The causes of obvious jaundice in South West Wales: perceptions versus reality

被引:85
作者
Whitehead, MW
Hainsworth, I
Kingham, JGC [1 ]
机构
[1] Singleton Hosp, Dept Gastroenterol, Swansea SA2 8QA, W Glam, Wales
[2] Morriston Hosp, Dept Chem Pathol, Swansea SA6 6NL, W Glam, Wales
关键词
jaundice; bilirubin; sepsis; hepatitis; gall stones; questionnaire;
D O I
10.1136/gut.48.3.409
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Aims-(1) A prospective analysis of clinically obvious jaundice (bilirubin >120 mu mol/l) in South Wales to determine accuracy of diagnosis, referral pattern, treatment, and outcome. (2) To compare British gastroenterologists' and local general practitioners' perceptions of common causes of jaundice with our study findings. Methods-Over a seven month period all patients with bilirubin >120 mu mol/l (excluding neonates with physiological jaundice) were identified by a biochemistry laboratory serving three general hospitals and the community. Clinical data were recorded prospectively. Sixty nine consultant gastroenterologists and 67 local general practitioners (GPs) were asked to cite the commonest causes of bilirubin >120 mu mol/l in their experience. Results-A total of 121 patients were identified of whom 95 were admitted to hospital because of jaundice, 22 developed jaundice while in hospital, and four remained in the community. Causes of jaundice were: malignancy 42, sepsis/shock 27, cirrhosis 25, gall stones 16, drugs 7, autoimmune hepatitis 2, and viral hepatitis 2. One in five was wrongly diagnosed, often as viral hepatitis. Although 30% were under surgical care only 4% required surgery. Overall mortality was high (31%) and greatest in sepsis/shock (51%). Gastroenterologists and GPs both perceived malignancy and gall stones to be the commonest causes of marked jaundice followed by viral hepatitis and cirrhosis; sepsis/shock was hardly mentioned. Conclusions-There are important discrepancies between gastroenterologists' and Gps' perceptions of likely causes of jaundice and the actual causes we have shown. In particular, sepsis/shock is common in hospital practice but is overlooked whereas viral hepatitis is rare but perceived as common and overdiagnosed. Gall stones usually cause mild jaundice with bilirubin levels less than 120 mu mol/l. Many patients are referred to surgical services for historical reasons yet rarely require surgery and are usually treated by physicians or endoscopists.
引用
收藏
页码:409 / 413
页数:5
相关论文
共 21 条
[1]   Accuracy of hepatic adverse drug reaction reporting in one English health region [J].
Aithal, GP ;
Rawlins, MD ;
Day, CP .
BRITISH MEDICAL JOURNAL, 1999, 319 (7224) :1541-1541
[2]  
[Anonymous], DIS LIVER BILIARY SY
[3]  
Bach N, 1996, HEPATOLOGY, V24, P959
[4]   LIVER-FUNCTION IN SEPTIC SHOCK [J].
BANKS, JG ;
FOULIS, AK ;
LEDINGHAM, IM ;
MACSWEEN, RNM .
JOURNAL OF CLINICAL PATHOLOGY, 1982, 35 (11) :1249-1252
[5]  
BJORNEBOE M, 1967, ACTA MED SCAND, V182, P491
[6]   EVALUATION OF BILIRUBIN IN A LIVER SCREENING PANEL [J].
BROWN, AN ;
SHEINER, LB ;
COHEN, SN .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1992, 268 (12) :1542-1542
[7]  
Byron D, 1996, HEPATOLOGY, V24, P813
[8]   Clinicopathology conferences: Inflammation-induced cholestasis [J].
Crawford, JM ;
Boyer, JL .
HEPATOLOGY, 1998, 28 (01) :253-260
[9]  
FRANSON TR, 1985, REV INFECT DIS, V7, P1
[10]   Clinical hepatology: Alcoholic liver disease, not viral hepatitis, predominates in South Wales [J].
Kingham, JGC .
HEPATOLOGY, 1997, 25 (05) :1297-1297