Pathophysiological consequences of obstructive jaundice and perioperative management

• Published in: Hepatobiliary & pancreatic diseases international Vol. 17; no. 1; pp. 17 - 21
• Main Authors: Pavlidis, Efstathios T, Pavlidis, Theodoros E
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.02.2018; Aristotle University of Thessaloniki, Medical School, Second Surgical Propedeutic Department, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
• Subjects: Animals; Bacterial Translocation; Biliary obstruction; Biliary Tract - metabolism; Biliary Tract - physiopathology; Biliary Tract Surgical Procedures - adverse effects; Biomarkers - blood; Blood Coagulation; Cytokines - blood; Endotoxin; Endotoxins - blood; Health Status; Hemodynamics; Humans; Inflammation Mediators - blood; Intestinal Mucosa - microbiology; Intestinal Mucosa - physiopathology; Jaundice, Obstructive - blood; Jaundice, Obstructive - microbiology; Jaundice, Obstructive - physiopathology; Jaundice, Obstructive - surgery; Lactulose; Liver - metabolism; Liver - physiopathology; Obstructive jaundice; Perioperative Care - adverse effects; Perioperative Care - methods; Perioperative management; Permeability; Postoperative Complications - etiology; Preoperative biliary drainage; Risk Factors; Treatment Outcome; Obstructive jaundice; Perioperative management; Biliary obstruction; Preoperative biliary drainage; Lactulose; Endotoxin
• ISSN: 1499-3872
• DOI: 10.1016/j.hbpd.2018.01.008

Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management. A PubMed was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated. The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier, the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production (TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders, nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma, albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases. The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.