65 year female patient with performance score of ECOG 2 underwent rt hepatectomy (segment 5,6,7,8 &1) with ducto-jejunostomy. Child pugh class A with preoperative bilirubin of 7.3, on pod 6 pt developed abdominal distension and oliguria...serum bilirubin was raised to 13 (both direct and indirect are almost equally raised). Rest of LFT (sgot sgpt INR albumin ) are normal TLC is raised to 24000 with procalcitonin 2.0. Clear cut case of septicaemia, ammonia 102 (normal range upto 90), on usg paralytic ileus, no ihbr dilatation or any collection. S create. 1.2 but urea is 170, blood culture sent.
Central line removed with tip for culture. Foleys changed, Patient put on higher antibiotics. what next? Is septicaemia the cause of ileus or vice versa? Why alone bilirubin is raised with other parameters of LFT is normal?
