Pattern of Liver Biochemical Profile Restoration Following Biliary Decompression in Benign and Malignant Conditions

Liver functions tests (LFTs) are used for determining the presence of liver disease that suggest the underlying cause, estimate the severity, assess prognosis and monitor efficacy of therapy. Altered LFTs may be the first indication of subclinical liver disease and may thereby guide further diagnostic evaluations. Specific pattern of liver test abnormalities may suggest the category of the underlying liver disease such as, hepatitis, biliary obstruction or infiltrative liver disease. Severity of liver dysfunction, especially when performed serially, may predict prognosis and their sequential measurements may be helpful in assessing response to medical therapy or a surgical intervention. This was a prospective study including fifty (50) cases of surgical obstructive jaundice admitted to the department of General and GI surgery in Command Hospital (western command), Chandimandir. The data was collected in all these patients in terms of age, sex, clinical presentation, etiology, total duration of stay in hospital, Surgical intervention carried out for biliary decompression and the laboratory liver biochemical and coagulation profiles on a day prior (D-1) to surgical intervention and post-operatively on 3 , 7 and 28 day were also recorded. A total of 50 patients were included in the study; of these 21 were males and 29 were females with a male to female ratio of 3:4. Duration of illness ranged from 7 to 60 days with a mean duration of 18 days. Age of patient population ranged between 26-72 years with a mean age of 52 years. Of the fifty patients, 17 had a benign and 33 had an underlying malignant cause for obstruction. Hepatomegaly and palpable gallbladder were observed in all the malignant lesions and distinguished them clinically from the benign conditions. Clay coloured stools and pruritis was more frequent in patients with underlying malignancy (66% & 81%) as compared to patients with benign conditions (29% & 41%). Serum bilirubin and transaminases were significantly higher (p<0.000) in patients with malignant lesions on different days of pre-op and postoperative assessment, however, a better biochemical recovery profile was observed in patients with benign lesions. Pre-operative serum bilirubin levels gave an indication towards the nature of obstructive lesion (benign or malignant). After decompression the rate of fall of Serum bilirubin, ALT & AST were almost identical in both benign and malignant biliary obstructions. However, a better biochemical recovery profile was observed in patients with benign lesions, as they returned to normal by 4 weeks but remained at 3 to 4 times of the normal in malignant lesions. Thus, sequential biochemical assessment of liver functions has diagnostic as well as prognostic value in surgical obstructive jaundice.