An increase in which type of bilirubin is associated with hepatic disease or excessive hemolysis?

The increase of indirect bilirubin is typically associated with hepatic disease or excessive hemolysis. Indirect bilirubin is derived from the breakdown of hemoglobin in red blood cells and is not water-soluble, causing it to accumulate in the body when there is excessive hemolysis.

In cases of hepatic disease, the liver's ability to conjugate and excrete bilirubin is impaired, leading to an increase in indirect bilirubin levels. Excessive hemolysis, such as that seen in hemolytic anemias, results in increased production of bilirubin, overwhelming the liver's capacity to deal with it.

In contrast, direct or conjugated bilirubin, which is the form that can be excreted in bile and is water-soluble, would typically increase in conditions where there is obstruction of bile flow or liver dysfunction that prevents the excretion of conjugated bilirubin. Thus, an increase in indirect bilirubin specifically points to problems related to hemolysis or liver dysfunction that affects the conversion of indirect to direct bilirubin.