Correlation of hepatobiliary ultrasound findings with liver enzyme assays in adult patients with jaundice at Moi Teaching and Referral Hospital-Kenya

Abstract

Background: Jaundice is a common manifestation of hepatobiliary disease and is associated with significant morbidity and mortality. The differential diagnosis of jaundice and subsequent management of these patients heavily relies on ultrasound and serum liver enzyme findings. Correlation of the two is therefore important in making clinical decisions. Objective: To describe the hepatobiliary ultrasound findings and determine their correlation with serum liver enzymes among adult patients with jaundice at Moi Teaching and referral Hospital, Eldoret, Kenya. Methods- This was an analytical cross-sectional census study conducted at Moi Teaching and Referral Hospital, Eldoret, Kenya between October 2015 and September 2016. Seventy-nine patients aged 18 years and above with jaundice, who had bilirubin as well as liver enzyme test results, and had hepatobiliary ultrasound scans done were enrolled. All the sonograms were reviewed by two consultant radiologists. Ultrasound findings were documented and correlation done with serum liver enzymes. Data was collected using a structured questionnaire and analysis was done using STATA version 13E software. Descriptive statistics were summarized for patient socio-demographics. Frequency tables were generated for categorical variables. Results were presented using tables and charts. Results: Median age of the participants was 34 years (IQR 22-50). Overall, the most common cause of jaundice as determined by ultrasound was acute inflammation of the liver (38%) with reduced echogenicity and a starry sky appearance, followed by pancreatic head mass and liver fibrosis/cirrhosis (11% and 10% respectively). Hepatocellular category of jaundice constituted 56% of the participants while obstructive jaundice constituted 31%. Thirteen per cent of the participants had normal ultrasound findings. Correlation with liver enzymes showed a significant difference in the median ratio of alanine transaminase (ALT): alkaline phosphatase (ALP), also known as the R-value, between obstructive jaundice (R-value 0.15; 95% CI 0.05-0.25) and hepatocellular jaundice (R-value 2.17; 95% CI 0.43-7.3); p0.0001. Conclusion: Acute inflammatory conditions of the liver were the commonest ultrasound finding among adult patients with jaundice, with pancreatic head mass being the commonest among the obstructive type of jaundice. This study has also shown that there is a statistically significant difference between the alanine transaminase: alkaline phosphatase ratio (R-value) for hepatocellular and obstructive jaundice as seen on ultrasound. Recommendation: There should be a high index of suspicion for acute inflammatory conditions of the liver and pancreatic head masses when scanning younger and elderly patients with jaundice respectively. Also, a larger study is recommended to check for true associations between the ALT: ALP ratio (R-value) and hepatocellular and obstructive types of jaundice.