Q: All of the following are the causes of unconjugated hyperbilirubinemia except?

A) Hemolysis
B) Heart failure
C) Portosystemic shunts
D) Hyperthyroidism
E) Total parenteral nutrition (TPN)


Answer: E

• Hemolysis causes increased production of bilirubin. 
• Heart failure and portosystemic shunts, tends to impair hepatic bilirubin uptake.
• Hyperthyroidism impairs bilirubin conjugation.

    - They all tend to cause unconjugated hyperbilirubinemia.

TPN causes intrahepatic cholestasis, and results in conjugated hyperbilirubinemia.

This information is very vital when patient is on TPN and cause of hyperbilirubinemia is sought.