 chemistry two but now it was merged to clinical chemistry one. So liver function would talk about liver of course, liver function and later I would teach you how to remember things better when it comes to liver function and even kidney function for our next meeting this Thursday which will be our last meeting on Thursday. So again good afternoon to everyone so the outline of our discussion would be the anatomy of your liver so both the growth and microscopic we will be discussing the biochemical function which I which will be the last part of what I will be discussing this afternoon so until the biochemical function of your biochemical function of your liver and that is just 17 slides okay that is just 17 important slides so as you all know everyone liver is liver is is the largest internal organ okay largest internal organ the largest organ of course is still your skin but the largest internal organ is your um is your liver so the liver is very large and it is a complex organ responsible for very vital tasks in your body so later on the reason why we have this thing called liver function test because your liver do function not just one but various um various function and various processes inside your body if you can still remember if you can still remember your liver is also a site of hematopoiesis when you are still and when you are still a fetus when you are still a fetus when we are all still fetus our liver is also a site for hematopoiesis okay aside for hematopoiesis same thing with your spleen so your liver can actually perform various uh various functions and in each function meron siyang nakarapat or meron siyang katapat na test okay meron siyang nakatapat na test later on you um you'll understand it much much better so let's go to the gross anatomy of your liver first so again your your your liver is divided into two lobes your right and your left low as you can see clearly in this picture your liver the right lobe of your liver is six times larger than the left lobe okay six times larger than the left lobe so your liver is located on the upper right portion of your abdominal cavity and is protected by your lower rib gauge so it is um it is placed by a ligamentous attachment so that um your liver will be in place on that um panabato um right high right um right abdominal right abdominal cavity okay upper right abdominal cavity so the liver is large in a complex organ weighing approximately 1.2 to 1.5 kilograms okay 1.2 to 1.5 kilograms and at the same time your liver also um is an organ where much of your blood is actually flowing um on your screen you can see your hepatic artery okay your hepatic artery you also have um you also have your portal vein and we have um your common bile duct your common bile duct where your liver and your gallbladder would be um connected your hepatic artery okay in your hepatic artery 25 percent of your blood 25 percent of your oxygenate 25 percent of your blood flows into your hepatic artery so your in your hepatic artery that is where the oxygenated blood is coming in so that all processes all aerobic processes in your liver will be supported on your portal vein on the other hand we have 75 percent okay 75 percent of your of your of the blood coming in are through your portal vein ano pinagkaiban ng blood coming in the hepatic artery and the portal vein the the hepatic artery these are oxygenated blood in the portal vein these are nutrient rich blood so when i say nutrient rich blood i'm talking about vitamins minerals carbohydrates lipids and even proteins okay so 75 percent of that blood actually flows through our our blood so again we have two blood sources ha your hepatic artery and your portal vein okay hepatic artery and your portal vein in addition to that okay in addition to that we also have your common bile duct okay we have your common bile duct where much of the drainage for the drainage of your waste for the drainage of your bile and also for your bilirubin okay also for your bilirubin so having said that now okay having said that now let's move forward with your mic i'll just jump into the microscopic part so i could spend more time with the more important information with your liver function okay so microscopically okay microscopically um your liver is said to be the chief metabolic organ why do we say metabolic organ um i'll ponder i'll elaborate that later it receives one hundred one point five liters of blood per minute makikitanda ako ng one point five liters because it had come out in a lot of licensure exams already um and in your cells we have in your in your liver rather we have two types of cell we have your hepatocytes and we have your copper cells which are your macrophages okay your liver macrophages so inside your ano inside your inside your liver there are majority of the cells are your hepatocytes okay majority of your cells are hepatocytes and unlike other cells in the body like your lungs like your heart na madeprive lang or masira lang ng konte yung in yung tissue in the lungs and tissue in your heart there would be complications already but remember okay remember for your liver for any for all the processes of your liver to be abolished 80 percent of the cell or 80 percent of the liver must be destroyed okay kahit 20 percent na lang okay kahit 20 percent na lang yung functional sa liver it can still perform its function mahirap man yes it would be difficult for the liver but it can still perform its function okay it can still perform its function again 80 percent okay 80 percent should be first abolished question how many percent of nitrogen is um is contained in your dietary protein can i see it in the chat box how many percent how many percent that is 16 correct that is 16 percent 16 percent of nitrogen comes from our diet okay so 16 percent so ganan talaga tatanungin ko yung mga magkakahawig na magkakahawig na tanong so 16 percent 80 percent total abolishment of function of 80 percent of your liver is already destroyed okay so the cells are arranged into your lobule okay or your hepatic globules which are the atomic unit of your liver okay the atomic unit of your liver are called your lobules sir do we have to be to be specific na like liver lobule or hepatic lobule no automatically i would understand that that is already eh um you're pertaining to the lobules okay so i don't know if you can see it clearly on your screen but you can also see here the portal vein and the portal vein at the same time the bile canal and the hepatic sinusoids the hepatic sinusoids later will be a very important area where part of your bilirubin would be um part of your bilirubin would be processed sir anong goal natin this afternoon okay anong goal natin this afternoon let's just set it no para um alam natin what to expect this afternoon this afternoon my goal is for you to understand number one the different functions of your liver okay the different functions of your liver so that when we go to the different tests alam ninyo na bawat test na yun ginagawa to check a specific function of your liver secondly for you to entirely understand the bilirubin metabolism okay the bilirubin metabolism so let's start with now with the biochemical function if you can see in your book it's divided into three only okay it's divided into three which is your um secret excretory secretory metabolism and your detox and your detoxification okay those are the common function of your liver but personally i would want that to be separated into five okay please write this down the five function of your liver because this five would help you classify the test later on in our discussions would be number one is your excretory okay the excretory function of your liver the ability of your liver to excrete biomolecules to excrete other um to excrete other substances that it is producing that is one excretory second is secretory okay second uh second is secretory secretory somehow similar to your excretory because it's secret and excrete almost the same ang inay excrete lang natin the ways secret natin are the one needed by the body so let me just fix that definition for you excretory the waste materials the secretory are the um the biomolecules needed by your body the second one is conjugation okay the your body's ability to conjugate okay is is um being done by your liver so conjugation next thing is a storage okay next is your storage um i opted to separate storage from metabolism because they are two different um things happening inside your body so when it comes to storage you all know that your glycogen is stored in your liver and in your muscles your amino acid pool is also in your liver so a lot of the storage are in your liver as well aside from that aside next one is metabolism because anabolism and catabolism of substances happen inside your liver and then the last one is detoxification okay the last one is detoxification what do we detoxify we detoxify alcohol and we detoxify toxins we detoxify your drugs so all of those five are function of your liver and as you can see madami siyang ganap okay madaming ganap yung liver and it's just so amazing how your liver can perform all those five right at this very moment that we are talking right at this very moment that we are talking some of your rbc are currently being ruptured okay either intravascular or extravascular and a lot of the processing afterwards will be done by your liver you just ate this um kanina uh you just ate your merienda or your lunch and did you know that your liver is now busy processing all those cholesterol triglyceride and carbohydrates and even proteins that you have digested okay and eventually later on it would be busy um metabolizing the drugs the vitamins that we have taken in so in short your liver is very important and hopefully um this afternoon you would find a very a new found love with your liver function okay alagaan yung liver wag laging nasa ps kada friday night at kada sunday uh kada sat kada weekends okay so let's go with the first one which is excretory and the secretary function and we also have the conjugation synthetic metabolic and we have the detoxification in your metabolism as you can see i separated synthetic and metabolic so later on um i'll i'll discuss that to you guys so when it comes to excretory and secretary function your liver is the one that excrete your bile and your bile acids your bile salts and your your pigments the pigment why your your stool is actually colored brown is because of your urobilin or your urobilinogen and that is actually i don't know if you know if you knew where does your urobilinogen came from let me just check where does urobilinogen came from where does urobilinogen came from san syagaling o three oh oh one oh two oh three oh four where did it came from the brown pigment in your stool where did it came from from your him okay medyo okay him intestines okay what else i want to see answers him sabi nila him okay pero later on ian na natin question what do you call the presence of um gray place clay colored stool clay colored stool what do you call that tapos na baka iso fecalisis clay colored stool okay so hindi ko nakikita wala naman ding sumasagot o let me just proceed okay so the bile acids uh the bile acids your colic acids and your um kennedy oxy colic acids are conjugated with your amino acids and your glycine and your thorium to form your bile salt so please remember that your bile acid is a product of your cholesterol as well okay by product of your cholesterol so with regards to excretory and secretary okay with regards to secretary and excretory this one is not directly associated sometimes with your liver kasinga it's it's situated in your gallbladder okay the bile acids will be transferred to your your gallbladder and eventually that is where um the portal the the portal triad will will take place and then yung bile acid natin will be emptied into your intestine for the emulsification of fats and lipids during um during digestion okay during digestion much of the i know much of the um discussion this afternoon with regards to liver function would actually revolve around your conjugation function and what is specific what compound are we are we talking about with regards to conjugation we're talking about your bilirubin metabolism and bilirubin came from him okay h e m e so tama yung sagot ni chuwa at sya kani josef with regards to where does uro bilina jen came from originally if we're gonna go to the genesis talaga it came from your him your proto your him which is your proto periphery nine okay your proto periphery nine on average okay on average a healthy individual produce around 200 to 300 milligrams of bilirubin which is a lot all right which is a lot and you would ask yourself now sir if a lot of my uh if there's a lot of bilirubin inside my body right now why is it that i do not have jaundice which lead me again to another point that yung yellow discoloration of your skin your sclera which is called your jaundice is because of increased bilirubin okay it is because of increased bilirubin so having said that now with regards to conjugation of your bilirubin okay the conjugation of your bilirubin is a main function of your liver the main function of your liver that's why in cases of hepatitis cirrhosis liver liver cirrhosis um alcohol alcoholism pag may liver may tama si liver okay pag may tama na yung liver mo you would start to have jaundice as well okay you would also have to have jaundice at the same time aside from that okay your liver function also as a synthetic and end as a metabolic organ so when i say synthetic we're talking about anabolism what do you mean by anabolism sir the building up the production the synthesis of a particular compound are all done by your liver okay so your carbohydrate your lipids and your proteins all are being um all are being um metabolized inside your body inside your liver rather so in your um carbohydrate metabolism so you didn't we talk about your glycolysis will it talk about your glycogenesis glycogenolysis your gluconeogenesis so all of these things are happening in your liver as well okay sir what do you mean na in your liver indi ba sir glycolysis can happen in any part of my body yes yourselves can do glycolysis but majority of course of that glycolytic processes are happening inside your inside your inside your liver in addition to that your glycogen and your glycogenolysis are happening in your liver because majority of your glycogen are stored in your liver as well okay they are stored in your liver so glycolysis does happen in your cells do not get confused with that okay do not get confused with with um glycolysis in the liver aside from carbohydrate metabolism i will not go to this things now one by one um you can just review that on your notes and on our recorded videos um lipid metabolism is also um happening inside your liver so if you can still remember um from the moment that your chylomicrons have um carried your exogenous triglyceride it will now deliver it to your liver your liver will process it will store it and then eventually will become endogenous triglyceride in your cholesterol okay your cholesterol so we have your citric acid cycle okay um and roughly okay 70 percent of your of the daily production of your cholesterol roughly 1.5 to 2.5 grams are produced by your liver i remember one of your batch mates sili ko na kasa bing classmate one of your batch mate asked me what about the cholesterol coming from my diet sir anong nangyari daw dun sa cholesterol coming from his diet so to answer it now 30 percent of that cholesterol 30 percent of the overall cholesterol in your body are actually exo are from your diet sir pano po ng yariyon um it's um it's also being carried by your chylomicrons okay carried by your chylomicrons so hopefully hindi ko ginugulo yung mga inyong pagkaka-intindi with regards to chylomicrons so akala ko baka chylomicrons only carry exogenous triglyceride it's wrong it's wrong to say it's it only carry your um it's wrong to say that it can only carry your your triglyceride because it can also carry your um it can also carry your cholesterol is okay your cholesterol so lipid metabolism ayan of course protein metabolism so all proteins specially the most important proteins are all synthesized by the liver such as your albumin except for your what except for your immunoglobulins okay except for your immunoglobulins your antibodies and another thing that is an exception would be your what would be your adult hemoglobin okay would be your adult hemoglobin sir why because um your hemoglobin if we're going to talk about the organ it's happening on your bone marrow okay it's happening in your bone marrow so remember that your albumin um the major or the general transport protein of your body is majority majority of all the chemicals or the substances in your body that's being carried by your albumin are also produced by your liver so now let's go to the detoxification okay the detoxification ayan wait lang yan at positive and negative acute phase reactant at the same time your um your coagulation um coagulation proteins or coagulation factors and the transamination and the the ammunition of proteins also happen in your liver so let's talk about your detoxification and drug metabolism so we have this thing called first pass metabolism so first pass metabolism is a concept in pharmacology okay a concept in pharmacology whereby um when you take in 100 kunaryo you take in 500 milligrams of paracetamol that 500 milligrams of paracetamol will not be delivered into your cells as 100 as 500 milligrams of um paracetamol because of first pass your your your drugs your your medicines will be first metabolized by your liver okay it will be first metabolized by your liver so your liver and can allow important substances to reach your systemic circulation um but your liver serves as a barrier okay it serves as a barrier for your your your body why because it prevents toxic and harmful substances from reaching your systemic circulation if you have discussed in your bacteriology already there are some drugs that are hepatotoxic nephrotoxic nabah may mga drugs na ganon so a lot of the drugs are actually affecting your liver why because your liver would first metabolize all of those things they metabolize all your medicine all the drugs that are in your body may may metabolize muna yan knee liver okay so that the toxification the drug metabolism happen inside your liver so sir can you give us an example of one of a substance that is being detoxified inside your body anyone baka may nakapag advance reading now can you give me an example of a substance that is being detoxified inside your body anyone Chuwang did are you raising your hand aliyah Hindi po sir nakapag-apresinang sorry po so answer so an example guys is your ammonia okay an example is your ammonia your ammonia is a natural byproduct of your protein metabolism so natural na nagpuproduce yung katawan mo ng ammonia it's just that ammonia is toxic for your body toxic for your brains toxic for your kidneys okay so who will save the day who will save the day it will be your liver your liver when we say the toxification we are transforming something that is toxic okay atoxin into a more safe into a more suitable form inside your body a safer version of that particular substance so in this case your ammonia will be will be converted into becoming your urea that's why you have your blood urea nitrogen okay your ammonia will be converted into your urea so that is a function um that is one function of your liver to detoxify your ammonia and other toxin inside your body and at the same time your other drug that you also take in your liver also metabolize that okay your liver also metabolize that so your liver can um the act can detoxify and metabolize your drug by performing two mechanism one can be in activation or your excretion okay one can be in activation and the second one is your excretion okay so before this day end okay before this day end i just want us to um discuss how bilirubin is um how bilirubin is being metabolized and guys uh pa i just want you to listen very um intently with the next few slides that i will be flashing on your screen so to start with bilirubin came from the destruction of your red blood cells okay bilirubin came from the destruction of your red blood cells and this is how the story went so remember that after 120 days okay after 120 days that is the normal and the normal lifespan of your rbc your rbc would undergo destruction either intra or extravascular okay so after your rbc is destroyed all the content of your rbc would now be liberated into your blood vessels or yeah into your in your plasma in general so you have your uh pag na rupture yung rbc mo anong lalabas si hemoglobin correct and your hemoglobin if you can still remember are made up of three major components what are the three major components of your bilirubin out of your hemoglobin rather that is your ion your globin which is your protein and your hem question what will carry your ion what will carry your ion here who will carry the ion who will carry your ion okay which which one will carry your ion correct that would be your transparent okay that will be your transparent what about your um what about your protein who will carry your protein si ginga who will carry your protein i'll just want I just want to check who can answer this. Who can, what substance or what protein will carry your amino acids, your globin? The one that will carry it actually will be your albumin, okay? Pakitandaan na lang yun ha, pakisulap sa inyong notes. The one that will carry it is your albumin. Why your albumin? Because your albumin is a major carrier. It is the general carrier molecule. Lahat ng kailangan ng carrier molecule na wala siyang specific na nang discuss would be carried by your albumin, okay? So your amino acids will be carried by your albumin, okay? Dadalihin niya sa liver. Si Ayorn susunduin ni transferin, okay? Susunduin ni transferin, i-store niya sa bone, sa liver in the form of your ferritin, okay? In the form of your ferritin. Sir, na wala po sa kwento si Himo pexin, ay na wala po sa kwento si HIM. Si HIM ay dadalihin nino, dadalihin po siya ni Himo pexin, okay? Your HIM will be carried by your Himo pexin and will deliver it to your liver. But if you have read your books right now, some of your HIM will readily be, some of your HIM will automatically be converted to your bilirubin, okay? Will automatically be converted to your bilirubin. What type of bilirubin? That is your unconjugated bilirubin, okay? Your unconjugated bilirubin. And in that sense, it will now be carried by your albumin. So let us just clear the air kasi alam ko ba ka na guguluhan na kayo. I will just focus on the HIM right now. So after your RBC is raptured, is destroyed, hemoglobin will go out. Now I just want to isolate your HIM. Your HIM will now be converted to your bilirubin. But there are two types of bilirubin that I want you to remember guys. The conjugated and the unconjugated bilirubin, okay? The conjugated and the unconjugated bilirubin. What happened is that your HIM will be readily be, will be converted into becoming your unconjugated bilirubin. Your unconjugated bilirubin in return will be carried by your albumin, okay? Will be carried by your albumin and then it will deliver it into your hepatocytes, okay? It will deliver your unconjugated bilirubin into your liver, now converting it to your unconjugated bilirubin. Which leads me now to the two major types of bilirubin. Your unconjugated bilirubin and your conjugated bilirubin, okay? Your conjugated bilirubin. Before I differentiate the two, let's just finish the pathway first. So the unconjugated bilirubin will be carried, will be delivered by your albumin into your liver. It's specifically in your hepatocytes, okay? In your hepatocytes. So the unconjugated bilirubin this time will be acted upon by an enzyme. And what enzyme is that? That is your UDPG, okay? That is your UDPGT, which is your uredeal diphosphate glucoronyl transferase. Sir, do we have to memorize the entire thing? Yes? Sadly, you should. So UDPGT is uredeal diphosphate glucoronyl transferase. Again, uredeal diphosphate glucoronyl transferase, okay? Glucoronyl transferase. That is the one that will reduce your unconjugated bilirubin into becoming your conjugated bilirubin, okay? Now that you have your conjugated bilirubin, your conjugated bilirubin will now be excreted out of your liver, okay? Into what? Into your intestines, okay? Into your intestine. So that conjugated bilirubin will now be further reduced by your gastrointestinal bacteria, forming now your urobilinogen, okay? Forming now your urobilinogen. Your urobilinogen is excreted into two ways. It can be excreted through your, it can be excreted through your feces or it can be reabsorbed back in your body, okay? It can be reabsorbed back in your body, whereby it will pass through your kidneys, kaya meron kaya meron karing urobilinogen sa urine, okay? Your urobilinogen in your urine. And so you can see the yellowish discoloration of both your feces and even your urine can be attributed through your urobilinogen, okay? Your urobilinogen, of course. If you've discussed in your AUBF that this urobilinogen will be converted pa to urobilin and then eventually excreted in your stool, okay? So some of the urobilinogen kasi will be reabsorbed back. 20% of your urobilinogen will be reabsorbed and will recirculate in your liver. Gananolit siya. Yung urobilinogen mo gagawin conjugated tapos ididispose ulit sa stool or either it can go to your urine, okay? It can go to your urine. Guys, am I still making sense to you? Ayun. Am I still clear? Hello? Ayun. So yun yung mangyayari sa ating, yun yung mangyayari sa ating... yun yung nag-reply. Yun yung mangyayari sa... Although hindi ko rin nakita yung wala palang nag-reply. So yun yung mangyayari sa bilirubin natin. So I'll just anon lang. Differentiate to yung ulitin ko nalang yung sinatabi ko kanina. So your bilirubin, there are two types of bilirubin inside your body. Your unconjugated and your conjugated bilirubin. They can also be called your B1 and your B2, okay? So your B1, okay? Your B1, according to order after him, your B1 is known as your unconjugated bilirubin. Your unconjugated bilirubin is water insoluble, meaning to say it cannot freely flow in your plasma that is the reason why your albumin needs to carry it and deliver it to your liver. Having said that it is water insoluble, automatically it is nonpolar. It is hydrophobic, okay? It is hydrophobic, okay? So other name, okay? Mamaya ko na hindi discuss yung indirect. We also call it your hemo bilirubin and we can also call it your prehepatic bilirubin, okay? Your prehepatic bilirubin. On the other hand, okay? On the other hand, we also have your bilirubin too, also known as your conjugated bilirubin which is a water soluble bilirubin. It doesn't need your albumin to carry it to be transported in your plasma. Your conjugated bilirubin is polar, meaning to say water-loving hydrophilic, okay? We can also call it your kole bilirubin and it is also known as the hepatic-posepatic obstructive and regulative bilirubin, okay? Regulative bilirubin. So let's talk about the indirect and the direct reacting, okay? Dahil na sa non-polar ang iyong bilirubin one, okay? Ang iyong unconjugated bilirubin upon the addition of your diazo reagent, okay? Diazo reagent. So just type it in na lang sa inyong ano. Diazo, diazo reagent, okay? We are using your diazo reagent, okay? We are using your diazo reagent and upon the addition of your diazo reagent, diazo reagent, okay? Upon the addition of diazo reagent, your bilirubin one cannot, okay? It cannot react with your diazo reagent immediately. Kaya siya tinawag na indirect reacting bilirubin. Sir, bakit naman po tinawag si B2 na direct? Because upon the addition of diazo reagent, okay? Upon the addition of your diazo reagent, it will now form your diazo bilirubin, okay? It will now form your diazo bilirubin, okay? So kaya din siya tinawag na slow reacting kasi na it will not readily react with your diazo reagent. And your B2 is a one-minute prompt bilirubin, meaning to say it is a fast reacting bilirubin with regards to your reagent. Sir, saan po bakit ano pung damit ng reagent? It is for the measurement of your bilirubin, okay? It is for the measurement of your bilirubin. So to differentiate it further, ha, to differentiate it further, B1 is synonymous to unconjugated bilirubin, to hemobilirubin, and indirect bilirubin. Your B2, on the other hand, we call it conjugated bilirubin and we call it your direct bilirubin, okay? We call it direct bilirubin. So on your exams, you can see, you can read your bilirubin in three ways. Either B1, B2, unconjugated, conjugated, direct, or indirect. Whatever is being used, you should be able to identify which is which, okay? Which is which. So having said that now, okay, we have your B1, we have your B2, we also have your delta bilirubin. Sir, is it normal to have delta bilirubin? No, it's not, okay? Is it normal? Is it normal? Ideally, hindi. Wala ka dapat delta bilirubin. So as you can see, we have here, you're conjugated, unconjugated, and you're total bilirubin. And the conversion factor is 17.1, okay? So what do we mean by 17.1? So if you multiply, when you multiply 0.2 milligrams, you would convert it to micromole per liter. So yun yung use ng conversion factor, okay? So we have your delta bilirubin, tabi ko nga kanina, your delta bilirubin is a conjugated bilirubin, okay? It is a type of a conjugated bilirubin, but it is tightly bound to albiumin. Sir, di ba sabi mo kanina, hindi kailangan ng carrier protein ng aking conjugated bilirubin dahil water soluble naman siya? Yes, hindi ko pa rin naman binabawi yun. Ang problema lang kay delta bilirubin is that your delta bilirubin is a type of conjugated bilirubin that is tightly attached to your albiumin, okay? It is tightly attached to your albiumin. So kung tightly attached siya sa yung albiumin, this type of bilirubin has a longer half-life, okay? It has a longer half-life than all the other bilirubin. Your delta bilirubin happens because number one of, ano, of biliary obstruction, okay? It happens because of biliary obstruction. Sir, bakit po? Let me go back to this part, okay? Di ba sabi natin kanina that your conjugated bilirubin will be excreted out of your lever into your intestine, okay? Going to your intestine. But because of biliary obstruction, kung na rin may gallstone, may gallstone doon, we call it colilithiasis, okay? Dahil nga mayroon kang gallstone, okay? Dahil mayroon kang gallstone, anong mangyare? Yung gallstone na yun, iobstruct niya yung kanal kung saan dadaan si bilirubin. Dahil walang ibang madahanan si bilirubin bakala ba siya sa intestine? Anong nangayare? Your bilirubin will be released in your bloodstream, okay? Will be released in your bloodstream and will be tightly, okay? Will be tightly adhering to your albumin, okay? Will be tightly adhering to your albumin. At the same time, your delta bilirubin is being monitored according to its decline after surgical removal of your gallstone, okay? After surgical removal of your gallstone dahil nga sarado yung, dahil nga di ba, mayroon kang gallstone, sarado yung, anong mo, sarado yung passage na yun. So ang bilirubin mo, nare-release sa pamamagitan ng pagsakay sa albumin, so na sa plasma mo siya. So because of that, okay? Because of that, your delta bilirubin, pagbaba ng delta bilirubin sa katawan mo, would be a good indicator that you are recovering na after surgical removal ng gallstone mo. So dahil tinanggal mo na ngayong gallstone mo, makakadaan na ulit si bilirubin. Dahil doon makakadaan na si bilirubin, bababa na si delta bilirubin, okay? So your delta bilirubin is calculated as follow, so total bilirubin, minus the direct bilirubin in the indirect bilirubin, you would get now your delta bilirubin. So it is calculated, it is not calculated in neonatal patients with 14 days, 14 days below na babies because it is normal for them to be higher, okay? Normal for them to have higher delta bilirubin. So for this particular topic, I will be ending it here. So before I officially end this recording, let me just ask you na lang. If you still have any questions with regards to the ano, I will repeat it na lang, but I'll end the recording na for today.