الفهرس 
PHYSIOLOGY OF JAUNDICEOnly 14 pages are availabe for public view
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Abstract
Jaundice, is a yellowish discoloration of the skin, the conjunctival membranes over the sclerae, and other mucous membranes caused by hyperbilirubinemia This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluids. It is usually apparent when bilirubin levels exceed 3 mg/dL or 50 µmol/L. (Guyton, Arthur, et al .2005 )
Hyperbilirubinemia results from one or more derangements in the complex multistep process that balances bilirubin production with bilirubin clearance. Consequently, jaundice can indicate a disorder in bilirubin metabolism, hepatic function, or biliary disease or combinations thereof. (Raphael B. and Marion G..2003)
Cholestasis is characterized by the constellation of physiological, morphologic, and clinical manifestations that result from the impairment of the bile excretory system in the liver and biliary tree. (Sherlock S.1998)
The investigation of a patient with jaundice begins with a thorough review of the history of presentation, medication use, past medical history, examination, and evaluation of liver-related laboratory tests. (Raphael B. and Marion G..2003)
Obstetric cholestasis is a condition of the liver which occurs in some pregnant women. Cholestasis means there is a reduced flow of bile down the bile ducts in the liver. Some bile then ’leaks’ out into the blood stream, in particular the bile salts. These circulate in the blood stream and can cause symptoms. Obstetric cholestasis is sometimes called intrahepatic cholestasis of pregnancy. (Milkiewicz P, Elias E.2002)
Clinical studies clearly show that when obstetric cholestasis complicates pregnancies it may lead to premature births in up to 60%, fetal distress in up to 33%,and intrauterine death in up to 2% of patients. ( Lammert F, Marschall HU, 2000)
The aetiology of obstetric cholestasis is undoubtedly multifactorial, with genetic, environmental, and hormonal factors having important roles. Obstetric cholestasis classically manifests itself in the second or third trimester of pregnancy with generalised pruritus, most pronounced in palms and soles. Jaundice is relatively uncommon, complicating only the most severe and prolonged episodes. (Milkiewicz P, Elias E.2002)
While providing anesthesia for patients with liver disease, the concept of oxygen supply-demand relationship in the liver should be kept in mind. Therefore, the main rule is to maintain adequate pulmonary ventilation and cardiovascular function, including cardiac output, blood volume, and perfusion pressures. (Simon Gelma.200A