5-16
Test for bilirubin in the urine:
To find out if the urine has bilirubin in it,
the students ask their ‘guest with cirrhosis’ to
urinate in a bottle. For comparison, another
student does the same.
URINE WITH
BILIRUBIN
foam
yellow
URINE WITHOUT
BILIRUBIN
foam
white
The guest steps outside, and returns with a
prepared urine sample containing normal urine
mixed with a little yellow food coloring or
yellow Kool-Aid. The color can be darkened by
adding a little cola drink, coffee, or blood.
On comparing the 2 urine samples, the
students find that the one containing ‘bilirubin’
is dark and that, when they shake it, the foam
is yellow. In the sample without bilirubin, the
foam is white.
Just because urine is dark, or has blood in
it, does not necessarily mean it has bilirubin.
To help students understand this, a third sample
can be prepared by mixing some blood with
normal urine. The urine is dark but the foam is
white, not yellow.
urine
often
dark
urine often
light, but
sometime
dark
URINE WITH BLOOD,
WITHOUT BILIRUBIN
foam
white
urine
dark,
cloudy,
or
reddish
Observing whether the person’s stool (shit) has bilirubin in it:
Bilirubin is a yellow waste product from
broken-down hemoglobin, the red dye in
red blood cells. When removed from the
blood by the liver, it becomes part of the
green bile. This slowly changes to brown in
the gut, and gives the color to normal stools.
Have the students ask the ‘guest with
cirrhosis’ (or one with gallbladder disease)
for a ‘stool sample’. The visitor returns with
a pretend stool made of whitish clay, or old,
sun-bleached dog shit. Ask students why it
is whitish and why this is a sign of a liver or
gallbladder problem.
COLOR CHANGES OF THE DYE
THAT MAKES BLOOD RED
RED................. HEMOGLOBIN (in blood)
YELLOW......... BILIRUBIN (in blood, skin,
and eyes of a person with a
sick liver or gallbladder)
GREEN........... (in some diarrhea and
severe vomiting)
BROWN......... SHIT (and in urine of a
person with severe liver
disease)
Health Education:
After the students have diagnosed the ‘cirrhosis’, they can try to explain to their
‘guest’ what they have learned. They can tell him clearly and simply what his
problem is, what it comes from, how the liver works, and the reason for each of
his symptoms and signs.
To bring the class even closer to real life, students can also discuss among
themselves what support they might be able to give their guest to help him stop
drinking and eat better. They may decide to visit and talk with his family and friends.
They also may want to discuss the problem of heavy drinking or alcoholism in their
communities, its causes, and possible steps to prevent it. This leads to questions of
the social order, human dignity, and raising of people’s awareness. Perhaps some
of the ideas that are raised in this class can be explored further in classes on social
awareness and preparation for home visits. (See Chapters 6 and 26.)