Conjugated or direct hyperbilirubinaemia occurs when the the liver is able to conjugate bilirubin, but the excretion is impaired.
Causes include:
The proportion of conjugated bilirubin with respect to the total raised bilirubin can give a clue as to cause of jaundice.
20-40% of total: more suggestive of hepatic than posthepatic jaundice
40-60% of total: occurs in either hepatic or posthepatic causes
> 50% of total: more suggestive of posthepatic than hepatic jaundice
Note that if conjugated bilirubin is less than 20% of total then the cause of hyperbilirubinaemia is secondary to haemolysis or constitutional e.g. Gilbert's disease, Crigler-Najjar syndrome
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