Frequency of Cholestatic Liver Diseases in Zagazig University Hospitals, with Special Emphasize on Extrahepatic Causes

Abstract

Background and study aim : Extrahepatic cholestasis results from the mechanical obstruction of large bile ducts outside the liver or within the porta hepatis. The common etiologies of cholestasis have been reported to vary from one center to another. Our aim was to assess the frequency of cholestatic disorders in patients admitted to our department and try to identify the underlying extrahepatic causes aiming at improving the quality of management offered to this patients group. Patients and methods: In the present study, 506 cases admitted to our department were included. Sixty one of them met our inclusion criteria, of high serum alkaline phosphatase (ALP≥1.5 times the upper limit of normal), high gamma glutamyl transferase (GGT≥3 times the upper limit of normal) and ultrasonogrpahic (US) features of extrahepatic cholestasis (dilated intra and/or extra-hepatic ducts) of whatever etiology. The selected patients underwent the following: Full history taking and thorough physical examination, complete blood picture, liver and kidney function tests and abdominal CT. Also, ERCP was performed whenever needed and the tumor markers, alpha feto-protein & (CA 19-9) were assessed in selected cases when mass lesions were detected. Results : The frequency of cholestatic liver diseases presented with elevated both ALP & GGT as described above, was %19.7 (100 of 506 patients).While the frequency of extrahepatic cholestasis was 12.1% with females accounting for 54.1% and males were 45.9% with mean ages SD of 51.1 11.7 years. Benign causes of surgical obstructive jaundice were more frequent than malignant ones (57.4% VS 42.6%). The most common cause was choledocholithiasis in 25/61 (40.9%), followed by cancer head of pancreas 9/61 (14.8%), peri-ampullary carcinoma 8/61 (13.11%), cholangiocarcinoma 5/61 (8.2%) and pancreatitis 4/61 (6.6%). Dark urine, clay stool and itching were more common in patients with malignant obstructive jaundice. There was a highly positive agreement between ALP and GGT with P Conclusion : We concluded that, the frequency of cholestatic liver diseases in our department was %19.7. Among them, extrahepatic causes had a frequency of 12.1% with choledocholithiasis as the commonest benign etiology, while cancer head of pancreas was the most frequently met with malignancy. ERCP is considered the gold standard modality in diagnosis and management of extrahepatic cholestasis