Geriatrik popülasyonda kolestatik karaciğer hastalıklarında etiyoloji ve tanısal yaklaşım: 185 vakalık tek merkez deneyimi

Abstract

nır (2). Tanısal ve tedavi yaklaşımında kolaylık sağlanması amacıyla kolestaz intrahepatik ve ekstrahepatik olmak üzere iki ana grupta değerlendirilir. İntrahepatik kolestaz, hepatoselüler disfonksiyon ve intrahepatik safra yollarının obstrüksiyonlarına sekonder olarak gelişirken, ekstrahepatik kolestaz ise ana safra yollarında safra akımına engel olan patolojiler sonucunda gelişmektedir (3). Tüm has-GİRİŞ Kolestaz, terim olarak Yunanca kökenlidir ve safra akışının durması anlamına gelir (1). Safranın oluşumu ve atılımı hayati bir fonksiyondur. İlaçlar, enfeksiyonlar, otoimmün, metabolik ve genetik hastalıklar neticesinde safranın oluşumunda ve/veya safra akımındaki bozukluk sonucunda gelişen kaşıntı, halsizlik ve genelde eşlik eden sarılık ile karakterize klinik tablo kolestaz olarak tanımla-Background and Aims: In this study, we aimed to analyze the etiology of cholestasis in a large geriatric patient population according to their complaints, laboratory parameters, and imaging results. Materials and methods: A total of 185 geriatric patients (age: > 65 years) with cholestasis were included in this retrospective study. The patients were divided into two groups, i.e., benign etiology and malignant etiology, in order to further analyze parameters that could indicate malignancy. Results: A total of 109 (58.9%) patients had benign etiologies and 69 (37.3%) had malignant etiologies. The most common etiologies were choledocholithiasis [56 patients (30.3%)], cholangiocellular carcinoma [25 patients (13.5%)], and pancreatic cancer [23 patients (12.4%)]. The chief complaint was abdominal pain. In patients with jaundice, benign diseases accounted for approximately 45.6% of etiologies, whereas malignant diseases accounted for approximately 54.4% of etiologies. In patients with weight loss, benign diseases accounted for approximately 6.2% of etiologies, whereas malignant diseases accounted for approximately 93.8% of etiologies. In addition, both conditions were statistically significant (p < 0.001). Multivariate regression analysis showed that total bilirubin and alkaline phosphatase were independent markers for malignant diseases. Ultrasonography correctly diagnosed only 46% of patients. Conclusion: Benign etiologies are the most frequent diagnosis for the management of cholestasis in the geriatric population. In patients with complaints of jaundice and weight loss and/or patients with high bilirubin and alkaline phosphatase levels, malignant diseases should be a priority in the differential diagnosis. Ultrasonography was inadequate in diagnosing cholestasis in the geriatric population, and further imaging studies are needed.