Exploration Of Etiological Factors Analysis And Diagnosis Of Cholestatic Jaundice

Background and purposeJaundice is the phenomenon that the increased level of bilirubin in the blood leads to the sclera, skin, mucosa, other tissues and body fluids stained yellow. Normal subjects’serum total bilirubin (TBIL) is lower than17.1μmol/L, direct bilirubin (DBIL) is lower than3.42μmol/L, indirect bilirubin (IBIL) below13.68μmol/L. When the serum bilirubin ranged from17.1to34.2μmol/L, the skin and sclera stayed normal in clinic, called invisible jaundice. When the serum bilirubin is more than34.2μmol/L, it appears jaundice clinically. In this study, it is the diagnostic criteria for jaundice. Jaundice is not an independent disease, but a symptom or a sign of many diseases, common in certain diseases of the hepatobiliary, pancreas and blood system, and other diseases may occur. According to etiology, we can classify the jaundice①Hemolytic jaundice;②Hepatocellular jaundice;③Bilirubin metabolism defects jaundice;④Cholestatic jaundice. Hemolytic jaundice can be definitely diagnosed depend on its high specificity and sensitivity in hematologic tests, hepatocellular jaundice often follows a clear Pathogeny and primary disease, according to the laboratory examination and auxiliary examination can definitely diagnosis, the incidence of bilirubin metabolism defective jaundice is usually very low, but cholestatic jaundice has many types, and the etiologies are complex. Current difficulty and hotspot is the diagnosis of cholestatic jaundice. Cholestasis is the liver lesions which caused by the abnormal of bile formation, secretion, excretion from all causes, or the damage of the liver cells and bile duct cell damage and bile duct obstruction. According to the presence or absence of biliary obstruction, it is divided into non obstructive cholestasis and obstructive cholestasisthe, the former is also called intrahepatic cholestasis, the latter is divided into intrahepatic obstructive and extrahepatic obstructive cholestasis, clinical manifestations are fatigue, Jaundice and itching. This article through the retrospective analysis of these cases to explore the etiology and diagnosis of cholestatic jaundice.MethodsDuring January2011to December2011in our hospital, the patients who diagnosed jaundice of unknown origin excluded cases under the age of15, we choose the200cases with a hospital diagnosis of cholestatic jaundice, access to medical records and notes the following items:gender, age, ALT, AST, GGT, ALP, and other Laboratory tests and ancillary tests to determine etiology. Using SPSS18.0software for statistical analysis, the measurement data using t test, count data using the x2test and the Wilcoxon rank sum test, p<0.05has statistical significant.Results1. Cholestatic jaundice is divided into intrahepatic cholestasis (non-obstructive cholestasis) and obstructive cholestasis. Intrahepatic cholestasis is commonly in viral hepatitis, drug-induced liver disease and hepatitis cirrhosis. Viral hepatitis mostly are HBV and HVC infection, drug-induced liver disease mostly are caused by traditional Chinese medicine and anti-TB drugs, obstructive cholestasis is majority of bile duct stones, and hepatobiliary and pancreatic malignancies.2. Viral hepatitis, hepatitis cirrhosis, alcoholic liver disease, liver cancer incidence of male patients was significantly higher than women, bile duct stones, gallbladder cancer, primary biliary cirrhosis incidence of female patients was significantly higher than men, according to x2test, p<0.05, and have statistical significance.3. The incidence of viral hepatitis of youth and middle age group was significantly higher than the older group; the incidence of liver cirrhosis after hepatitis, malignancy (cholangiocarcinoma, liver cancer, gallbladder cancer, pancreatic cancer) of middle-aged group and elderly group was significantly higher than the young group, according to x2test, p<0.05, and have statistical significance.4. Compared with benign cholestatic jaundice, serum GGT, ALP rises significantly in malignant cholestatic jaundice, the difference has statistical significance (P<0.05). Conclusions1．When diagnose cholestatic jaundice,①First, determine whether there is cholestasis;②Second, using ultrasound examination to ensure whether there is bile duct dilatation and judge intrahepatic cholestasis or obstructive cholestasis;③To ensure etiology:if it is obstructive cholestasis, further check to identify the site of obstruction (intrahepatic or extrahepatic) and etiology(stones, inflammation, parasites, tumor or congenital.)as well as the etiology (stones, inflammation, parasites, tumor or congenital etc.); If it is intrahepatic cholestasis, the first consideration are virus infection, liver cirrhosis after hepatitis, drug-induced liver disease and alcohol liver disease, when the virological examination is negative and no alcohol and no poison of medication history, we need to consider if there is autoimmune liver disease.2. When diagnose cholestatic jaundice, male patients may first consider viral hepatitis, hepatic cirrhosis after hepatitis, alcoholic liver disease, liver cancer, women can first considered gallstones, gallbladder carcinoma, primary biliary cirrhosis, and do different examinations on purpose3. When diagnose cholestatic jaundice, young patients first consider viral hepatitis, when do etiology inspection, in addition to the common HBV, HCV infection, we cannot ignore HAV, HEV and Non-Hepatotropic cell virus EBV, CMV infection, the elder first consider liver cirrhosis after hepatitis and malignant tumor.4. When serum GGT and ALP were significantly increased of cholestatic jaundice, we should alert the possibility of malignant tumor.