Liver failure and death following surgery on patients with obstructive jaundice are not uncommon. Such a postoperative course is usually manifested in part by a febrile coma, a rising level of serum bilirubin, and a falling level of cholesterol esters and albumin. There can be little doubt that the operation in some way has directly influenced the course of the patient. The specific etiological details, however, are rather obscure. The relative importance of such details is difficult to assess from clinical cases. Some of these factors are the impaired liver function existing preoperatively, the anesthesia, the nonspecific stress of the operation and coincident hypoxia or sepsis.
In an effort to clarify the problem by experimental observations the authors have undertaken a series of studies to evaluate the relative importance of each factor. A detailed and thorough analysis of the course of liver function in dogs with simple uncomplicated obstructive jaundice
MACGREGOR CA, GRIFFITH JB, MUNRO GA. The Influence of Stress upon Liver Function in Obstructive Jaundice. AMA Arch Surg. 1955;71(3):395–403. doi:10.1001/archsurg.1955.01270150089010