A Study of Obstructive Jaundice With Focus on Predictive Factors for Outcome

Abstract

BACKGROUND AND OBJECTIVES: Obstructive jaundice is a problem frequently encountered by general surgeons. A clear understanding of the etiology, presentation and management is a prerequisite for the management of obstructive jaundice. There is a need to identify the risk factors which may predict outcome. Hence, a detailed study of the various causes of obstructive jaundice and their management is of paramount importance. METHODS: A Prospective observational study was undertaken to investigate the pattern of clinical presentation, diagnosis and management of the different causes of obstructive jaundice. About 21 consecutive patients with symptoms and signs of obstructive jaundice were included in the study. Cases were admitted, examined, investigated and operated during the period of Nov 2010 to Aug 2012. RESULTS & CONCLUSION: The highest age incidence of obstructive jaundice was in the 50-80 years with maximum incidence in the 6th decade. There was an increased incidence in female i.e. M: F=1:2.5. Most common cause of obstructive jaundice is choledocholithiasis, followed by periampullary carcinoma. Among periampullary carcinoma, Ca head of pancreas and Ca Ampulla of Vater are the common causes. Jaundice is the most common presentation of surgical jaundice followed by pain abdomen, nausea/vomiting, itching, loss of weight and fever. Ultrasonography was the investigation of choice in our hospital. It is cheap, safe and reliable. Early diagnosis and management helps to reduce the mortality and morbidity rate. ERCP is comparatively as good as Open exploration of CBD and Choledochoduodenostomy for CBD calculi. Good survival benefit in cases of malignant obstructive jaundice depends on detecting the disease early in its course. It was noted on statistical analysis of malignant cases that the values of direct bilirubin levels were significantly higher in those patients who expired postoperatively compared to surviving patients. Hence these parameters can be considered as those which may predict perioperative outcome as well as long term survival. The levels of total bilirubin and alkaline phosphatase did not show significant difference.