Obstructive Jaundice- Aetiological Spectrum, Clinical, Biochemical And Radiological Evaluation At A Tertiary Care Teaching Hospital.

摘要

Objective–This study was done to assess the aetiological spectrum of obstructive jaundice as well as common clinical findings and relevance of laboratory and radiological imaging investigations.Methods: A prospective study of 110 patients with obstructive jaundice confirmed by thorough history and physical examination, biochemical tests and radiological investigations was done with final confirmation of diagnosis on histopathology. The data was analyzed using SOFA analytical software ver 0.9.24.Results: Out of 110 patients 62 (56%) were male and 48 (44%) were female. The mean age of the study population was 50.4 years (range 3–85 years). Malignant obstructive was more common than benign (62.73% Vs 47.27%). Abdominal pain and clay coloured stools were more frequent in patients with malignant disease. Carcinoma (Ca) of the head of pancreas was commonest aetiology 37/110 (33.63%) followed by Choledocholithiasis 32/110 (29%), Ca gall bladder 20/110 (18.18%), periampullary carcinoma 6/110 (5.45%), cholangiocarcinoma 4/110 (3.64%), CBD stricture 3/110 (2.73%), acute pancreatitis 3/110 (2.73%) and choledochal cyst 3/110(2.73%). and HCC(1.8%). Regarding etiology of the obstruction, the accuracy of ultrasound, CT scan, MRCP and ERCP was 87.3%, 92.7%, 90% and 100%, respectively. The sensitivities of USG, CT, MRCP and ERCP in the diagnosis of benign disease were 85.3%, 84.6%, 92.3% and 100%, respectively, whereas specificities were 88.4%, 94.2%, 86% and 100%, respectively. Sensitivities for diagnosis of malignant disease were 88.4 %, 94.2 %, 86 % and 100% for USG, CT, MRCP and ERCP respectively whereas specificities were 85.3%, 85%, 92% and 100% respectively.Conclusion: Malignant obstructive jaundice is predominant in males compared to females. Benign obstruction is seen at a comparatively younger age group compared to malignant (Mean age 38.6yrsVs 58.7yrs). Carcinoma of head of pancreas and choledocholithiais were the commonest malignant and benign etiology respectively. Ultrasound and CT have high diagnostic accuracy, sensitivities and specificities and along with MRCP have largely confined the role of invasive cholangiography (ERCP/PTC) to therapeutic/palliative procedures in biliary obstruction. Introduction The word “jaundice” comes from the French word jaune, which means yellow. Jaundice is a yellowish staining of the skin, sclera, and mucous membranes by bilirubin, a yellow-orange bile pigment. Bilirubin is formed by a breakdown product of heme rings, usually from metabolized red blood cells. The discoloration typically is detected clinically once the serum bilirubin level rises above 3 mg per dL (51.3 μper L).1 Jaundice is a common problem in both medical and surgical practice.1 Its cause can often be correctly anticipated clinically but usually biochemical and radiological imaging investigations are required for confirmation. It could be because of a variety of causes and is broadly divided into obstructive (surgical) and non obstructive (medical) categories.2 Obstructive jaundice (jaundice due to intra or extrahepatic organic obstruction to biliary outflow), can present problems with the diagnosis and management. The surgical jaundice can be caused by the obstruction of the bile duct as with gall stones, strictures, malignancy, such as cholangiocarcinoma, carcinoma gall bladder and carcinoma head of pancreas & periampullary carcinoma. Various rare causes like Choledochal cyst; Caroli’s syndrome and primary and metastatic liver tumors have also been reported.1,2,3 The symptoms of obstructive jaundice include jaundice with or without pain, dark urine, pruritis, pale stools, weight loss and anorexia.1,2 Biochemistry/HematologyElevated serum bilirubin level with a preponderance of the conjugated fraction is usually seen. In general, patients with benign disease have less hyperbilirubinemia than those with malignant obstruction. The transaminases (AST & ALT) may abruptly rise many fold above normal and decrease rapidly once the obst