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Postoperative Liver Dysfunction

By

Danielle Tholey

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Jan 2021| Content last modified Jan 2021
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Postoperative jaundice

Multifactorial mixed hyperbilirubinemia is the most common reason for postoperative jaundice Jaundice Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. Jaundice becomes visible when the bilirubin level is about 2 to 3 mg/dL (34 to 51 micromol/L)... read more Jaundice . It is caused by increased formation of bilirubin Overview of bilirubin metabolism The liver is a metabolically complex organ. Hepatocytes (liver parenchymal cells) perform the liver’s metabolic functions: Formation and excretion of bile as a component of bilirubin metabolism... read more and decreased hepatic clearance. This disorder most often occurs after major surgery or trauma requiring multiple transfusions. Hemolysis, sepsis, resorption of hematomas, and blood transfusions can increase the bilirubin load; simultaneously, hypoxemia, hepatic ischemia, and other poorly understood factors impair hepatic function. This condition is usually maximal within a few days of operation. Hepatic insufficiency is rare, and hyperbilirubinemia typically resolves slowly but completely. Liver laboratory tests can often differentiate multifactorial mixed hyperbilirubinemia from hepatitis. In multifactorial mixed hyperbilirubinemia, severe hyperbilirubinemia with mild aminotransferase and alkaline phosphatase elevations are common. In hepatitis, aminotransferase levels are usually very high.

Postoperative hepatitis

Ischemic postoperative “hepatitis” Ischemic Hepatitis Ischemic hepatitis is diffuse liver damage due to an inadequate blood or oxygen supply. (See also Overview of Vascular Disorders of the Liver.) Causes are most often systemic: Impaired hepatic... read more results from insufficient liver perfusion, not inflammation. The cause is transient perioperative hypotension or hypoxia. Typically, aminotransferase levels increase rapidly (often > 1000 units/L [16.7 microkat/L]), but bilirubin is only mildly elevated. Ischemic hepatitis is usually maximal within a few days of the operation and resolves within a few days.

Halothane-related hepatitis can result from use of anesthetics containing halothane or related agents. It usually develops within 2 weeks, is often preceded by fever, and is sometimes accompanied by a rash and eosinophilia.

Postoperative cholestasis

The most common cause of postoperative cholestasis is extrahepatic biliary obstruction due to intra-abdominal complications or drugs given postoperatively. Intrahepatic cholestasis occasionally develops after major surgery, especially after abdominal or cardiovascular procedures (benign postoperative intrahepatic cholestasis). The pathogenesis is unknown, but the condition usually resolves slowly and spontaneously. Occasionally, postoperative cholestasis results from acute acalculous cholecystitis or pancreatitis.

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