Approach to the patient with postoperative jaundice
- Scott A Fink, MD, MPH, FACP
Scott A Fink, MD, MPH, FACP
- Clinical Associate Professor of Medicine
- Jefferson Medical College, Philadelphia, PA
- Section Editor
- Robert S Brown, Jr, MD, MPH
Robert S Brown, Jr, MD, MPH
- Section Editor — Liver Transplantation
- Vice Chair, Transitions of Care, Department of Medicine
- Interim Chief, Division of Gastroenterology and Hepatology
- Weill Cornell Medical College
- Professor of Clinical Medicine, Columbia University College of Physicians & Surgeons
Postoperative jaundice, the presence of bilirubin elevation with or without clinical icterus appearing in the period following surgery, occurs as a result of numerous causes. This topic review will provide an overview of postoperative jaundice and a suggested approach for evaluation and management.
There is no widely accepted classification of postoperative jaundice. Nevertheless, postoperative jaundice can be considered a part of a spectrum of abnormal liver biochemical tests, which are common in the postoperative period. A subset of patients who develop abnormal liver biochemical tests have preexisting liver disease, increasing their vulnerability to further hepatic injury from a variety of causes. Others develop liver biochemical abnormalities without preexisting liver disease. The distinction is potentially important since it can help clarify contributing causes, influence prognosis, and may guide long-term management.
We have found it useful conceptually to subdivide postoperative jaundice into three categories: prehepatic, intrahepatic, and posthepatic.
●Prehepatic, which results from overproduction of bilirubin such as from hemolysis or a resolving hematoma.
●Intrahepatic, which results from injury to hepatocytes or biliary epithelial cells and is due to a variety of causes such as hepatic ischemia, infection, and drug toxicity. All of these conditions may be more likely and clinically more severe in patients with preexisting liver disease.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Drug-induced liver injury
- Total parenteral nutrition
- Viral hepatitis
- Bile leaks
- Biliary strictures
- Acalculous cholecystitis
- MULTIFACTORIAL CAUSES
- Benign postoperative jaundice
- Bacterial infections
- MANAGEMENT AND PROGNOSIS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS