Post operative jaundice

Question 1

Hyperbilirubinemia is:

Answer 1

Bilirubin greater than 1.5

Question 2

Pre-hepatic jaundice: what causes it, and what is your total bilirubin? what is increased? what is often normal?

Answer 2

Anything that causes an increase rate of hemolysis
Normal to increased total bilirubin
increased serum unconjugated/indirect bilirubin
Serum alk phos and ALT often normal

Question 3

Hepatic hypoperfusion-

Answer 3

Non-cardiogenic shock/bacteremia/infection/sepsis or cardiogenic shock Can cause decreased hepatic clearance secondary to hepatic hypoperfusion

Question 4

Hepatic causes of post operative jaundice result from? what does total bilirubin, ALT and conjugated bilirubin look like?

Answer 4

Due to direct hepatocellular injury 
Increased total bilirubin 
predominant ALT elevation 
Conjugated bilirubin present in urine  
Examples: viral hepatitis, drugs,

Question 5

Post hepatic jaundice is due to: what are those labs looking like?

Answer 5

Due to obstructive/cholestatic (caused by an interruption to drainage of bile in biliary system). Can present with pale stools, dark urine, severe itching 
Labs: increased total bilirubin 
increased direct/conjugated bilirubin 
Elevated alk phos 
Ex: gallstone,

Question 6

Halothane induced jaundice:

Answer 6

Associated with fever, rash and eosinophilia

Question 7

What to do if you get called for post-op jaundice:

Answer 7

Full hx and physical
ask:
onset of jaundice, fever, hepatomegaly, hx of liver porblems
See if pt got transfusion, if they had any offending meds, send LFTs, hgb, serum eosinophilia, consult GI after all of that.