Jaundiced patients

• For patient undergoing any surgery, ERCP or PTC

• Perform COAG, FBC, FDP 2 days before procedure

• Correct coagulopathy with vitamin K (Konakion) and FFP or platelets as necessary

• G&H

• Maintain adequate hydration to prevent hepato-renal syndrome. This usually requires IV fluid supplementation for 24 hours preop and may require urethral catheterisation to monitor output, see 9.5

• Antibiotic Prophylaxis - Co-amoxiclav or as per ERCP Antibiotic prophylaxis Post PTC/ERCP observe for evidence of cholangitis. May need Antibiotic treatment with Piperacillin (Tazocin).

Instrumentation of an obstructed biliary system predisposes to severe and sudden biliary sepsis!! This may present as collapse, often with dyspnoea/hypoxia and appear to be a respiratory problem.

Sudden deterioration in a jaundiced patient is biliary sepsis unless proven otherwise. Emergency treatment is required, and Senior team member to be informed if any change in condition of these patients.