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Postoperative jaundice.
Thomas W Faust1, K Rajender Reddy
1Division of Gastroenterology, Department of Internal Medicine, The University of Pennsylvania School of Medicine, 3 Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA. thomas.faust@uphs.upenn.edu
Clinics in Liver Disease
|April 6, 2004
Summary
Evaluating abnormal liver function tests (LFTs) post-surgery is crucial for critically ill patients. Prompt diagnosis and management of liver conditions, whether preoperative or postoperative, are essential for patient well-being and surgical outcomes.
Area of Science:
- Hepatology
- Surgical Complications
- Critical Care Medicine
Background:
- Abnormal liver function tests (LFTs) are common after surgery, necessitating expert evaluation in critically ill patients.
- Patients with a history of liver disease undergoing elective surgery require thorough presurgical assessment.
- Postoperative jaundice evaluation involves reviewing surgical procedures, anesthetics, medications, and blood product administration.
Purpose of the Study:
- To outline the comprehensive evaluation of abnormal liver function tests (LFTs) in the perioperative setting.
- To differentiate between unconjugated and conjugated hyperbilirubinemia and guide diagnostic workup.
- To provide management strategies for various causes of abnormal LFTs, including biliary obstruction and intrahepatic cholestasis.
Main Methods:
- Detailed patient history and physical examination, including assessment of liver disease history.
- Laboratory investigations: complete blood count, electrolytes, liver function tests (LFTs), coagulation profile, haptoglobin, reticulocyte count, LDH, and Coomb's test.
- Imaging studies: abdominal sonography to screen for biliary obstruction, and potentially ERCP for diagnosis and intervention.
Main Results:
- Unconjugated hyperbilirubinemia may stem from blood transfusions, hemolysis, hematomas, drugs, or Gilbert's syndrome.
- Conjugated hyperbilirubinemia can indicate intrahepatic or extrahepatic disorders, with imaging guiding diagnosis.
- Ischemic liver injury, drug-induced hepatitis, or viral infections are suggested by elevated aminotransferases and LDH with normal ultrasound.
- Biliary obstruction requires interventions like ERCP or surgery, while intrahepatic cholestasis management involves addressing underlying causes like sepsis or medication effects.
Conclusions:
- A systematic approach to abnormal LFTs, considering preoperative and postoperative factors, is vital for patient care.
- Distinguishing hyperbilirubinemia types and identifying the underlying cause guides targeted treatment.
- Management strategies range from supportive care and medication adjustment to endoscopic or surgical interventions for biliary pathologies.