Obstructive jaundice in the elderly patient

Morse, Thomas S.; Deterling, Ralph A.

doi:10.1016/0002-9610(62)90400-2

Cited by 6 publications

(7 citation statements)

References 3 publications

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“…Many of these unfortunate consequences could have been avoided had elective surgery been undertaken soon after the emergence of the first symptoms of biliary tract disease. 20 Regarding the etiology for the obstructive jaundice, 58.71% of patients have malignant causes for development of obstructive jaundice as compared to benign causes in 41.29% of patients. Similar type of etiological distribution have been found in the study done by Gupta et al, in which it was observed that 63.89% of cases have malignant causes while 36.11% of cases have benign causes.…”

Section: Malignant Etiologymentioning

confidence: 99%

Clinical profile of patients with obstructive jaundice: a surgeon’s perspectives

Khan¹

2019

Int Surg J

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Background: There are various causes of obstructive jaundice, choledocholithiasis– the commonest. Patients with obstructive jaundice usually present with complain of yellow skin and eyes, pale stools, dark coloured urine, jaundice, and pruritus.Abdominal pain often misleading for diagnosis. The objectives of the study were to study the clinical profile of patients with obstructive jaundice.Methods: The study included the patients clinically diagnosed as suffering from obstructive jaundice. Thorough history taking and clinical examination was done. Patients undergone for various laboratory investigations, and radiological evaluation.Results: A total 201 patients were included in the present study. Males are more affected (55.72%) as compared to females. Elder age groups (>65 years; and 55-65 years) were commonly affected. 58.71% of patients have malignant causes for development of obstructive jaundice as compared to benign causes in 41.29% of patients. Choledocholithiasis (30.35%) is the commonest cause of obstructive jaundice followed by carcinoma of pancreas (25.87%). Jaundice is the commonest symptom of presentation.Conclusions: Better understanding of the clinical profile in the patients with obstructive jaundice will facilitate appropriate management and lead to improved survival.

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Section: Malignant Etiologymentioning

confidence: 99%

Clinical profile of patients with obstructive jaundice: a surgeon’s perspectives

Khan¹

2019

Int Surg J

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“…In people, obstructive jaundice is a common indication for abdominal surgery in the elderly, 19 although it also can affect patients of any age, including neonates 20 . Approximately one‐third of elderly patients with obstructive jaundice have malignant hepatobiliary neoplasia (also known as malignant jaundice) 19 . In people with obstructive jaundice of benign origin (nonneoplastic), elective hepatobiliary surgery is recommended shortly after the onset of the first symptoms of biliary tract disease 19 .…”

Section: Discussionmentioning

confidence: 99%

“…This finding is interesting and suggests that conditions associated with BO might be more prevalent in older cats whereas, as already known, inflammatory conditions such as FIP 14 , 15 and nonsuppurative cholangitis‐cholangiohepatitis 16 , 17 , 18 (as causes of hyperbilirubinemia) are more prevalent in younger animals. In people, obstructive jaundice is a common indication for abdominal surgery in the elderly, 19 although it also can affect patients of any age, including neonates. 20 Approximately one‐third of elderly patients with obstructive jaundice have malignant hepatobiliary neoplasia (also known as malignant jaundice).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and predictive ability of hyperbilirubinemia severity in cats: A multicenter retrospective study

Salord Torres,

Jeevaratnam,

Schofield

et al. 2024

Veterinary Internal Medicne

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BackgroundTotal serum bilirubin concentration (TBIL) can provide useful information on several pathophysiological conditions in cats. Nevertheless, whether the variable severity classification of hyperbilirubinemia can reliably indicate certain disease processes or predict a biliary obstruction (BO) has not been investigated.Hypothesis/ObjectiveDetermine if hyperbilirubinemia of variable severity can assist clinicians to identify BO, which often is considered a surgical emergency.AnimalsTwo‐hundred sixteen client‐owned cats.MethodsData were retrospectively collected from all cats (January 2015‐August 2022) with an increased TBIL (>0.58 mg/dL [>10 μmol/L]) presented to 3 referral centers in the United Kingdom (UK). Presenting clinical features and diagnostic outcomes were collected. The predictive ability of TBIL to indicate BO was evaluated by multivariable binary logistic regression modeling and receiver operating characteristic (ROC) curves.ResultsMedian TBIL was 1.73 mg/dL (range, 0.59‐26.15; 29.5 μmol/L; range, 10.1‐447.1) with severity classification of hyperbilirubinemia categorized as mild (>0.58‐2.92 mg/dL; >10‐50 μmol/L; 68.1%), moderate (>2.92‐5.85 mg/dL; >50‐100 μmol/L; 17.6%), severe (>5.85‐11.70 mg/dL; >100‐200 μmol/L; 9.7%) and very severe (>11.70 mg/dL; >200 μmol/L; 4.6%). Biliary obstruction was present in 17 (7.9%) cats, all of which received recommendation for emergency surgery. Median TBIL in cats with BO (9.69 mg/dL; 165.7 μmol/L) differed significantly from those without obstruction (1.51 mg/dL; 25.8 μmol/L; P < .01). The optimal TBIL cut‐off to discriminate between cats with and without BO was ≥3.86 mg/dL (≥66 μmol/L) with a sensitivity of 94.1% and specificity of 82.4%. Using multivariable logistic regression, as age increased, the odds of BO increased significantly (odds ratio, 1.20; 95% confidence interval, 1.01‐1.42; P = .04).Conclusions and Clinical ImportanceAs part of a thorough clinical assessment, the severity classification of hyperbilirubinemia has the potential to predict the likelihood of a BO and to discriminate between cats that may or may not require surgery for BO at a suggested cut‐off of ≥3.86 mg/dL (≥66 μmol/L). Alongside TBIL, age is also useful when assessing for the likelihood of BO in a cat presented with hyperbilirubinemia.

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“…Literatürdeki benzer çalışmalarda da karın ağrısı etiyolojisi olarak en sık benign sebepler bulunmuştur (12,21). Genel popülasyonda yapılan çalışmalar ve geriatrik popülasyonda yapmış olduğumuz çalışma beraber değerlendirildiğinde, yaş ilerlese bile karın ağrısı ile başvuran hastalarda benign etiyolojiler öncelikle düşünülmelidir.…”

Section: Gereç Ve Yöntemunclassified

“…Çalışmamızda 2. en sık görülen şikayet ise sarılıktı ve sarılık ile başvuran hastaların malign olma ihtimali istatistiksel olarak anlamlı düzeyde daha yüksekti. Bu konuda yapılan çalışmaların bazılarında karın ağrısı en sık şikayet olarak belirtilirken (24,25) bazılarında da sarılık en sık başvuru şikayeti olarak bildirilmiştir (12,18). Bu farklılık da etiyolojiden kaynaklanmaktadır.…”

Section: Gereç Ve Yöntemunclassified

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

Köker

Uyar

Özçelik

et al. 2021

Akademik Gastroenteroloji Dergisi

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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.

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Obstructive jaundice in the elderly patient

Cited by 6 publications

References 3 publications

Clinical profile of patients with obstructive jaundice: a surgeon’s perspectives

Clinical profile of patients with obstructive jaundice: a surgeon’s perspectives

Diagnostic and predictive ability of hyperbilirubinemia severity in cats: A multicenter retrospective study

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

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