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Approach to the patient with postoperative jaundice

Author
Scott A Fink, MD, MPH, FACP
Section Editor
Robert S Brown, Jr, MD, MPH
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

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.

CLASSIFICATION

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.

                 

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Literature review current through: Nov 2016. | This topic last updated: Fri Mar 04 00:00:00 GMT+00:00 2016.
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