ABSTRACT
Acute or chronic jaundice due to bile duct obstruction is often associated with the risks of hypotension, circulatory shock, and acute renal failure. Hypotension and shock may result from impaired cardiac muscle contractility, decreased arterial and venous vascular tone resulting from impaired response of the vascular smooth muscle cell to endogenous vasoconstrictors to decreased intravascular filling, i.e., decreased effective plasma volume. In man, acute obstructive jaundice has been shown to be associated with hypovolemia, whereas chronic biliary obstruction with impairment of liver function usually results in renal fluid and sodium retention. Under the conditions of extra- or intrahepatic bile duct obstruction, jaundice is associated with the retention of bile of which bilirubin and bile salts constitute major components besides cholesterol and other lipids. Hyperbilirubinemia has been shown to potentially affect renal function. The human jejunum is normally exposed to high concentrations of conjugated bile acids, and bacterial overgrowth may produce, in addition, large amounts of unconjugated bile acids.
