Siderin, on the other hand, converts to biliverdin. For example, a subcutaneous hemorrhage is initially red, and then as the body absorbs it, you can see that redness gradually turning green thanks to biliverdin. This biliverdin, after some time, converts to indirect bilirubin.
Indirect bilirubin, being a waste product, is transported directly to the liver by binding to albumin in the blood. In the liver, it undergoes a chemical process and is conjugated to become direct bilirubin. Direct bilirubin combines with cholesterol and bile salts, previously mentioned, to form bile. The produced bile is secreted from the liver into the intestines through the common bile duct (choledochus). Here, a portion of bilirubin is broken down and converted into urobilinogen. While urobilinogen is excreted by the kidneys through urine, giving urine its color, a portion is reabsorbed back into the body for reuse. The remaining part is excreted through feces, and the brown color of feces is due to this substance.
In liver diseases, enzyme deficiencies, cirrhosis, and especially in cases of hepatitis, certain production problems arise. When the liver cannot adequately process bilirubin and bile salts, the waste product bilirubin begins to rise in the blood. The elevation of bile in the blood, which is produced from the body's waste but is incredibly beneficial, is an indicator of a significant symptom known as jaundice in the general population.
In the case of physiological jaundice observed in newborn infants, the bilirubin that causes jaundice can rise incredibly in the blood due to the rapid breakdown of erythrocytes brought from the womb. If this condition is not under medical supervision and the necessary procedures are not performed, it is thought that bilirubin can settle in the brain, causing brain damage leading to kernicterus. It is stated that this excess in material production is also observed in hemolytic blood diseases where erythrocytes break down excessively, and the accumulation of excess bilirubin in the blood, settling in the brain system, can cause various problems.