Nisan 2010
Ciddi hiperbilirübinemi nedenleri, tani ve sagaltimi
The causes, diagnosis and treatment of severe jaundice
- Ana Sayfa
- Sayılar
- Nisan 2010
- Ciddi hiperbilirübinemi nedenleri, tani ve sagaltimi...
Özet
Giris ve Amaç: Bu çalismanin amaci, ciddi sariligi olan hastalarda nedenleri belirlemek, kullanilan tanisal yöntemleri ve uygulanan tedavileri saptamaktir. Gereç ve Yöntem: Üç aylik dönem içinde toplam bilirübin degeri 5 mg/dL üzerinde olan eriskin hastalar belirlendi. Hastalarin klinik bilgileri, laboratuar degerleri, kullanilan tanisal yöntemlerle uygulanan medikal, cerrahi ve girisimsel yöntemler kaydedildi. Bulgular: Yirmi üç kadin, 27 erkek, toplam 50 hasta kaydedildi. Ortalama yas 53 idi. En sik sarilik nedeni malignensi idi ve toplam 24 hastada saptandi. Bunlarin 8'inde karaciger metastazi, 4'ünde kolanjiyoselüler karsinom, 3'ünde pankreas kanseri, 3'ünde periampüller bölge tümörü, 2'sinde hepatoma, 2'sinde Hodgkin lenfoma, 2'sinde akut lenfositik lösemi vardi. Ikinci en sik sebep viral hepatit idi ve 7 hastada saptandi. Üçü HAV, 3'ü HBV, 1'i HCV hepatiti idi. Karaciger sirozu 5, koledokolitiazis 3, otoimmün hepatit ve toksik hepatit 2'ser hastada saptandi. Birer hastada da kolesistit, alkolik hepatit, immün hemolitik anemi, hipertiroidi, iskemik hepatit, ürosepsis ve gebelige bagli kolestaz vardi. Hastalarin tümüne ultrasonografi, 19'una bilgisayarli tomografi, 13'üne endoskopik retrograd kolanjiyo-pankreatografi, 5'ine perkütan transhepatik kolanjiyografi, 2'sine de manyetik rezonans kolanjiyopankreatografi yapildi. Otuz bes hasta sadece medikal olarak tedavi edilirken, 8'i endoskopik, 5'i girisimsel, 2'si de cerrahi yöntemlerle tedavi edildi. Üç aylik izlem süresi içinde mortalite orani %30 (15 hasta) olarak saptandi. Bunlarin 11'i malignitesi olan hastalardi. Sonuç: En sik ciddi sarilik nedenleri, malignensi ve viral hepatit olarak bulunmustur. Ileri yaslarda olup, 5 mg/dL üzerinde hiperbilirübinemisi olanlarda ilk olarak malignite düsünülmelidir.
Abstract
Background and Aims: The aim of this study was to identify the causes and determine the diagnostic methods and treatments in patients with severe jaundice. Materials and Methods: In a three-month period, adult patients whose total bilirubin levels were above 5 mg/dl were identified. Clinical information and laboratory values of the patients and the applied diagnostic, medical, surgical, and interventional methods were recorded. Results: The study group included 23 females and 27 males; a total of 50 patients were recorded. The average age was 53. The most common cause of jaundice was malignancy, detected in 24 patients (liver metastasis in 8, cholangiocellular carcinoma in 4, pancreatic carcinoma in 3, periampullary tumor in 3, hepatoma in 2, Hodgkin lymphoma in 2, and acute lymphoblastic leukemia in 2). Viral hepatitis was found as the second most common cause, detected in 7 patients (hepatitis A virus in 3, HBV in 3, HCV in 1). Liver cirrhosis was determined in 5, choledocholithiasis in 3, autoimmune hepatitis in 2, and toxic hepatitis in 2 patients. Cholecystitis, alcoholic hepatitis, immune hemolytic anemia, hyperthyroidism, ischemic hepatitis, urosepsis, and cholestasis of pregnancy were determined in 1 patient each. Ultrasonography was performed in all patients, endoscopic retrograde cholangiopancreatography in 13, percutaneous transhepatic cholangiography in 5, and magnetic resonance cholangiopancreatography in 2 patients. Thirty-five patients were treated medically, 8 endoscopically, and 5 by invasive and 2 by surgical methods. The mortality rate was found as 30% (15 patients) in the three-month followup period. Eleven of these were patients with malignancies. Conclusions: The most common causes of serious jaundice were found as malignancy and viral hepatitis. In advanced ages, malignancy should be considered first in patients whose bilirubin levels are above 5 mg/dl.
