الفهرس 
Anatomy and Physiology of Biliary TractOnly 14 pages are availabe for public view
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Abstract
Jaundice is a yellow discoloration of the skin and eyes. It is clinically obvious when total serum bilirubin exceeds 3mg/dl.
Jaundice is a common symptom in newborn babies and is usually not a sign of serious illness. In older children, it can be a sign of a liver disease or a blood disorder.
Several diseases causing hyperbilirubinemia will cause jaundice and the causes of hyperbilirubinemia can be classified to:
1. Unconjugated Hyperbilirubinemia.
2. Conjugated Hyperbilirubinemia.
Any operative procedure on the jaundiced patients carries a risk of renal failure; this risk is increased if there is endotoxemia from infected bile. So, the patients must not be allowed to present for surgery relatively dehydrated and adequate antibiotic should be given before surgery.
Patients with liver disease who require surgery are at greater risk for surgical and anesthesia related complications than those with a healthy liver.
In patients with acute hepatitis: elective surgery should be postponed until the acute hepatitis has resolved as indicated by normalization of liver tests.
In patients with chronic liver disease: they may have prolonged prothrombin time so vitamin K should be given to these patients. Also, the decreased serum albumin should be corrected because it would increase the pharmacologically active fractions of injected drugs.
The anesthetic technique used for the jaundiced patients should aim to maintain liver and kidney blood flow and to maintain a good urine production. Fentanyl is the opioid of choice. Also, hepatic blood flow and hepatocytes oxygenation seem to be maintained during administration of isoflurane, desflurane and sevoflurane but not halothane. Short acting muscle relaxant (mivacurium) and intermediate acting muscle relaxant (attacurium and cis-atracurium) are the choice in patients with severe liver disease.
Regardless of the drugs selected for anesthesia, postoperative liver dysfunction is likely to be exaggerated in patients with chronic liver disease, presumably owing to non specific effects of anesthetic drugs on hepatic blood flow. So, continuation to monitor liver functions and the serum bilirubin level postoperativly is essential.