Conjugated occurs when the the liver is able to conjugate bilirubin, but the excretion is impaired.

The kidneys do not filter unconjugated bilirubin because of its avid binding to albumin. For this reason, the presence of bilirubin in the urine indicates the presence of conjugated hyperbilirubinemia.


  • Impaired intrahepatic excretion
    • Sepsis
    • Cholestatic jaundice of pregnancy
    • hpatocellular disease (viral, drugs)
    • drug induced cholestasis (Antibiotics)
  • Impaired extrahepatic excretion
    • obstruction to biliary flow i.e. cholestasis,


  • Overproduction  of bilirubin
    • haemolysis
    • ineffective haematopoesis
    • rhabdomyolysis
  • Decreased hepatic conjugation           
    • Transferase  deficiency (Gilbert Sy, Crigler, Najjar Sy)
  • Hepatitis
    • viral
    • drugs/toxins