Hepatobiliary complications of sepsis.

Jaundice developing in critically ill or injuried patients should probably be thought of as a manifestation of severe sepsis until proven otherwise. Septic jaundice occurs in about 50 to 60 per cent of patients with generalized peritonitis. Biochemically, jaundice associated with bilirubin (particularly the direct fraction) and liver enzymes (particularly the alkaline phosphatase) and a decrease in the serum albumin. Histologically there is intrahepatic cholestasis. The etiology of these changes in unknown, but they appear to be due to an end organ response to sepsis. Optimal treatment involves control of the sepsis and maintenance of a glood flow of well-oxygenated blood to the liver.