In this case, the patient's most likely diagnosis is post-hepatic jaundice which could be due to the presence of gallstones blocking the bile duct, known as extrahepatic obstruction. Another cause is carcinoma of the head of the pancreas. The elevation of the bilirubin level which is 250 µmol/l will lead to severe, painless and profound jaundice. Posthepatic jaundice is characterized by elevated alkaline phosphatase (ALP) activity that is more than seven times higher than the upper limit of the reference range. In the present case, aspartate and alanine aminotransferase activities do not indicate serious hepatocellular damage. Say no to plagiarism. Get a tailor-made essay on “Why violent video games should not be banned”?Get the original essayA high bilirubin level is ten times the reference range, so this often indicates that obstruction of bile flow or a defect in the processing of bile by the liver. Signs and symptoms of biliary obstruction include light-colored stools, dark urine, nausea, vomiting, and jaundice. Other possible causes of increased bilirubin are red blood cell destruction (anemia), liver scarring, liver inflammation, and pancreatic or gallbladder cancer. Several diseases are associated with hyperbilirubinemia. Hemolytic jaundice is one such disease because a greater amount of bilirubin is conjugated and excreted than usual, but the conjugation mechanism is overwhelmed and an abnormally large amount of unconjugated bilirubin is found in the blood. Gilbert's disease may be caused by an inability of hepatocytes to absorb bilirubin from the blood. As a result, unconjugated bilirubin accumulates. Physiological jaundice and Crigler-Najjar syndrome are conditions in which conjugation is impaired. Unconjugated bilirubin is retained by the body. Dubin-Johnson syndrome is associated with the inability of hepatocytes to secrete conjugated bilirubin after its formation. Conjugated bilirubin returns to the bloodstream. The given result showed that the AST exceeds the reference range value. AST levels increase when the tissues and cells where the enzyme is found are damaged. High levels indicate that there is a certain amount of damage in that area. AST is less specific for liver diseases than ALT. It is elevated in other conditions such as myocardial infarction. The sensitive indicator of liver cell damage is aminotransferase. They are particularly useful in helping to recognize acute hepatocellular diseases such as hepatitis and cirrhosis. ALT is more specific for liver damage than AST. ALT usually increases more than AST in cases of liver damage. Usually, aminotransferases are present in serum in low concentrations. When the liver cell membrane is damaged, leading to increased permeability, these enzymes are released in greater quantities into the bloodstream. The activities of two enzymes, including alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT), are normally increased in obstructive liver disease, also known as cholestasis. The elevation of serum alkaline phosphatase is more specific than that of GGT. GGT estimation is performed to identify patients with occult alcohol consumption. Normal serum alkaline phosphatase is made up of many distinct isoenzymes found in the liver, bone, placenta, and, more rarely, the small intestine. The elevation of alkaline phosphatase of hepatic origin is not entirely specific forcholestasis. Less than threefold elevation can be seen in almost all types of liver diseases. An elevation greater than four times normal in alkaline phosphatase in patients indicates a cholestatic liver disorder, infiltrative liver disease such as cancer, and bone conditions characterized by rapid bone turnover (e.g., Paget's disease). This elevation is due to an increase in the amount of bone isoenzymes in bone diseases, while it is due to an increase in the amount of liver isoenzymes in liver diseases. In case of intrahepatic obstruction, the valuesincreased as in drug-induced hepatitis and primary biliary cirrhosis. The values ​​found in cases of extrahepatic obstruction are very high due to cancer, common duct stones or bile duct structure. Increased serum alkaline phosphatase level is not useful in differentiating between intrahepatic and extrahepatic cholestasis. Values ​​are also significantly elevated in hepatobiliary disorders seen in AIDS patients. In addition to biochemical tests, certain parameters must be used to confirm that it is post-hepatic jaundice. Surgical History: The surgical history of patients, whether recent or past, should be understood as it may be involved in the cause of post-hepatic jaundice. . This can be due to various problems during the first three weeks postoperatively. Bilirubin levels increased due to hemolysis of transfused erythrocytes (especially stored blood), resorption of hematomas or hemoperitoneum, and rarely hemolysis of the patient's erythrocytes due to G- deficiency. 6PD or malaria parasites in transfused blood. Administration of halogenated anesthetic agents, exposure to other hepatotoxic drugs, sepsis or hepatic ischemia associated with preoperative or intraoperative hypotension or hypoxia may result in impaired hepatocellular function. It is very important to review the operative record regarding transfusion, anesthesia, radiographs, medications, and potential hypotension or hypoxia, as well as the surgeon's dictated note of intraoperative events and its visual and palpatory impression of the liver, of the biliary tree, of the biliary tree, of the patient. and pancreas when a case of jaundice potentially linked to surgery had to be studied. Family history: A family history of jaundice, liver disease, or anemia (especially when requiring splenectomy) should be sought. A positive family history of liver disease may involve genetically transmitted non-hemolytic hyperbilirubinemia (Crigler-Najjar, Gilbert, Dubin-Johnson or Rotor syndromes), recurrent benign intrahepatic cholestasis, Wilson's disease, hemochromatosis, alpha-1 antitrypsin deficiency or hereditary. spherocytosis in the differential diagnosis.Imaging assessment:To study jaundice, some advanced techniques and equipment are very useful, such as high-resolution ultrasound, computed tomography (CT), percutaneous transhepatic cholangiography (PTC), retrograde cholangiopancreatography endoscopic (ERCP) and hepatobiliary scintigraphy. (HBS). A valuable screening test in the jaundiced patient is abdominal ultrasound. Demonstration of bile duct dilatation, gallstones, liver mass injury, or an enlarged or abnormally shaped pancreas requires further investigation or treatment. CT scanning has the advantage of examining the entire abdomen as well as.