scholarly journals Diagnostic laparoscopy in acute abdominal pain

2019 ◽  
Vol 6 (4) ◽  
pp. 1104
Author(s):  
Ravichandran Subramaniam
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Laparoscopy ◽  
Acute Abdominal Pain ◽  
Tertiary Care ◽  
Medical Science ◽  
Ovarian Torsion ◽  
Care Hospital ◽  
Number Of Patients ◽  
Study Results

Background: Acute Abdominal pain is an important surgical problem in all age groups. Early diagnosis is needed to rule out life threatening conditions. Diagnostic laparoscopy is a modern useful tool in giving proper treatment for all needed individuals. The aim of the present endeavor is to study the use of laparoscope in patients with acute pain over the abdomen, to diagnose and confirm conditions like acute appendicitis, appendicular abscess, doudenal perforation, ileal perforation. Ovarian torsion. mass formation, etc. where clinical and imaging studies are inconclusive.Methods: This study was conducted in the tertiary care hospital and the Department of General Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Science and Research, Melmaruvathur. The period of study was from June 2017 to May 2018. All patients coming to the hospital with acute abdominal pain in the age group of ten years to seventy years were included in this study. Results: Majority of the patients had the findings relevant to the correct clinical diagnosis. However significant number of patients had unexpected findings and so the diagnosis was changed, and treatment also changed. Total 100 patients were included in this prospective study. 79 patients were found to have acute appendicitis. Duodenal perforation seen in 7 patients. Jejunal perforation seen in 2 patients. Mesenteric ischemia seen in 1 patient. Acute cholecystitis seen in 3 patients. Gall bladder perforation seen in 1 patient. Ectopic pregnancy was seen in 2 patients. Ovarian torsion seen in 3 patients. Ileocecal tuberculosis seen in 1 patient. No abnormality seen in 1 patient.Conclusions: The best approach in abdominal pain is to do diagnostic laparoscopy and proceed, rather than going for open laparotomy. Diagnostic laparoscopy gives all benefits of minimal invasive surgery. Not much of pain, shorter period of hospitalization, small scars, low infection rates and most importantly, accurate diagnosis and the correct treatment of most of the intra-abdominal conditions are the gifted things.

ORAL IRON VERSUS PARENTERAL IRON SUCROSE IN A RURAL TERTIARY CARE HOSPITAL OF SOUTHERN INDIA

2021 ◽  
pp. 48-50
Author(s):  
Ravindra S Pukale ◽  
Kavyashree H B
Keyword(s):  
Tertiary Care ◽  
Mode Of Delivery ◽  
Cell Mass ◽  
Medical Science ◽  
Oral Iron ◽  
Iron Sucrose ◽  
P Value ◽  
Care Hospital ◽  
Study Results ◽  
Group B

Introduction: Nutritional iron deciency is one of the most common deciency disorders affecting more than one billion people, with pregnant women at particular risk. In pregnancy iron decit attributable due to increased iron demand of the feto-placental unit and an increase in maternal red cell mass. 30% of anaemic women have haemoglobin levels below 10g/dl above 10% below 8g/dl. Irrespective of mode of delivery blood loss can also be a contributing factor postnatal. Oral iron therapy and intravenous iron sucrose are the main therapy of iron deciency anaemia. The present study is aimed at comparing both their efcacy side effects. METHOD : Aprospective randomised control study was done from June 2019- September 2020, in the department of Obstetrics and gynaecology, Adichunchanagiri Institute of Medical Science, BG nagara. 253 women including antenatal women between 8-38 weeks gestational age were studied and postnatal women studied with no associated obstetrics and medical complication. They were divided into Group A (Oral) and Group B(Intravenous) by randomization. The two groups were monitored clinically, and for an improvement in laboratory parameters after four weeks on day 30 haemoglobin and haematocrit were repeated in both the groups. This study results were expressed as mean +/- standard deviation. And to test the signicance of difference between Oral and IVmode of treatment, student Ttest was done to verify the statistical signicance. RESULTS: Out of 253 patients in the study the mean age of ANC patients was 24.7+/- 4.4years. Mean age of PNC patients was 24.15+/- 3.5years. The peripheral smear showed Dimorphic anaemia in 9.1% and Microcytic Hypochromic picture in 90.9 % of the patients. Initial haemoglobin of ANC patients was 9.8+/- 0.3g/dl. The initial haemoglobin of PNC patients was 9.73+/- 0.91g/dl. 59.3% of the patient had a haemoglobin between 7.1 and 10.0g/dl. Final haemoglobin of an ANC patient was 11.68+/-0.98g/dl, PNC patients 11.69+/-0.99g/dl. There was a substantial increase in Group Ahaemoglobin (oral iron) raising from 10.2+/-7.2g/dl to 12.0+/-0.92g/dl with a T value of 9.25. as well as in Group B (iron sucrose) raising from 9.3+/-8.5g/dl to 11.3+/-0g/dl with T value of 5.65. In both cases this raise in haemoglobin after four weeks had a p value less than 0.01 which was highly statistically signicant. Conclusion:Intravenous iron sucrose is more effective than oral iron for correction of anaemia with lesser side-effect

APPENDICITIS IN PREGNANCY : OUR CLINICAL EXPERIENCE AT A TERTIARY CARE CENTRE

2021 ◽  
pp. 22-23
Author(s):  
Anil Kumar ◽  
Rekha Rani ◽  
Hamid Wani
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
Tertiary Care ◽  
Fetal Loss ◽  
Common Symptom ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Lower Quadrant ◽  
Number Of Patients

Objective: Acute appendicitis is a common surgical condition presented to emergency. In this study we evaluated the clinical presentation, management and outcome of acute appendicitis complicating pregnancy at a tertiary care centre. Material And Methods: A total of 20 cases of pregnant women who were diagnosed as a case of acute appendicitis were studied from January 2018 to December 2020. Results: Total number of patients diagnosed with acute appendicitis were 20. There were 10 (50%) patients in rst trimester , 6 (30%) in second and 4 (20%) in the third trimester. Abdominal pain was the most common symptom seen in all patients. 12 (60%) patients were multigravida whereas 8 (40%) patients were primigravida. Duration of abdominal pain was 6 hours to 5 days with median of 30 hours. Right lower quadrant was the most common site of pain. Rebound tenderness was seen in 14 (70%) patients. Total leucocyte was raised in 14 (70%)cases. Ultrasound was done in all patients showing viable fetus and features of acute appendicitis in 12 (60%) cases. Surgery was done in 16 (80%) cases. Midline laparatomy was done in 3 patients whereas 4 (20%) patients were managed conservatively with antibiotics. Postoperative tocolytics were given in 6 patients. Postoperative complications such as wound infections seen in 5 cases and pelvic abscess in 1 case. Fetal loss was seen in 2 (10%)cases. Conclusion: Diagnosis of acute appendicitis during pregnancy can be difcult due to anatomical and biochemical changes during pregnancy. Correct diagnosis can be achieved by taking proper history, clinical examination and relevant investigations. Surgery remains the treatment of choice.

scholarly journals A study of correlation between clinical, radiological and pathological diagnosis of appendicitis: a retrospective analytic study

2018 ◽  
Vol 5 (9) ◽  
pp. 3011
Author(s):  
Prabhu R. ◽  
Vijayakumar C. ◽  
Balagurunathan K. ◽  
Senthil Velan M. ◽  
Kalaiarasi R. ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Scoring System ◽  
Acute Abdominal Pain ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Radiological Finding ◽  
Clinical Signs ◽  
Emergency Setting ◽  
Alvarado Score

Background: Acute appendicitis is the most common cause of acute abdominal pain in young adults requiring emergency surgery. Appendicectomy is the most frequently performed surgery. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. A combination of clinical signs and symptoms with laboratory findings in many scoring systems are suggesting the probability of appendicitis and the possible subsequent management pathway. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological finding and histopathological examination for the diagnosis of acute appendicitis.Methods: A retrospective study was conducted in the department of general surgery in a tertiary care centre in South India. Total of 237 patients with acute abdominal pain were included and evaluated with the clinical Alvarado scoring system, radiological finding with (USG/CT abdomen) and histopathological examination for the diagnosis of acute appendicitis. The data was collected and analyzed retrospectively.Results: Of the 237 patients, 164 patients were male (69.1%) and rest is female. The correlation of the Alvaroda score with histopathological findings in groups with score > 7 and ≤7 the correlation of Alvarado score and the ultrasound findings were comparable between the study groups. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score >7 was 72.99%. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score ≤7 was decreased to 27%.Conclusions: The diagnostic accuracy of clinical features is far better than radiological investigations in the diagnosis of acute appendicitis. Therefore, it is concluded that it is better to use radiological investigations only to confirm the diagnosis of acute appendicitis rather to diagnose it.

scholarly journals THE PHARMACOECONOMIC IMPACT OF GASTRO-PROTECTIVE AGENTS AT A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 92-96
Author(s):  
NIRUPAMA KULKARNI ◽  
MOPIDEVI RASI ◽  
NAZARIYA NIZAR ◽  
NISHOJA DAVID ◽  
PRASAD N BALI ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Cost Benefit Analysis ◽  
Tertiary Care ◽  
Medical Science ◽  
Cost Effective ◽  
Care Hospital ◽  
Statistical Tool ◽  
Protective Agents ◽  
Cost Effective Treatment ◽  
Study Results

Objectives: The study aimed to evaluate the pharmacoeconomic impact of gastro-protective agents (GPA) by carrying out cost-benefit analysis (CBA) and cost-effective analysis (CEA). Methods: This prospective observational study was carried out by simple randomization technique at Karnataka Institute of Medical Science, Hubballi. Data used were socio-economic details based on modified B. G Prasad scale. Current Index of Medical Specialists updated version March 2021 was used for CBA and CEA. Regression analysis was the statistical tool used in the study. Results: A total of 120 participants were included in the study. 57.5% were male and 42.5% were female. 3.33% were pediatrics, 32.5% were young adults, 37.5% were elder adults and 26.67% were geriatrics. Out of 120 samples, 94 participants were prescribed with pantoprazole, other drugs prescribed include domperidone and pantoprazole, rabeprazole, and ranitidine. The CBA revealed ratio of benefits over costs for pantoprazole was 3.86, ranitidine was 9.31, pantoprazole and domperidone was 0.84 and rabeprazole was 0.84. Additional cost of 138.30 Indian Rupee must be spent on pantoprazole over ranitidine to get cost-effective treatment without disease for one whole year. Conclusion: The CBA revealed that maximum patients received benefits for pantoprazole. CEA gives an idea on best effective treatment over two drugs of different class. Our study concludes that pantoprazole is deemed to be superior over other drugs of GPA prescribed among study participants.

EVALUATION OF MODIFIED ALVARADO SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS AT TERTIARY CARE HOSPITAL IN WESTERN RAJASTHAN

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Anil Kumar Dadhich ◽  
Atul Kumar Sharma
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdominal Pain ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Alvarado Score ◽  
Common Complaint ◽  
Emergency Department Patients ◽  
Modified Alvarado Score ◽  
High Degree

Background: Acute abdominal pain is a common complaint among emergency department patients. Methods:  A 100 consecutive patients suspected of acute appendicitis who were admitted in department of surgery. They were prospectively evaluated using the modified Alvarado scoring (MAS) to determine whether or not they had acute appendicitis. Result: In present study, out of total 100 patients 78(78%) were have MAS score 7-9, 20% were have 5-6 and 2% have MAS score 1-4. Conclusion: The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy. Keywords: Modified Alvarado Score (MAS), acute appendicitis, Patients.

scholarly journals Pattern of Paediatric Rheumatic Diseases: An Experience in a Tertiary Care Hospital, Dhaka, Bangladesh

2013 ◽  
Vol 37 (2) ◽  
pp. 97-101 ◽  
Author(s):  
Mohammad Imnul Islam ◽  
Manik Kumar Talukdar ◽  
Shahanaa Rahman
Keyword(s):  
Systemic Sclerosis ◽  
Rheumatic Diseases ◽  
Early Recognition ◽  
Tertiary Care ◽  
Classification Criteria ◽  
Care Hospital ◽  
Number Of Patients ◽  
Study Results ◽  
Childhood Vasculitis ◽  
Paediatric Rheumatic Diseases

Background: The importance of Paediatric Rheumatic Diseases (PRDs) is increasing globally day by day. These diseases are considered as important chronic cause of childhood morbidity and disability. It is recognized that early recognition and diagnosis as well as timely intervention can improve the outcome of PRDs. Objective: To estimate the pattern of PRDs and to compare the profile of JIA with other studies were done abroad. Method: Retrospective study was done in the paediatric rheumatology clinic and in patient department of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the study period from July 2007-December 2012. All the patients fulfilling the ILAR classification criteria of Juvenile idiopathic arthritis (JIA), ACR classification criteria of systemic lupus erythematosus ( SLE), PReS-EULAR-PRINTO classification criteria of childhood vasculitis Bohan A, Peter JB Classification criteria for juvenile dermatomyositis (JDM) and preliminary criteria for the classification of systemic sclerosis (SS) were enrolled in this study. Results: A total of 540 patients were enrolled. Highest number of patients had JIA (77%), which was followed by SLE (10%). Among childhood vasculitis, Henoch Shonlein purpura (HSP) was predominant (4.2%) followed by Polyarteritis nodosa (1.9%) and Kawasaki Disease (0.6%). Juvenile dermatomiositis (JDM), systemic sclerosis (SS) and rheumatic fever was also found in 1.6%, 1.3% and 3% cases respectively. Polyarticular JIA was the commonest type (33 %) in this series, followed by oligoarthritis, systemic onset and enthesitis related arthritis (ERA). Conclusion: JIA was the commonest among the paediatric rheumatic diseases followed by SLE and childhood vasculitis. DOI: http://dx.doi.org/10.3329/bjch.v37i2.17267 BANGLADESH J CHILD HEALTH 2013; VOL 37 (2) : 97-101

scholarly journals Laparoscopy: a tool for undiagnosed pain abdomen

2018 ◽  
Vol 5 (10) ◽  
pp. 3350
Author(s):  
Arpit Sharma ◽  
Deepak Sethi ◽  
Anjali Sethi
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Laparoscopy ◽  
Clinical Symptoms ◽  
Histopathological Examination ◽  
Abdominal Cavity ◽  
Tertiary Care ◽  
Care Hospital ◽  
Chronic Appendicitis ◽  
Pain Abdomen

Background: Diagnostic laparoscopy has been in the armamentarium of the surgeon and gynaecologist for many years as a useful technique for evaluating pelvic pathology and it is now one of the most frequently performed laparoscopic procedures. The purpose of this study is to evaluate the role of diagnostic laparoscopy in undiagnosed pain abdomen. The Objectives of this study is to evaluate laparoscopy as a diagnostic tool in cases of undiagnosed abdominal pain where clinical symptoms and investigations are not conclusive and to evaluate benefits and complications of diagnostic laparoscopy.Methods: The study was done in 60 patients, presenting with chronic undiagnosed pain abdomen to a tertiary care hospital. All the patients were operated under general anesthesia in supine position. Diagnostic laparoscopy was done using 3 ports, one umbilical 10 mm, other two depending upon possible pathology. After the study, the data was analyzed to evaluate the role of laparoscopy in undiagnosed abdominal pain.Results: Out of 60 patients, 44 were female and 16 males. On diagnostic laparoscopy, findings were- chronic appendicitis - 31, chronic appendicitis with left ovarian cyst - 1, endometriosis with adhesions - 3, PID - 5, PID with adhesions - 3, suspected TB (GI/Genital) - 4, adhesions - 12, negative diagnostic lap - 1. So it may be concluded that diagnostic laparoscopy is a very useful tool to establish diagnosis in patients with undiagnosed abdominal pain with the following benefits are, superior diagnostic ability, better visualization of the abdominal cavity including the paracolic gutters and the pelvis, able to pin point the sites of adhesions with adhesiolysis during the same procedure, retrieval of specimen for histopathological examination, management of the pathology during the same procedure, avoiding unnecessary laparotomy, low complication rate.Conclusions: Laparoscopy is an efficient tool in the armamentarium of the surgeon to diagnose the patients of undiagnosed pain abdomen with numerous benefits and minimal complications.

scholarly journals Measurement of antibiotic consumption in surgical ward of a tertiary care hospital

2020 ◽  
Vol 9 (10) ◽  
pp. 1565
Author(s):  
Rashmi R. Pujari ◽  
Bhabagrahi Rath ◽  
Tapan Kumar Nayak
Keyword(s):  
Antibiotic Resistance ◽  
Average Length ◽  
Tertiary Care ◽  
Medical Science ◽  
Antibiotic Consumption ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Number Of Patients ◽  
Improper Use ◽  
Bed Days

Background: Antibiotic resistance is a global health problem. Improper use of antibiotics leads to development of antibiotic resistance, side effects, superinfections and increase in treatment costs. There are few publications on antibiotic consumption. Serious morbidity and mortality are associated with postoperative wound infections. The use of peri or pre-operative antibiotics has resulted in a reduced risk of postoperative infection when appropriate principles of prophylaxis are applied.Methods: An observational study during a 2-month period was carried out in the department of surgery of Veer Surendra Sai Institute of Medical Science and Research, Burla. We utilized the administrative data for expression of antibiotic consumption using anatomical therapeutic classification (ATC) / defined daily dose (DDDs) methodology. The information included were drug names, strength, pharmaceutical form, quantity dispensed, total number of patients admitted during the study period and average length of stay. Each drug was then given a code according to the ATC classification. The number of DDDs and DDDs/100 bed days was calculated.Results: The most frequent antibiotic used was cephalosporin group with DDDs 62.70 DDDs/100 bed days (44.34%) followed by metronidazole with 23.10 DDDs/100 bed days (16.34%). Among cephalosporin group most common antibiotic used was ceftriaxone with 24.46 DDDs/100 bed days. The mean duration of stay was 7.2 days.Conclusions: The results of this study are similar to previous studies and it showed that there is irrational use of antibiotics as there is no antibiotic policy in our hospital. Drug utilization research should be carried out at frequent intervals to improve rational use of antibiotics.

Risk Factors Associated with Peritoneal Involvement in Acute appendicitis in Territory of Punjab, Pakistan

2021 ◽  
Vol 15 (11) ◽  
pp. 3076-3077
Author(s):  
Fauzia Siraj ◽  
Rabbiah Manzoor Malik ◽  
Zafar Iqbal ◽  
Rifat Shamim ◽  
Attya Zaheer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Appendicitis ◽  
Tertiary Care ◽  
Previous History ◽  
P Value ◽  
Care Hospital ◽  
Factors Associated ◽  
Time Of Surgery ◽  
Number Of Patients ◽  
History Of

Aim: To study the frequency and factors associated with peritoneal involvement among patients operated for acute appendicitis in a tertiary care hospital. Place and duration of study: Department of Surgery, Benazir Bhutto Hospital Rawalpindi Pakistan from 1stJuly 2020 to 30thJune 2021. Methodology: This comparative cross-sectional study 500 patients diagnosed as acute appendicitis and operated by consultant surgeon were included. Peritoneal involvement was defined as signs of inflammation or infection on abdominal lining observed by operating surgeon during the time of surgery. Factors like age, gender, presence of comorbid illnesses and history of previous abdominal surgeries were associated with presence of peritoneal involvement. Results: There were 305 (61%) males while 195 (39%) were females with mean age was 32.331±4.544 years.Four hundred and forty two (88.4%) did not show any peritoneal involvement at the time of surgery while 58 (11.6%) had peritoneal involvement. Chi-square test revealed that history of previous abdominal surgeries and advancing age had statistically significant association with peritoneal involvement among the study participants (p-value<0.05). Conclusion: Peritoneal involvement was found in considerable number of patients operated as acute appendicitis by the treating surgeons. Patients with previous history of abdominal surgeries and advancing age were more at risk of having peritoneal involvement in our study. Keywords: Acuteappendicitis, Peritonitis, Risk factors, Frequency

Sign in / Sign up

Export Citation Format

Share Document