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.
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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
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS