Differential based on labs: Drugs, sepsis, increased exogenous bilirubin (blood transfusion), hematoma, Hemolysis, benign postoperative hepatic cholestasis, immune related hepatotoxicity, check preoperative records for hypotension, hypoxemia, hypoventilation, and hypovolemia
Causes: hemolysis, hematoma, bilirubin overload from blood transfusion
Hepatic flow seems maintained during admin of volatiles (except halothane)
IV anesthetics are valuable w or w/o N2O.
Muscle relaxants: Hepatic clearance must be considered. Ascites causes a higher dose needed. Cisatracurium elimination is not affected.
Monitoring: Maintain acceptable urine output to help decrease renal failure. Glucose infusion may be needed to prevent hypoglycemia. Avoid unnecessary esophageal instrumentation in patients with esophageal varies.
Causes: increased bilirubin production, decreased hepatic uptake of bilirubin, or decreased conjugation
Causes: decreased canalicular transport of bilirubin, acute or chronic hepatocellular dysfunction, or obstruction of the bile ducts.
Gilbert's syndrome: Most common hereditary form. Glucoronosyl transferase enzyme mutation