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Mechanism of Hepatic Dysfunction Following Shock and Trauma

Geoffrey Nunes, MD; F. William Blaisdell, MD; William Margaretten, MD
Arch Surg. 1970;100(5):546-556. doi:10.1001/archsurg.1970.01340230012003.
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Mild jaundice is relatively common in patients who are recovering from major trauma. It is often attributed to the effect of multiple transfusions, transfusion reaction, absorption of blood from hematomas, or preexisting liver disease. Occasionally, the jaundice in such patients may be severe and may closely resemble obstructive jaundice. Examination to exclude obstructive jaundice may be hampered by postoperative abdominal tenderness, ileus, or depressed mental function due to head trauma. The effects of anesthesia and a wide variety of drugs must also be considered.

Although hepatic dysfunction following trauma has been well described in the literature, the large number of factors involved in clinical cases has made determination of the underlying mechanisms difficult.

Our recent experience with this syndrome of marked jaundice following trauma prompted an investigation into its etiology.

Clinical Material  Between January 1965 and January 1969, approximately 500 patients were admitted to San Francisco General Hospital with major,


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