Postoperative jaundice: Differential diagnosis


Postoperative jaundice is defined as the elevation of bilirubin that occurs after the completion of surgery and has many possible causes, associated laboratory findings, and implications. It can, but not always, be associated with icterus. Causes of postoperative jaundice can be divided into several functional categories including: prehepatic, intrahepatic, and posthepatic. Prehepatic causes are a result of overproduction of bilirubin and can be from hemolysis or resolution of a hematoma. Hemolysis can be a consequence of a transfusion reaction or shearing forces placed upon RBCs by intravascular devices such as cardiopulmonary bypass. Erythrocyte breakdown occurs with internal bleeding and subsequent resorption of the hematoma produced.

Intrahepatic causes include those that result in injury to hepatocytes or biliary epithelial cells and include total parenteral nutrition, hypoxia, ischemia, drugs (including inhaled anesthetics and antibiotics), newly acquired viral hepatitis, and sepsis. Patients with preexisting liver disease may be more likely to experience these conditions and be more severe.

Posthepatic causes are due to obstruction of the extrahepatic biliary tree and include retained stones, stricture, and direct injury from abdominal surgery. Postoperative jaundice can arise from many factors as seen above. With that said the two most common causes of postoperative jaundice are resorption of a large hematoma and hemolysis following blood transfusion.

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