These patients may show other signs of chronic liver disease as listed in Table 1. The poorest outcome is predicted by the combination of deranged clotting, oedema and encephalopathy. Obstructive Jaundice Biliary obstruction is the most likely cause of jaundice to be encountered by the anaesthetist in the developing world. It can result from a stone in the common bile duct, pancreatic tumour or ascending cholangitis where the bile and biliary tree are infected. As conjugated bilirubin is water-soluble it will be excreted in the urine which becomes dark.
Stools are pale as a result of poor lipid absorption.
Although protein synthesis is normal, the production of vitamin K dependant clotting factors will be reduced, as the absorption of vitamin K is dependent on the excretion of bile salts into the small intestine. The clotting time can, therefore, be prolonged but this can be readily reversed by parenteral administration of vitamin K. Surgery in these cases is to remove or bypass the obstruction or to drain infected obstructed bile.