oh, the patient with jaundice. what can I do?

The jaundiced patient must be always taken seriously, and an accurate preoperative diagnosis of the cause is important. Three major category of diseases can cause jaundice:

• prehepatic( unconjugated hyperbilirubinemia)
• hemolytic anemias
• gilbert syndrome
• Crigler Najar syndrome
• hepatic parynchemal diseases, furthur divided into acute or chronic
• biliary obstruction(intrahepatic or extrahepatic)

preoperative considerations:
an accurate daignosis of the type and cause of jaundice can be reached by taking a careful history, a review of liver function tests, and other investigations.
history:
history of family jaundice, contact with jaundice patient, blood transfusion, tattooing, acupuncture, drug addiction,foreign travel, alcoho; intake, general health, and occupational hazards.
investigations:
liver function tests
full blood count:
A low blood count may be the result of concealed blood loss or hemolysis.
A raised white blood count may be seen with cholicystitis or cholangitis.
urea and electrolytes:
rising urea is important and require uergent treatment.
clotting studies:
PT may be prolonged.
virology:
hepatitis B may need to be excluded.
radiograpgs:
chest; both cholecystitis and hepatomegaly inhibit right sided diaphragmatic movements, thus giving a propensity for lower right chest infections and pulmonary effusions.
abdominal; only in aminority of cases the radiograph shows gall stones (ground glass appearance).
barium meal or endoscopy: it will reveal esophageal varices. distorsion and fixation od doudenum occurs in carcinoma of pancreas.
cholangiography: ERCP has a low complication rate and is effective at demonstrating the site of obstruction,even when the obstruction is complete.
ultrasonography and CT
thes investigations will demonstrate grossly dilated ducts and will give information about liver parynchema, gall baldder, and even the site of obstruction.
liver biopsy:
percutaneous needle biopsy is now accepted as a routine investigation in liver diseases.
the perioperative management  depends on reaching a correct diagnosis of the type and cause of jaundice.