A Prospective Study of Evaluation and Management of Obstructive Jaundice in a Tertiary Care Hospital, North Coastal Andhra Pradesh

BACKGROUND Obstructive jaundice is defined as a condition occurring due to block in pathway between the site of conjugation of bile in liver cells and entry of bile into duodenum through the ampulla. This block may be intraheptic or extraheptic in the duct. Evaluation and management of obstructive jaundice is a challenging task to the surgeon owing the varied etiology and wide management option. Common bile duct (CBD) varies in length from 5 to 15 cm with average diameter of 6 mm. CBD can be divided in to four portions: supra duodenal, retro duodenal, intra duodenal and intramural portion. The purpose of this study was to evaluate the pattern of aetiology of obstructive jaundice in these parts and compare the clinical and laboratory presentations with obstructive jaundice between benign and malignant cases. METHODS This is a prospective analytical study. Patients with obstructive jaundice who attended the outpatient department of Surgery, GITAM Institute of Medical Sciences and Research, Visakhapatnam over a period of 24 months from November 2017 to October 2019 were admitted and taken up for the study. A total of 60 cases were studied. RESULTS Abdominal pain was a presenting symptom in 48 patients (80 %). Ninety five percent of patients of benign and 50 % of patients of malignant aetiology presented with this symptom. P value was found to be statistically significant for this symptom. This means that jaundice with pain in abdomen is more common in benign conditions while malignant conditions cause painless jaundice. CONCLUSIONS Malignant obstructive jaundice is most commonly seen in males while benign conditions are more common in females. Benign conditions causing obstructive jaundice is most common under 40 years of age while malignant obstructive jaundice is commonly seen between 50 and 60 years of age. KEYWORDS Cholestasis, Extraheptic, Obstructive Jaundice