The most important part of a therapeutic strategy for managing jaundice in the critically ill is to make the correct diagnosis. A wide range of diagnostic tests and modalities are now available, not only to identify the site of interruption to bilirubin excretion but also to identify the etiological agent(s).
As in any patient with jaundice, an accurate history is crucial. The onset of the jaundice in relation to the critical illness, previous evidence of, or risk factors for, chronic liver disease, use of hepatotoxic drugs or anesthetics, and alcohol consumption will need to be recorded. Clinical examination may reveal stigmata of chronic liver disease (Table 1).
Table 1 Diagnostic strategy for jaundice in critically ill patients
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