Causes of postoperative jaundice or hepatic dysfunction

Pre hepatic/ Haemolytic/ Bilirubin overload

  • Massive blood transfusion

  • Transfusion reaction

  • Haemolytic anaemia

  • Surgical trauma with multiple injuries

  • Prosthetic heart valve

  • Cardiopulmonary bypass

Hepatocellular injury

  • Exacerbation of preexisting liver disease

  • Hepatic ischemia: hypotension, hypovolemia, cardiac failure

  • Hypoxia

  • Drug-induced - Halothane 

  • Septicaemia

Intrahepatic Cholestasis 

  • Viral hepatitis

  • Alcoholic hepatitis

  • Cholestasis in pregnancy 

  • TPN

  • Steroid, OCP

Extra hepatic cholestasis

  • Biliary obstruction, stricture, injury, leak
  • Pancreatitis

Patients with severe cholestasis may have an elevated prothrombin time, which may respond to vitamin K.

Prolonged cholestasis may lead to malabsorption of fats and other fat-soluble vitamins, and thus nutritional evaluation may be required.

INR should be monitored until normalization unless another explanation such as coagulopathy or medication is provided.


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