Etiology and epidemiology of obstructive jaundice in Continental Croatia [Etiologija i epidemiologija opstrukcijske žutice u kontinentalnoj Hrvatskoj]

Gudelj Gračanin, Ana and Kujundžić, Milan and Petrovečki, Mladen and Romić, Željko and Rahelić, Dario (2013) Etiology and epidemiology of obstructive jaundice in Continental Croatia [Etiologija i epidemiologija opstrukcijske žutice u kontinentalnoj Hrvatskoj]. Collegium Antropologicum, 37 (1). pp. 131-133. ISSN 0350-6134

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Abstract

The etiology and epidemiology of obstructive jaundice in Continental Croatia has been studied in 174 patients. The objective of this research was also to explore the importance and efficiency of endoscopic retrograde cholangiopancreatography (ERCP) as a non-surgical method of treatment of obstructive jaundice in the population of Continental Croatia. Obstructive jaundice is the illness of elderly population which is also confirmed by the information on the average age of our patients. The frequency of illness is higher among female population, and the most frequent cause of obstructive jaundice are gallstones (54.1% of patients). In 29.8% of patients the primary or secondary malignant disease was the cause of blockage in gall flow and subsequent jaundice, and the most frequent malignant cause of obstructive jaundice is pancreas cancer in 11.5% of patients. The mean value of serum concentrations of total bilirubin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and gamma glutamiltransferase 24 hours before the biliary decompression by ERCP has been significantly above the upper referential value, and 24 hours after the ERCP it has dropped to normal with their statistically significant difference (p < 0.0001). The normal values of markers for synthetic liver function (total proteins and prothrombin time) have been noticed as well as elevated values of inflammatory markers in obstructive jaundice independently of etiology. Out of the total number of patients, 37.7% required the surgical treatment while 60.3% of patients were treated by ERCP, i.e. either the stone extraction or the implantation of endobiliary stent was performed.

Abstract in Croatian

U radu je istraživana etiologija i epidemiologija opstrukcijske žutice područja kontinentalne Hrvatske kod 174 ispitanika. Cilj ovog istraživanja također je bio istražiti značaj i učinkovitost endoskopske retrogradne kolangiopankreatografije (ERCP) kao nekirurškog načina liječenja opstrukcijske žutice u navedenoj populaciji. Opstrukcijska žutica je bolest starije životne skupine s čim je u skladu podatak da je prosječna dob naših ispitanika bila 67 godina. Učestalost oboljenja veća je u ženskoj populaciji budući su najčešći uzrok opstrukcijske žutice žučni kamenci (u 54,1% bolesnika). U 70.2 % bolesnika uzrok opstrukcijske žutice je bio benigan, dok je kod 29,8% bolesnika primarna ili sekundarna maligna bolest uzrokovala zastoj u protoku žuči i posljedičnu žuticu. Najčešći maligni uzrok opstrukcijske žutice je karcinom gušterače u 11,5% bolesnika. Srednje vrijednosti serumske koncentracije ukupnog bilirubina, alkaline fosfataze, aspartat aminotransferaze, alanin aminotransferaze i gama glutamiltransferaze 24 sata prije bilijarne dekompresije ERCP-om su bile znatno iznad referentnih vrijednosti, a 24 sata nakon ERCP padaju na normalu uz statistički značajnu razliku. Uočene su uredne vrijednosti biljega sintetske funkcije jetre (ukupnih proteina i protrombinskog vremena) i povišene vrijednosti upalnih biljega kod opstrukcijske žutice neovisno o etiologiji. Od ukupnog broja ispitanika 37,7% je zahtijevalo kirurški tretman, dok je 60,3% liječeno metodom ERCP-a, tj. učinjena je ekstrakcija kamenaca ili implantacija endobilijarnog stenta.

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