EVALUATION OF THE AETIOLOGICAL SPECTRUM OF OBSTRUCTIVE JAUNDICE
AbstractBackground: Jaundice is a common problem in medical and surgical gastroenterological practice. Thesurgical jaundice can be caused by the obstruction of the bile duct as with gall stones, strictures,malignancy, such as cholangiocarcinoma (in which the jaundice is persistent and progressive),periampullary carcinoma, carcinoma gall bladder 6 and carcinoma head of pancreas. The objective ofthis descriptive study was to evaluate the Etiological spectrum of obstructive jaundice. Methods: Aprospective, descriptive study was carried out at Surgical Unit-II Holy family Hospital, Rawalpindi,from mid of May 2006 till March 2007. Sixty patients, who presented in the surgical OPD of Holyfamily Hospital, were included in the study. Thorough history and physical examination was followedby biochemical tests and various investigations like USG abdomen, ERCP, CT-Scan, & MRCP andhistopathology. The data was analyzed using SPSS ver 14.0. Results: Of the 60 patients; 40 (66.66%)were male and 20 (33.33%) were female, their mean age being 49.50 years. Malignant obstructivejaundice was seen in 34 (56.66%) patients while 26 (43.33%) had benign etiology. Amongst thecommonest symptom; clay coloured stools (75%) was more frequent in patients with malignant diseasewhereas abdominal pain (51.66%) was most common in benign conditions. Commonest malignancywas Carcinoma (Ca) of the head of pancreas 18/60 (30%) followed by Ca gall bladder 8/60 (13.33%),cholangiocarcinoma 7/60 (11.66%), and periampullary carcinoma 1/60 (1.66%). Choledocholithiasis21/60 (35%) was the commonest benign cause followed by stricture of common bile duct 3/60 (5%)and acute pancreatitis 2/60 (3.33%). Conclusion: Obstructive jaundice is common amongst femalesand the cause is mostly malignant. Ca head of pancreas is the commonest malignancy whileCholedocholithiasis is the commonest benign cause. USG, ERCP and CT-Scan are importantdiagnostic modalities for evaluation of patient with obstructive jaundice with ERCP having theadditional advantage of being therapeutic as well.Keywords: Choledocholithiasis, Obstructive jaundice, ERCP, Ca Head of pancreas, Ca gall bladder.
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