Diagnostic approach to the patient with jaundice following trauma.
Open Access
- 1 September 2004
- journal article
- review article
- Published by SAGE Publications in Scandinavian Journal of Surgery
- Vol. 93 (3), 176-183
- https://doi.org/10.1177/145749690409300302
Abstract
Background and Aims: Jaundice in trauma patients may reflect serious underlying pathology. The aim of this review was to determine the appropriate diagnostic approach to the patient with jaundice following trauma. Methods: A MEDLINE search was performed to retrieve publications which outlined the causes of jaundice in trauma patients. Results: The main causes of jaundice in trauma patients were found to be bilirubin overload caused by breakdown of transfused- and extravasated blood and hepatic dysfunction caused by sepsis, infections, initial shock and systemic hypotension. Bile duct injury or drug induced liver injury are rare. Liver function tests are often uninformative but commonly show a cholestatic pattern. Ultrasound, CT or ERCP are the diagnostic imaging methods most widely used. Abdominal ultrasound and CT may reveal specific organ injuries, bile duct dilatation, intraabdominal fluid collections, hematomas or acalculus cholecystitis. ERCP is often diagnostic and permits a therapeutic intervention when a bile duct injury is present. Conclusions: The primary aim of the diagnostic approach should be to identify all cases of bile duct injury or obstruction. Sepsis and infections should be actively looked for. The number of blood transfusions must be calculated. Ultrasound, CT or ERCP are the diagnostic imaging methods most widely used.Keywords
This publication has 37 references indexed in Scilit:
- Aetiology and Prognostic Implication of Severe Jaundice in Surgical Trauma PatientsScandinavian Journal of Gastroenterology, 2003
- Laparoscopic treatment of an isolated gallbladder rupture following blunt abdominal trauma in a schoolboy rugby playerBritish Journal of Sports Medicine, 2002
- HaemobiliaBritish Journal of Surgery, 2001
- Evaluation of Pancreatic Injury After Blunt Abdominal TraumaAnnals of Emergency Medicine, 1996
- Bile and Bilirubin Excretion in Relation to Hepatic Energy Status Hemorrhagic Shock and Hypoxemia in RabbitsThe Journal of Trauma and Acute Care Surgery, 1995
- Etiologic factors of jaundice in severely ill patients: A retrospective study in patients admitted to an intensive care unit with severe trauma or with septic intra-abdominal complications following surgery and without evidence of bile duct obstructionJournal of Hepatology, 1988
- Postoperative JaundiceSeminars in Liver Disease, 1988
- Traumatic Rupture of the Hepatic Duct Demonstrated by Endoscopic Retrograde CholangiographyThe Journal of Trauma and Acute Care Surgery, 1985
- Frequency and Characteristics of Hyperbilirubinemia Associated with BacteremiaClinical Infectious Diseases, 1985
- Extrahepatic Biliary Steering-wheel Trauma Simulating Pancreatic Carcinoma—A Dilemma in ManagementThe Journal of Trauma and Acute Care Surgery, 1980