FREQUENCY OF CHOLANGIOCARCINOMA IN PATIENTS OF OBSTRUCTIVE JAUNDICE IN SURGICAL DEPARTMENT OF LADY READING HOSPITAL, PESHAWAR
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Keywords
Cholangiocarcinoma, Obstructive jaundice.
Abstract
INTRODUCTION: Cholangiocarcinoma is the second most common primary hepatic cancer. Despite advances in diagnostic techniques during the past decade, cholangiocarcinoma is usually encountered at an advanced stage. In this review, we describe the classification, diagnosis, and initial management of cholangiocarcinoma with obstructive jaundice. Cholangiocarcinoma (CC) is an epithelial malignancy with markers of cholangiocyte differentiation arising within the biliary tree. It is characterized by a marked genetic heterogeneity which explains its high therapeutic resistance. CC is rare but related mortality is high because it is most often diagnosed at a locally advanced stage, not amenable to curative surgery.2 As no such study has been conducted in our population for the last five years so this will provide us the latest and updated information regarding frequency of common causes of obstructive jaundice. More over the results of this study will be compared with other studies conducted on national and international level to observe any significant difference in the disease pattern. The recommendations will be suggested regarding starting baseline treatments of patients with obstructive jaundice keeping in front the results of this study.
OBJECTIVE: To determine the frequency of cholangiocarcinoma in patients of obstructive jaundice.
METHODOLOGY: The present study was carried out at the department of General Surgery, Lady Reading Hospital Peshawar. It was a descriptive cross sectional study and duration of study was one year from 1st August 2019 to 30th July 2020. The sample size was 241. All the patients presenting with clinical jaundice having serum bilirubin >3 mg/dl14, alkaline phosphatase levels > 306 mg/dl, age between 18-60 years and both gender were included The diagnosis in all these cases was based on history, clinical examination and routine laboratory investigations including Liver Function Tests (LFT’s). Ultrasound was done in all patients for the diagnosis of cholangiocarcinoma. All these patients were prepared for surgery for 2 to 3 days after admission with injection vitamin K, intravenous antibiotics and infusion Mannitol, hydration status checked and corrected. After preparation all the patients were operated on the next list and in cases where mass is found biopsy were taken and sent for histopathology to detect cholangiocarinoma. All the data was analyzed in SPSS 20.0
RESULTS: In the current study a total of 241 patients were observed in which 75(31%) patients were in age range 18-30 years and 166(69%) patients were in age range 31-60 years. 140(58%) patients were male and 101(42%) patients were female. More over 7(3%) patients had cholangicarcinoma and 234(97%) patients didn’t had cholangicarcinoma.
CONCLUSION: Our study concludes that the frequency of cholangiocarcinoma was 3% in patients of obstructive jaundice.
References
2. Khurram M, Durrani AA, Hasan Z, Butt A, Ashfaq S. Endoscopic retrograde cholangiopancreatographic evaluation of patients with obstructive jaundice. J Coll Physicians Surg Pak 2003;13(6):325-8.
3. Venneman NG, Buskens E, Besselink MG, Stads S, Go PM, Bosscha K, et al. Small gallstones are associated with increased risk of acute pancreatitis: potential benefits of prophylactic cholecystectomy? Am J Gastroenterol 2015;100(11):2540-50
4. Gupta AK, Singh A, Goel S, Tank R. Profile and pattern of obstructive jaundice cases from a tertiary care teaching hospital of Uttar Pradesh. Int Surg J 2017;4(2):743-6.
5. Wang Q, Gurusamy KS, Lin H, Xie X, Wang C. Preoperative biliary drainage for obstructive jaundice. The Cochrane Database Syst Rev 2008(3):Cd005444.
6. Siddique K, Ali Q, Mirza S, Jamil A, Ehsan A, Latif S, et al. Evaluation of the aetiological spectrum of obstructive jaundice. J Ayub Med Coll Abbottabad 2008;20(4):62-6
7. Kevin C. The gall bladder and bile ducts. In: Williams NS, Bulstrode CJK, O’Connel PR, editors. Bailey and Love’s Short Practice of Surgery. 26th ed. Boca Raton, CRC Press, Taylor and Francis. 2015. p.1097-1117
8. Kevin C. The gall bladder and bile ducts. In: Williams NS, Bulstrode CJK, O’Connel PR, editors. Bailey and Love’s Short Practice of Surgery. 25th edition. London, Hodder Arnold Publishers. 2008.p.111-29
9. Kavin S, Rottenberg G, Ultrasound in surgery. Surg Inter 2013;80:80-2
10. Wong JC, Lu DS. Staging of pancreatic adenocarcinoma by imaging studies. Clin Gastroenterol Hepatol 2008;6(12):1301-8.
11. Ghaffar A, Buledi GQ, Imran M. Role of imaging in obstructive jaundice. J Surg Pak 2013;18(3):28-33
12. Westaby D, Wadsworth C. The gall bladder and bile ducts. In: Kumar P, Clark M, editors. Kumar and Clark’s Clinical Medicine. 9th edition. London, Elsevier. 2017.p.489-517
13. Roy BC, Hanifa A, Alam S, Naher S, Sarkar P. Etiological spectrum of obstructive jaundice in a tertiary care hospital. Glob J Med Res. 2015;15(4);S1.
14. Shukla S, Kharat PR, Kumar K. Clinicopathological study on patients presenting with obstructive jaundice. Int Surg J. 2018;5(2):705-10
15. Siddique K, Ali Q, Mirza S, Jamil A, Ehsan A, Latif S, et al. Evaluation of the aetiological spectrum of obstructive jaundice. J Ayub Med Coll Abbottabad 2008;20(4):62-6
16. Kevin C. The gall bladder and bile ducts. In: Williams NS, Bulstrode CJK, O’Connel PR, editors. Bailey and Love’s Short Practice of Surgery. 26th ed. Boca Raton, CRC Press, Taylor and Francis. 2015. p.1097-17.
17. 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(1):147
18. Shukla S, Kharat PR, Kumar K. Clinicopathological study on patients presenting with obstructive jaundice. Int Surg J. 2018;5(2):705-10
19. Aziz, M, Ahmad N. Incidence of malignant Obstructive Jaundice - a study of hundred patients at Nishtar Hospital Multan. Annals of King Edward Medical University. 2016;10(1):1-10.
20. Björnsso E, Gustafsson J, Borkman J. Anders Kilander. Fate of patients with obstructive jaundice. J. Hosp. Med. 2008 March;3(2):117-123
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Sana Ullah Khan
Resident General Surgeon, Surgical Department, Lady Reading Hospital, Peshawar - Pakistan
Abdullah Khan
Resident General Surgeon, General Surgery Department, Lady Reading Hospital, Peshawar - Pakistan
Nida Mumtaz
Resident, Surgical Department, Lady Reading Hospital, Peshawar - Pakistan
Ali Hasnain Malik
General Surgeon, General Surgery Department, Lady Reading Hospital, Peshawar - Pakistan
Sara Asmat
Resident Histopathology, Histopathology Department, PIMS Hospital, Islamabad - Pakistan
Maleeha Nisar
Gynecologist, Gyne/Obs Department, Lady Reading Hospital, Peshawar - Pakistan