Which type of bilirubin predominates in cases of hepatocellular disease?

In cases of hepatocellular disease, direct or conjugated bilirubin predominates due to impaired liver function. The liver is responsible for processing bilirubin, and when hepatocellular damage occurs, the ability of hepatocytes to conjugate bilirubin becomes compromised.

As a result, while some unconjugated bilirubin may still be produced from the breakdown of red blood cells, the compromised liver function leads to a build-up of conjugated bilirubin because the liver cannot effectively excrete it into bile. This accumulation often results in an increase in the serum levels of direct bilirubin, which is water-soluble and can be detected in cases of liver dysfunction.

The other forms of bilirubin, such as unconjugated or indirect bilirubin, are less affected in hepatocellular diseases compared to the direct bilirubin levels, which specifically highlight the impaired conjugation and excretion processes of the liver.