Single Best Answer (SBA) · Surgical (Obstructive) Jaundice
A jaundiced patient has the following urine findings: bilirubin present, urobilinogen absent. Stools are pale and urine is dark. Which type of jaundice do these urinalysis findings indicate?
Show answer and explanation
Answer: A. Post-hepatic (obstructive) jaundice
Urinalysis in jaundice
The pattern of urine bilirubin and urobilinogen helps localise the level of jaundice.
The findings here
- Bilirubin present in urine: only conjugated (water-soluble) bilirubin appears in urine, so its presence indicates a conjugated (direct) hyperbilirubinaemia.
- Urobilinogen absent: in complete biliary obstruction, conjugated bilirubin cannot reach the gut, so none is converted to urobilinogen - hence pale stools and absent urinary urobilinogen.
Putting it together
| Type | Urine bilirubin | Urine urobilinogen | Stool |
|---|---|---|---|
| Pre-hepatic (haemolytic) | Absent | Increased | Normal/dark |
| Hepatic | Present | Variable | Variable |
| Post-hepatic (obstructive) | Present | Absent | Pale |
The clinical tetrad of obstructive jaundice
- Deep jaundice, dark urine (conjugated bilirubin excreted renally), pale stools/steatorrhoea (no bilirubin reaching the gut) and pruritus (retained bile salts).
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