Management of extrahepatic cholestasis

The management of extrahepatic cholestasis depends on the cause.

There are three general risks when operating on a patient with extra-hepatic cholestasis:

• hypocoagulability:
  • due to prothrombin deficiency
  • may be corrected by vitamin K administration
    
    
• postoperative renal failure:
  • due to nephrotoxic effects of bile pigments and bowel toxins which escape hepatic detoxification
  • may be prevented with intra- and post-operative use of diuretics e.g. frusemide
    
    
• sepsis:
  • the combination of biliary sepsis and renal failure is usually fatal
  • is prevented with prophylactic antibiotics