Prevalence of undiagnosed hypothyroidism in patients with gall bladder stones in Belagavi

Background: Contribution of hypothyroidism to gallstone formation is debated over years. With this background, the study intended to analyze the prevalence of undiagnosed hypothyroidism in patients with cholelithiasis. The aim is to understand the prevalence of hypothyroidism in patients with gallstones.Methods: A prospective, hospital-based study was done on 100 patients admitted for the management of gall stone disease in Belagavi. After initial screening, a detailed history was obtained with special reference to symptomatology and the risk factors as per proforma from patients meeting selection criteria. Thyroid function test was done on all eligible patients. Patients were divided into three groups of Euthyroid, Subclinical hypothyroid and clinical hypothyroidism. Statistical analysis used. Percentage of gall stones in different age groups and gender of the study population was calculated followed by prevalence of hypothyroidism and subclinical hypothyroidism in all the patients included.Results: Among the study population, 40% were male and 60% were female. 23 of them have subclinical hypothyroidism and 6 of them were diagnosed with hypothyroidism. Majority of subclinical hypothyroid patients (39.13%) were aged 41-60 years. Hypothyroid symptoms were shown by the study population with unknown thyroid status.Conclusions: The prevalence of hypothyroidism in cholelithiasis is 29% in the study and is significant. The study demands further studies to consider hypothyroidism as a cause /risk factor for biliary calculus.

Impact of COVID -19 on Gallstones Patients

Background: It is well known that most of the healthcare centers have redistributed their material and human resources to face the health issues associated with COVID-19 pandemic. Aims: In the current study, we aimed to investigate the impact of COVID-19 pandemic on gall stone patients. Methods: Comparison was conducted in our own center regarding gallstones related activities before, during and after the pandemic. We reviewed also the number of elective laparoscopic cholecystectomies during these periods. Data were obtained from the hospital recording system. Results: We found a significant increase in the number of gall stones related complications during the COVID-19 pandemic when compared with non-pandemic periods. Conclusion: It is recommended that laparoscopic cholecystectomies should be considered whenever possible, taking all relevant measures to avoid contagion of patients and the health team.

PSUEDOPANCREATIC CYST INVASION INTO PSOAS MUSCLE: CASE REPORT OF UNUSUAL LOCATION OF PSEUDO- PANCREATIC CYST

A 53 year old female patient presented in emergency with heaviness and pain in left hypogastrium and lumber region. On detailed history, patient revealed getting admitted for acute abdomen approximately 3 months back where she was diagnosed with gall stone induced pancreatitis. She was managed conservatively.

P-EGS01 Cholecystectomy after gall stone pancreatitis

Background According to the UK guidelines for the management of acute pancreatitis commissioned by the British Society of Gastroenterology, All patients presenting with gallstone pancreatitis should be considered for cholecystectomy when they are well enough to undergo surgery. In cases of mild biliary pancreatitis, cholecystectomy should ideally be performed during the index admission or within 2 weeks of discharge as interval cholecystectomy is associated with a significant risk of readmission for recurrent biliary events. In cases of severe gallstone pancreatitis, cholecystectomy may need to be delayed until collections have improved, unless the patient is well enough for surgery and the gallbladder is some distance from the collection Methods Methods Inclusion Criteria Exclusion Criteria Results 80 patients were collected during the study period, 96 % of them were classified as mild pancreatitis Cholecystectomy rate Total percentage of cholecystectomies performed for mild gall stone pancreatitis during index admission or within 2 weeks from discharge : 37% Percentage of early cholecystectomies for eligible patients (i.e.after ruling out unfit patients, patients declining treatment, previous cholecystectomy..etc) : 54% Re-admission rate Re-admission rate for early cholecystectomy patients : 7.4% Re-admission rate for delayed cholecystectomy patients : 20.7% Conclusions

P-EGS28 Management of obstructive jaundice secondary to gall stones in an ambulatory setting

Background Our data from Leeds shows a 30% increase in patient attendance to the Surgical Assesment Unit (SAU) across a 5 year period, putting unprecedented demands on the acute surgical service. A new Ambulatory Surgical Centre (ASC) was established for the advancement of ambulatory care pathways that would ensure that acute patients are seen promptly and kept safe with monitoring in an appropriate setting without needing admission to the hospital bed base. Gallstone related disease accounts for a third of patient attendance to the emergency surgical services. We present our experience with an ambulatory pathway to manage patients with obstructive jaundice caused by gall stones, and propose a protocol driven pathway. Methods The ASC operates an acute, consultant led clinic, with access to urgent blood tests and dedicated USS, CT and MRI imaging capacity, and offers a direct referral service from Primary Care Networks (PCNs) through the Primary Care Access Line (PCAL). Patients referred with clinical jaundice or RUQ/Epigastric pain are investigated for derangement in their liver function, and assessed for the presence and severity of Acute Cholangitis (AC), according to the 2018 Tokyo Guidelines. Patients without evidence of cholangitis, or with AC Grade I are planned for management in the ambulatory setting, including investigations, monitoring and endoscopic/surgical intervention. Outcome data was collected retrospectively from PCAL data source, spanning from Oct 2020 till July 2021. Results A total of 98 patients were referred to the acute surgical service during this period. Out of these, 47% had Grade II (n = 35) or Grade III (n = 17) AC. 48% were suitable for ambulatory management, with no evidence of AC(n = 5) or Grade I AC(n = 43). 20% patients were found to have a cause other than gall stone disease. 55% have undergone intervention (33 Laparoscopic cholecystectomies, 22 ERCP) while 12 are on the waiting list for surgery. Conclusions Our protocol offers a safe, comprehensive and timely pathway for the management of patients with gall stone related obstructed jaundice in an ambulatory setting. This has helped reduce the demand on hospital beds for surgical patients.

A Cross Sectional Study on the Rising Frequency of Gallbladder Stones

Objective: The aim of this study was to determine the occurrence of cholelithiasis in the city of Lahore and its surrounding area. Material and Methods: This study was conducted at Shalamar Medical and dental college Lahore and data for this study was collected from different hospitals of Lahore and the duration of this study was from 2019 to 2021. The participants of this study were from both genders’ male and female from of the age of 10 years to 80 years, and the sample size for this study was 483 and 1583. The main focus of our study was to examine the occurrence of Cholelithiasis surgical in the duration of our study. A questionnaire was used to analyses the occurrence of gall stone, and also the sex, age and dietary habits of the patients. Results: In the results of this study the frequency of gall stones were observed 4.0% in males and 12.0% in females and the percentage of occurrence of gall stones in both these genders were 1% to 3.3%. the high occurrence rate of gall stones in the months are May and November, in both these months the observation of gall stones in these were very high. Both the genders were divided into two main age groups in which male age group were from 10 years to 78 years and the females age group were from 11 years to 80 years. The ideal age for the occurrence of gall stones in male were 45 years to 59 years and in females were 3 years to 44 years respectively. Conclusions: In the conclusion of this study, we examine that the overall occurrence of gall stones in both the genders were 7.01%, but at same the time occurrence rate in the females were very high as compared to the male which were 1% in males and 3.3% in females. Keywords: Cholelithiasis, Surgical Incidence, Gallstones.

Magnitude of hypothyroidism among patients of cholelithiasis in a tertiary care centre in rural West Bengal: a prospective study

Background: Cholelithiasis is a common pathology of the gall bladder affecting about 10 to 15% of the adults in western countries and 2 to 29% in India. More than 80% of the patients with cholelithiasis are asymptomatic. Hypothyroidism may cause gall stone formation due to the hyperlipidemia, motility disorders affecting the bile duct and sphincter of Oddi.Methods: This was a descriptive cross-sectional study conducted at Department of Surgery, Bankura Sammilani Medical College and Hospital, Bankura from March 2019 to February 2020 for duration of one and half year. The sample size was 54 and consecutive non-probability sampling technique was used for the sampling. All the collected data were recorded in a pre-designed proforma and analyzed in MS excel.Results: Out of 54-patients with cholelithiasis, 28% patients were from the age group 45-54 years.40% patients were hypothyroid pre-dominantly females. Among 30-female patients 11 (26.82%) were hypothyroid and among 11-male patients 2 (15.38%) were hypothyroid. Hypothyroidism in male and female was statistically significant.Conclusions: This study was introduced to determine the relationship between hypothyroidism and cholelithiasis. It was concluded that hypothyroidism was more common in female, obese and elder patients. The gender distribution of the hypothyroidism in patients with cholelithiasis was statistically significant while all other variables were statistically not significant.

Comparison of Body Mass Index and Cholelithiasis Diagnosed on Ultrasound in the Population of Pindi Bhattian

Obesity is one of the emerging conditions in our population. Gallstones are composed of cholesterol. It is postulated that gallstones are associated with the deposition of cholesterol. Ultrasound is the first line imaging modality for the diagnosis of cholelithiasis. If gallstones are correlated with BMI, it will open up a new vista for further research. In Yaqoob Ultrasound Clinic, PindiBhattian, Pakistan, a cross sectional analytical study was conducted. All included patients were inquired regarding variables like Age, Height, Weight, Presences of stones, Wall thickness of gall bladder, and location of gall stones on grey scale ultrasound findings. Patients were asked to lie down and expose their abdomen; grey scale abdominal ultrasound was performed of these patients. All variables mentioned above for each patient was recorded and maintain in their individual case record form (CFR). Data was collected during allocated period. Statically package SPSS version 2.4 was used to check the collected data and to organize and compile results. According to results out of total 160 patients, 105 were females and 55 were male. Out of 160 patients 150 (93.8%) were present with gall stones and 10 (6.3%) were having no gall stone. In total 61 patients (38.1%) were having single gall stone whereas 89 (55.6%) were diagnosed with multiple gall stones. According to the results, minimum age was 18 years and maximum was 80 years. Our study concluded that obesity is one of the major risk factors for gall stones. Obesity is usually more common in females, so they are more likely to have gall stones and overweight patients were more prone to GB stones.