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

Öz

Giriş ve Amaç: Kolestaz etiyolojik nedenlerinin ve klinik bulgularının 65 yaş üstü hastalarda geniş hasta popülasyonu ile dökümante edilmesi amaçlandı. Gereç ve Yöntem: Kolestaz nedeniyle yatışı yapılan 65 yaş ve üstü hastalar retrospektif olarak şikayetleri, laboratuvar parametreleri ve görüntüleme sonuçlarına göre değerlendirildi. Benign ve malign etiyolojik nedenler olarak iki gruba ayrılan hastalarda malignite göstergesi olabilecek parametreler için ileri analiz yapıldı. Bulgular: Çalışmamıza retrospektif olarak 65 yaş ve üstü 185 hasta dahil edildi. 109 (%58.9) hastanın etiyolojisi benign, 69 (%37.3) hastanın malign nedenlere bağlı olarak saptandı. 56 hastada (%30.3) koledokolitiazis, 25 hastada (%13.5) kolanjioselüler karsinom, 23 hastada (%12.4) pankreas kanseri en sık görülen tanılardı. En sık başvuru şikayeti karın ağrısıydı. Sarılık şikayetiyle başvuran hastaların %45.6’sı (n: 52) benign, %54.4’ü (n: 62) malign iken kilo kaybıyla başvuran hastaların %6.2’si benign, %93.8’i maligndi. Sarılık ve/veya kilo kaybı şikayetiyle başvuran hastaların malign olma ihtimali istatistiksel olarak anlamlı düzeyde yüksek saptandı (p < 0.001). Çok değişkenli analiz sonuçlarına göre total bilirübin ve alkalen fosfatazın diğer değişkenlerden bağımsız olarak malignite ile pozitif olarak ilişkili olduğu görüldü. Ultrasonografi ile 185 hastanın 85’ine (%46) tanı koyulabilirken, 100’üne (%54) ise tanı koyulamadığı görülmüştür. Sonuç: Geriatrik popülasyonda kolestaz etiyolojisinde benign sebepler daha sık görülmüştür. Sarılık ve kilo kaybı şikayetleri olan ve/veya bilirübin ve alkalen fosfataz düzeyi yüksek olan hastalarda ise malign hastalıklar ayırıcı tanıda öncelikli olmalıdır. Ultrasonografi geriatrik popülasyondaki kolestazlı hastalarda tanı koymada yetersiz bulunmuş, ileri görüntüleme tetkiklerine ihtiyaç duyulmuştur.

Anahtar Kelimeler

• Kolestaz
• geriatrik popülasyon
• sarılık
• benign/malign etiyoloji
• koledokolitiazis
• kolanjioselüler kanser

Etiology and diagnosis of cholestatic liver diseases in the geriatric population: A single-center experience of 185 cases

Öz

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.

Anahtar Kelimeler

• Cholestasis
• geriatric population
• jaundice
• benign/malignant etiology
• choledocholithiasis
• cholangiocellular cancer

Kaynakça

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