ABSTRACT
Background: Acute appendicitis is the most common cause of acute abdomen in young adults requiring Emergency Surgery. Diagnosing Acute Appendicitis clinically still remains a common surgical problem. Accurate diagnosis can be aided by additional testing or expectant management or both. These might delay surgery and lead to appendicular perforation with increased morbidity and hospital stay. The aim of the study: To study the incidence of hyperbilirubinemia in cases of acute appendicitis and its complications (Gangrenous/ Perforated). Materials and methods: This Prospective study was done in the Department of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital in 2017. Patient admitted with clinical diagnosis of acute appendicitis or its complications (Perforated/ Gangrenous) in the Emergency. Final HPE was considered as a gold standard for diagnosing and categorizing patients as having Normal Appendix, Acute appendicitis and Acute appendicitis with Perforation/Gangrene. Results: Out of 246 cases of Acute appendicitis 42 Cases were Gangrenous/ Perforated Appendix (17.07%). Out of 42 cases of Gangrenous/ Perforated appendix maximum cases seen in the Age group 21-30 years (31%) and least seen in below 10 years (0.0%). Above 50 years no of cases of Gangrenous/ Perforated appendix were 3 (7.1%). Rebound tenderness predominantly present in cases of Gangrenous/ Perforated Appendicitis than Acute appendicitis cases and its statistically significant. Among 246 cases minimum age was 9 and the maximum age was 65 years and the mean age was 24 years. Mean Total leukocyte count was 12687 and Mean polymorph count was 75. Serum mean total T. Avvai, S. Nedunchezian. To study the role of hyperbilirubinemia as a marker of gangrenous/ perforated appendicitis. IAIM, 2019; 6(3): 272-277. Page 273 bilirubin was .92 and maximum was 2.4 Alvarado’s score maximum seen was 10 and least was 5 with mean about 7. Conclusion: Patients with clinical signs and symptoms of Acute appendicitis with raised serum bilirubin should be considered as having high predictive potential for Appendicular gangrene/ Perforation. Serum Bilirubin is an important adjunct in diagnosing the presence of Gangrenous/ Perforated Appendicitis along with other diagnostic aids.
ABSTRACT
Background: Deep vein thrombosis (DVT) is one of the most dreaded complications in postoperative patients as it is associated with considerable morbidity and mortality. The prevalence of Deep Vein Thrombosis (DVT) in various series involving Western population ranges from 15% to 40% among patients undergoing major general surgical procedures. The aim of the study: To identify risk factors of deep vein thrombosis in asymptotic patients after prolonged surgery Age, Gender, Diabetes, Hypertension, COPD, Hyperlipidemia, Renal disorder, liver disorder, duration of surgery, blood transfusion, nature of surgery elective or emergency, type of surgery. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. 100 patients admitted to our hospital for a period of 11 months according to inclusion criteria. All the patients were subjected to handheld doppler study of the deep venous system of both lower limb and ileac system on a postoperative day 2, day 5 and day 7 Confirmation of DVT using duplex scan. Results: The predominant age group was 40-59 years constituting 37% followed by 20- 39 years constituting 36%. 31% of patients were diabetic on insulin and 17% were hypertensive on treatment. D. Princess Beulah, T. Avvai. A comprehensive study on incidence and risk factors of deep vein thrombosis in asymptomatic patient after prolonged surgery. IAIM, 2019; 6(3): 237-242. Page 238 Out of 100, 21 patients were suffering from malignancies. Majorities were carcinoma breast and gastrointestinal malignancies. 33% received injection low molecular weight heparin as prophylaxis. Conclusion: For patients who undergo surgery for a prolonged duration (especially > 3 hours) and prolonged immobilization (> 2 days), it is recommended to screen them with Doppler for the incidence of DVT along with appropriate DVT prophylaxis in the post-op period to avoid morbidity and mortality associated with unforeseen and asymptomatic deep vein thrombosis.
ABSTRACT
Background: Cholelithiasis is a disease prevalent worldwide because of an imbalance of bile salt and cholesterol concentrations that leads to precipitation inside the gallbladder. Gall stones are the most common biliary pathology both in India and western countries. Recent studies concentrate on gall stones and thyroid hormones – T3 and T4 have an effect on both bile content and bile flow. Patients with hypothyroidism have a serum level of cholesterol approximately 50% higher level than in euthyroid patients and 90% of all hypothyroid patients have elevated cholesterol level. Likewise, low levels of t4 have an effect in relaxing the sphincter of odds, leading to biliary stasis and stone formation. The aim of the study: To check thyroid status in patients who are diagnosed with gallstone disease, thereby dividing into euthyroid, hypothyroid, hyperthyroid and subclinically hypothyroid, correlating the prevalence of subclinical hypothyroidism in patients with cholelithiasis. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. Patients were divided according to history, clinical examination, and USG neck and lab estimation of T3, T4, and TSH. Subclinical hypothyroidism: The symptom-free patient with TSH concentration above the upper limit of normal range and T3/T4or both decrease below normal limit. Clinical hypothyroidism: In which there were symptoms of hypothyroidism with TSH level above the upper limit and T3/T4or both decreases below normal limit. Euthyroid group: Where clinical and lab tests were within normal range. Manimegalai, T. Avvai. The prevalence of undiagnosed thyroid dysfunction and diagnosed diseases of gallstones. IAIM, 2019; 6(3): 231-236. Page 232 Results: The predominant age group was 51-60 years constituting 36.67% of patients. Youngest patient age was 21 years and the oldest was 80 years of age. Of the 60 patients, the majority of patients were euthyroid status 52 (86.67%). 6 (10%) patients were subclinical hypothyroidism, 2 (3.33%) were clinical hypothyroidism. Of the 60 patients, 52 were diagnosed with gallstone only and 8 were diagnosed with gallstone and CBD stones. In this study, hyperlipidemia was present in 7 of the hypothyroidism. Conclusion: There is a relationship between thyroid dysfunction particularly hypothyroidism and gallstone diseases. Hypothyroidism is seen more in GB stones patients compare with CBD stone patients. Subclinical hypothyroidism is more common than clinical hypothyroidism. Hypothyroidism has a higher prevalence in females than males. High cholesterol levels are seen in gallstone disease with thyroid dysfunction.