Preoperative Considerations of the Jaundiced Patient
In the jaundiced patient, the surgeon must decide whether he is dealing with primary disease of the liver or biliary tract, with mechanical obstruction, or with a blood dyscrasia. He must remember that jaundice is but a symptom.
A careful history is extremely valuable. In addition to knowing whether the jaundice has been transient or persistent, a history of the presence or absence of pain, particularly in relation to the jaundice, is important. The symptom of pain has been the chief aid in making a diagnosis in a great number of the operative cases. In patients who have been operated upon previously, it is likewise important to know the nature and extent of the operation, and whether a cholecystectomy, cholecystostomy, or a choledochotomy has been done. In secondary operations the length of time the drainage persisted after the first operation, and the appearance of jaundice in relation to operation is of particular interest.
Jaundice was due to the presence of gall stones or associated lesions in 30 per cent of our cases. Hartman1 states that 25 per cent of all cases of jaundice are due to gall stones or to complications from associated conditions, and 30 per cent to carcinoma, either primary or meta-static lesions which obstruct the biliary ducts. It is significant that in only 25 per cent of the cases in his series, including infectious and toxic cases, was the jaundice due to lesions of the liver parenchyma.
With these figures in mind, it must be concluded that. . .