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MBBS QUESTION #10270
Question 1
A patient develops obstructive (post-hepatic) jaundice due to a pancreatic head tumor compressing the distal common bile duct. Which bilirubin pattern, and associated clinical findings, would be expected?
  • Predominantly unconjugated hyperbilirubinemia with normal-colored stools
  • Predominantly conjugated (direct) hyperbilirubinemia, with dark urine, pale (clay-colored) stools, and absent urinary urobilinogen✔️
  • Normal total bilirubin with markedly elevated urobilinogen
  • Isolated elevation of unconjugated bilirubin only, with no change in stool or urine color
Correct Answer Explanation
In obstructive jaundice, bilirubin is normally conjugated by the liver but cannot reach the intestine, so it regurgitates into the blood as conjugated (water-soluble) bilirubin — appearing in urine (dark urine) while stools become pale from lack of intestinal bilirubin/stercobilin, and urinary urobilinogen (formed from intestinal bacterial action on bilirubin) is characteristically absent or reduced.