Pathophysiological consequences of obstructive jaundice and perioperative management

Area of Science:

• Hepatology
• Gastroenterology
• Critical Care Medicine

Background:

• Obstructive jaundice presents significant clinical challenges.
• Pathophysiological changes require deeper understanding for effective management.

Purpose of the Study:

• To evaluate the impact of obstructive jaundice on key physiological systems.
• To identify critical management strategies for jaundiced patients.

Main Methods:

• Systematic literature search of PubMed up to August 2016.
• Analysis of obstructive jaundice effects on cytokines, coagulation, hemodynamics, and organ function.

Main Results:

• Obstructive jaundice leads to endotoxemia, increased proinflammatory cytokines (TNF-α, IL-6), and systemic inflammatory response syndrome.
• Clinical manifestations include hemodynamic instability, acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders, and impaired healing.
• Management involves fluid/electrolyte replacement, antibiotics, lactulose, vitamin K, plasma, albumin, and dopamine; preoperative biliary drainage is selectively indicated.

Conclusions:

• Perioperative management is vital for improving surgical outcomes in jaundiced patients.
• Special attention is needed for jaundiced patients with malignancy.