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Jaundice, or icterus, is the yellow discoloration of the skin, sclerae, and mucous membranes. It happens when plasma bilirubin levels rise above 2.5-3 mg/dL, leading to bilirubin deposition in tissue.Bilirubin is a byproduct of hemoglobin degradation. In macrophages, hemoglobin breaks down into globin and heme. Globin is converted into amino acids, while heme is turned into biliverdin by heme oxygenase, which is then reduced to unconjugated bilirubin by biliverdin reductase.Unconjugated...
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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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Obstructive jaundice and perioperative management.

Long Wang1, Wei-Feng Yu1

  • 1Department of Anesthesia and Intensive Care, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.

Acta Anaesthesiologica Taiwanica : Official Journal of the Taiwan Society of Anesthesiologists
|July 8, 2014
PubMed
Summary

Perioperative management of obstructive jaundice requires careful preoperative assessment and optimization to mitigate risks. Addressing coagulopathy, infection, renal dysfunction, and cardiovascular effects is crucial for patient outcomes.

Keywords:
anesthesiacardiovascular systemjaundice, obstructiveperioperative care

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Area of Science:

  • Hepatology
  • Anesthesiology
  • Surgical Oncology

Background:

  • Obstructive jaundice, commonly caused by gallstones, strictures, or malignancies, presents significant perioperative risks.
  • Surgical intervention in jaundiced patients is associated with increased complications and mortality.
  • Effective perioperative management is essential for improving outcomes in these challenging cases.

Purpose of the Study:

  • To outline the association between obstructive jaundice and perioperative management strategies.
  • To review clinical and experimental studies on the pathophysiology of obstructive jaundice.
  • To provide recommendations for optimizing perioperative care in jaundiced patients.

Main Methods:

  • Review of clinical and experimental studies on obstructive jaundice pathophysiology.
  • Analysis of associations between obstructive jaundice and perioperative management.
  • Synthesis of current knowledge to inform clinical practice.

Main Results:

  • Obstructive jaundice causes coagulopathies, infection risk, renal dysfunction, and cardiovascular depression.
  • Anesthesia drug requirements may be altered, necessitating dose adjustments.
  • Preoperative optimization of these factors is critical for reducing perioperative morbidity and mortality.

Conclusions:

  • Comprehensive preoperative evaluation and optimization are vital for jaundiced patients undergoing surgery.
  • Management strategies should include biliary drainage, infection control, nutritional support, coagulation correction, and hemodynamic optimization.
  • Further research into the cardiovascular effects of obstructive jaundice is warranted.