The ultrasonographic pattern of findings seen on hepatobiliary system in patients with jaundice

Abstract

Background: Jaundice is a common presenting sign for various causes of morbidity ~d mortality in Kenya Diagnosing the cause of jaundice needs a multi-displinary approach and various imaging modalities are applied especially to differentiate obstructive versus parenchymal causes and for obstructive causes to identify the site of obstruction. Imaging also provides interventional procedures like biliary drainage and in guided biopsies. Among the various imaging modalities employed include Ultrasonography (US), Computerized . Tomography (CT), Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Resonance Cholangiopancreatography(ERCP) and Percutaneous Transhepatic Cholangiography(PTC) . Study objective:To evaluate the ultrasound pattern offmdings seen in hepato-biliary system in patients with jaundice, assess their frequency, age distribution and relate the findings to clinical diagnosis Study design and setting :A descriptive prospective study carried out at Kenyatta National Hospital and DDIRM University of Nairobi radiology departments. Methodology: A total of 165 patients with clinical and laboratory evidence of jaundice who presented for ultrasound examination and who were eligible for inclusion, were entered prospectively from September 2008 to April 2009. Trans-abdominal ultrasound was carried out to assess the liver, biliary system and the the pancreas for any pathology that could explain the cause of jaundice. Other morphological features were also assessed. Results: One hundred and sixty five patients were studied by ultrasound (mean age 38, range 0-100 years). The main results in frequency were: normal findings (27), hepatitis(19), metastasis (14), hepatocellular carcinoma( 8), liver cirrhosis(12), pancreatic carcinoma (15), gallstones (7), fatty liver(9), gallbladder carcinoma (8) and indeterminate(12). Ancillially investigations done were as follows CT abdomen(22), MRCP(7), DECIDA (1), laboratory tests 27 were positive for hepatitis B and 3 for hepatitis C. HIV positive patients were 24 (14.5%). Surgical exploration was done on 14 patients and biopsies either percutaneous or tissue were done on 32 patients. The main clinical question was on differentiation of obstructive from non-obstructive jaundice, which was achieved in 93% of the cases. Conclusion: The findings in this study were similar to other studies in the causes of jaundice. Ultrasound was able to differentiate obstructive from non-obstructive jaundice. The myriad causes of diffuse liver disease were not accurately differentiated. In obstructive jaundice, the cause and site of obstruction was not accurately determined by ultrasound