Bilirubin Metabolism — FRCA Primary MCQ
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Correct answer: B — Hepatocytes conjugate bilirubin with glucuronic acid before bile excretion
The best answer is “Hepatocytes conjugate bilirubin with glucuronic acid before bile excretion”. Unconjugated bilirubin circulates bound to albumin and is lipid soluble. Hepatocytes conjugate it with glucuronic acid via UDP-glucuronosyltransferase, producing water-soluble conjugated bilirubin for bile excretion. Conjugated bilirubin can appear in urine when it refluxes into plasma, whereas albumin-bound unconjugated bilirubin is not filtered.
Reference: Royal College of Anaesthetists, Primary FRCA Syllabus 2021: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf