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

Yıl 2021, Cilt: 20 Sayı: 2, 94 - 103, 26.08.2021

Gökhan Köker Seyit Uyar Gülhan Özçelik Mehmet Çatlı Yasin Şahintürk Feyzi Bostan Ayhan Çekin

https://doi.org/10.17941/agd.980348

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

• 1. Heathcote EJ. Diagnosis and management of cholestatic liver disease. Clin Gastroenterol Hepatol 2007;5:776-82.
• 2. Trauner M, Meier PJ, Boyer JL. Molecular pathogenesis of cholestasis. N Engl J Med 1998;339:1217-27.
• 3. European Association for the Study of the L. EASL Clinical Practice Guidelines: management of cholestatic liver diseases. J Hepatol 2009;51:237-67.
• 4. Solter PF. Clinical pathology approaches to hepatic injury. Toxicol Pathol 2005;33:9-16.
• 5. Khan SS, Singer BD, Vaughan DE. Molecular and physiological manifestations and measurement of aging in humans. Aging Cell 2017;16:624-33.
• 6. Mattiuzzi C, Lippi G. Worldwide disease epidemiology in the older persons. Eur Geriatr Med 2020;11:147-53.
• 7. Ogura S, Jakovljevic MM. Editorial: Global Population Aging - Health Care, Social and Economic Consequences. Front Public Health 2018;6:335.
• 8. Russo CA, Elixhauser A. Hospitalizations in the Elderly Population, 2003: Statistical Brief #6. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb.
• 9. Leandros E, Alexakis N, Archontovasilis F, et al. Outcome analysis of laparoscopic cholecystectomy in patients aged 80 years and older with complicated gallstone disease. J Laparoendosc Adv Surg Tech A 2007;17:731-5.
• 10. Mabula JB, Gilyoma JM, McHembe MD, et al. Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania. Tanzan J Health Res 2013;15:216-22.
• 11. Ozemir IA, Buyuker F, Gurbuz B, et al. An Educational Clinic's Experiences On Diagnosis And Treatment Of Patients With Obstructive Jaundice. Marmara Medical Journal. 2010;24:119-22.
• 12. Morse TS, Deterling RA Jr. Obstructive jaundice in the elderly patient. Am J Surg 1962;104:587-90.
• 13. Chalya PL, Kanumba ES, McHembe M. Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges. BMC Res Notes 2011;4:147.
• 14. Aziz M, Ahmad N, Faizullah. Incidence of malignant Obstructive Jaundice - a study of hundred patients at Nishtar Hospital Multan. Annals of King Edward Medical University. 2016;10 (1).
• 15. Guler O, Aras A, Aydin M, et al. Biliyer Obstrüksiyon Nedenleri ve Uygulanan Tedaviler; 139 Olguluk Seri. 2000;7:10-5.
• 16. Roy C, Hanifa A, Alam S, Naher S, Sarkar P. Etiological spectrum of obstructive jaundice in a tertiary care hospital. Global Journal of Medical Research. 2015;15:1-5.
• 17. Siddique K, Ali Q, Mirza S, et al. Evaluation of the aetiological spectrum of obstructive jaundice. J Ayub Med Coll Abbottabad 2008;20:62-6.
• 18. Verma S, B.Sahai S, K.Gupta P. Title of the article: Obstructive jaundice-aetiological spectrum, clinical, biochemical and radiological evaluation at a tertiary care teaching hospital. Internet Journal of Tropical Medicine 2011;7.
• 19. Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran's Gastrointestinal and Liver Disease E-book: Pathophysiology, Diagnosis, Management: Elsevier; 2020.
• 20. Neki NS. Jaundice in elderly. Journal of Medical Education and Research 2013;15:113-16.
• 21. Chalya PL, Kanumba ES, McHembe M. Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges. BMC Res Notes 2011;4:147.
• 22. Altıntaş E, Tombak A, Tellioğlu B. The causes, diagnosis and treatment of severe jaundice. Akademik Gastroenteroloji Dergisi 2010;9:2-7.
• 23. Whitehead MW, Hainsworth I, Kingham JG. The causes of obvious jaundice in South West Wales: perceptions versus reality. Gut 2001;48:409-13.
• 24. Moghimi M, Marashi SA, Salehian MT, et al. Obstructive jaundice in Iran: factors affecting early outcome. Hepatobiliary Pancreat Dis Int 2008;7:515-9.
• 25. Bekele Z, Yifru A. Obstructive jaundice in adult Ethiopians in a referral hospital. Ethiop Med J 2000;38:267-75.
• 26. Wu Y, Potempa LA, El Kebir D, Filep JG. C-reactive protein and inflammation: conformational changes affect function. Biol Chem 2015;396:1181-97.
• 27. O'Connor OJ, O'Neill S, Maher MM. Imaging of biliary tract disease. AJR Am J Roentgenol 2011;197:W551-8.
• 28. Farrukh SZ, Siddiqui AR, Haqqi SA, et al. Comparison of ultrasound evaluation of patients of obstructive jaundice with endoscopic retrograde cholangio-pancreatography findings. J Ayub Med Coll Abbottabad 2016;28:650-2.
• 29. Stott MA, Farrands PA, Guyer PB, et al. Ultrasound of the common bile duct in patients undergoing cholecystectomy. J Clin Ultrasound 1991;19:73-6.