An inquiry of Obstructive Jaundice at Tribhuvan University Teaching hospital, Katmandu, Nepal

Abstract

Abstract This degree project in medicine, “An inquiry of Obstructive Jaundice at Tribhuvan University Teaching hospital, Kathmandu, Nepal” written by Sabina Delin, medical student at the University of Gothenburg, Sweden, 2018. Introduction: No previous studies have been made in Nepal concerning the causes and symptoms of obstructive jaundice. This study explores correlations between the disease and sex, age, underlying causes and symptoms. Method: The study consisted of two parts. The first was a retrospective study where one-hundred-and-ten patients were included. Their medical records were used as a basis. The other was a prospective cross-sectional study where eighteen patients were included, of the one-hundred-and-ten patients from the retrospective part. A patient form and their medical records were used to collect data. Results: Retrospective data: 110 patients were included. There were 61 (55.5 %) females and 49 (44.5 %) males. About half of the patients had a malignant cause to the disease and half had a benign cause. The mean age of the patients with malign cause was 61 years compared to the mean age of 47 years for those with benign cause. There was a difference of 14 - years in mean difference. The most common cause was distal cholangiocarcinoma (15.5%) followed by pancreatitis (13.6%). The most common presentation of obstructive jaundice (presented as percentage of how many patients had each symptom) was jaundice (79.1%), other symptoms (58.2%), RUQ - pain (40.9%), itching (38.2%), anorexia/loss of appetite/loss of weight (38.2%) and epigastric pain (37.3%. Prospective cross-sectional data: 18 patients were included, of these were 11 (61.1%) women and 7 (38.9%) men. There were 10 (55.6%) malign cases, 6 (33.3%) benign cases and 2 (11.1%) patients with unknown cause. The mean age of the patients with malign cause was 62 years compared to the mean age of 34 years for those with benign cause. There was a difference of 28 years in mean difference. Hilar cholangiocarcinoma was the most common cause of all followed by bile duct injury. The presenting symptoms noted in the medical journals were jaundice 58.8 %, itching 41.2%, anorexia/weight loss/loss of appetite 35.3%, RUQ - pain 35.3%, fever without chills 35.3%, clay-coloured stool 29.4%, other symptoms 29.4%, dark urine 17.6%, epigastric pain 17.6 % and fever with chills 5.9%. The symptoms found in the patient forms were jaundice 83.3%, itching 77.8%, RUQ - pain 55.6%, fever with chills and rigor 33.3%, clay-coloured stool 38.9% and dark urine 61.1%. Conclusions: It is more common for older people to have a malignant cause of obstructive jaundice. This study indicates other proportions of the malign spectrum, compared to comparative studies, with distal cholangiocarcinoma as the leading cause. It seems like cholangiocarcinoma is more common in Nepal compared to what studies have shown in neighbouring countries. This indicates a different pattern of care-seeking due to i.e. economic factors or that cholangiocarcinoma as a cause to obstructive jaundice is more common in Nepal and possibly has a hinger incidence in the Nepalese population.