Factors affecting incorrect interpretation of abdominal computed tomography in non-traumatic patients by novice emergency physicians

Objective Accurate interpretation of computed tomography (CT) scans is critical for patient care in the emergency department. We aimed to identify factors associated with an incorrect interpretation of abdominal CT by novice emergency residents and to analyze the characteristics of incorrectly interpreted scans.Methods This retrospective analysis of a prospective observational cohort was conducted at three urban emergency departments. Discrepancies between the interpretations by postgraduate year-1 (PGY-1) emergency residents and the final radiologists’ reports were assessed by independent adjudicators. Potential factors associated with incorrect interpretation included patient age, sex, time of interpretation, and organ category. Adjusted odds ratios (aORs) for incorrect interpretation were calculated using multivariable logistic regression analysis.Results Among 1,628 eligible cases, 270 (16.6%) were incorrect. The urinary system was the most correctly interpreted organ system (95.8%, 365/381), while the biliary tract was the most incorrectly interpreted (28.4%, 48/169). Normal CT images showed high false-positive rates of incorrect interpretation (28.2%, 96/340). Organ category was found to be a major determinant of incorrect interpretation. Using the urinary system as a reference, the aOR for incorrect interpretation of biliary tract disease was 9.20 (95% confidence interval, 5.0–16.90) and the aOR for incorrectly interpreting normal CT images was 8.47 (95% confidence interval, 4.85–14.78).Conclusion Biliary tract disease is a major factor associated with incorrect preliminary interpretations of abdominal CT scans by PGY-1 emergency residents. PGY-1 residents also showed high false-positive interpretation rates for normal CT images. Emergency residents’ training should focus on these two areas to improve abdominal CT interpretation accuracy.

To the technique and diagnostic value of duodenal intubation

Duodenal intubation, as a diagnostic method of biliary tract disease, has become more and more widespread in recent years, and now there is hardly at least one inpatient therapeutic or surgical department where duodenal probing is not used, although its historical past is still very not long ago.

Dysbiosis of the faecal and biliary microbiotas in biliary tract cancer

Background Characteristic bile duct and colonic microbiotas have been identified in patients with chronic biliary tract disease. Therefore, a characteristic microbiota is likely also formed in cholangio- and gallbladder carcinoma patients. This study aimed to characterize the faecal and bile microbiotas in biliary tract cancer (BTC) patients and their relationship to each other. Methods Patients with BTC (n = 30) and benign biliary disease (BBD) without cholangitis (n = 11) were prospectively included. Ten healthy, age-matched subjects were also recruited for faecal microbiota comparison. The colon and bile duct microbiotas were analysed by sequencing the 16S rRNA gene V3-V4 region. We also obtained live bacteria in the bile collected from three BTC patients by culture and performed metagenomics-based identification. Results The faecal microbiota composition differed in the BTC patients. Linear discriminant analysis (LDA) effect size (LEfSe) showed a higher Enterobacteriaceae abundance and a lower Clostridia abundance, including that of butyrate-producing bacteria including Faecalibacterium and Coprococcus, in the BTC patients than in the other subjects. Notably, 10 of 17 operational taxonomic units (OTUs) assigned to Enterobacteriaceae in the bile samples were matched with the OTUs found in the BTC subject faecal samples. Further metagenomic approaches revealed a bile-isolated strain that possessed the carcinogenic bacterial colipolyketide synthase (PKS)-encoding gene. Conclusions Enterobacteriaceae was enriched in the BTC faeces. Taken together with the finding that more than half of Enterobacteriaceae in the bile matched that in the faeces at the OTU level, our data suggest that faecal microbiota dysbiosis possibly contributes to BTC onset.

Quick Looks Into the Acute Abdomen- Findings from A 1 Year Audit of Asian Emergency Department Ct Scans

BackgroundMuch of the literature regarding Emergency Department CT scan usage for abdominal pain has been in American and European settings, and less so in the rest of the world. We performed an audit for this in our Southeast Asian hospital to see how we compare with international data, also to glean some insights into optimising its use locally.Results – An anonymised de-identified electronic database of all ED patients had been set up since 2020 with the aim of capturing 10 years of ED retrospective data for audit of our clinical performance. From this master database, a subset of all CTAPs done in 2020 was created and then extracted for analysis. Costs, length of stay in the ED and wards, CT reports, disposal from ED, and other data were captured for study. A description was made of the common conditions found, with a subgroup analysis of the elderly, and disposal outcomes from the ED. Specific analysis was done for appendicitis using Mann-Whitney U tests. For 2020, 1860 patients (56% male, and ages 14 to 99 years) had ED CTAPs done. Top indications included right upper and lower quadrant pains, flank pains, persistent abdominal pain despite analgesia, and suspicion for intestinal obstruction. Acute appendicitis, biliary tract disease, renal stones, ovarian disease, and bowel disease were the common diagnoses. 16.2% of CTAPs revealed no abnormality. Malignancies were uncommon diagnoses. For the patients that were discharged from the ED after a negative CTAP, no patient returned within 72 hours nor were there any adverse outcomes. When analysed using Mann-Whitney U tests, patients who had ED CTAPs done for appendicitis had significantly faster time to CT and surgery than those with inpatient imaging, with lower inpatient costs and lengths of stay.Conclusion – CT scans in the ED for appendicitis patients reduces costs, time to surgery, and lengths of stay. Generally, ED CTAPs allows better siting and disposition of patients. Presence of RLQ pain increases the likelihood of a positive scan. Our negative scan rate of 16.2% is comparable to other studies. Protocols and senior inputs can improve accuracy of this important ED resource.

Magnetic Resonance Cholangiopancreatography Evaluation of Biliary Tract, Gall Bladder, and Pancreas

BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging method of demonstration of hepatic, cholangio- and pancreatic-systems and their duct system and depends on heavy T2-weighted (T2-W) images. The present study was undertaken to study and evaluate patients with clinical suspicion of the biliary tract, gall bladder and pancreatic pathology, with conventional magnetic resonance imaging (MRI) and MRCP and to assess the pitfalls in MRCP for the evaluation of the biliary tract, gall bladder, and pancreas. METHODS The study included sixty patients with clinical signs and symptoms of obstructive jaundice referred for MRCP to the Department of Radiodiagnosis at Katuri Medical College and Hospital and patients who were referred to the department with clinical suspicion of pancreas, gallbladder and biliary tract disease. Pregnant patients, claustrophobic patients and patients with MRI contraindications such as cardiac pacemakers, aneurysm clips and metallic implants were excluded from the study. RESULTS Most of the patients in our study were of 30 - 70 years age group. Of the sixty cases included in our study, 58 % were males and 42 % were females. In most of the patients, in our study, benign pathology was observed which included cholelithiasis and choledocholithiasis and acute pancreatitis being next common. Case of choledochal cyst were also encountered. Most of common bile duct strictures were of benign aetiology. Of the malignant pathology detected, cholangiocarcinoma followed by periampullary carcinoma and gallbladder carcinoma were commonly encountered. CONCLUSIONS Magnetic resonance pancreatic cholangiography is an imaging modality for evaluation of pancreaticobiliary disorders. MRCP detected the exact location and cause of biliary tract obstruction and aetiology was well demonstrated. Pure cholesterol stones are difficult to detect on CT because they are iso attenuating or slightly hypoattenuating to bile. Sub centimetric calculi are well demonstrated by MRCP. Malignant strictures and benign strictures are well demonstrated. MRCP being non-invasive and radiation hazard free with inherent high resolution with multiplanar imaging capability could be considered as gold standard in imaging of few gall bladder and biliary system disorders. KEYWORDS Magnetic Resonance Cholangiopancreatography, Cholelithiasis, Pancreatitis, Periampullary Carcinoma, Gall Bladder Carcinoma, Cholangiocarcinoma

The Study of Laparoscopic Cholecystectomy in Acute Cholecystitis, Complication and Management: Analysis of 150 Cases in the Ibn Sina Medical College, Bangladesh

Background: Laparoscopic Cholecystectomy has now become a better option instead of the Open Cholecystectomy for treatment of Cholelithiasis that it has been a gold standard for the Cholelithiasis condition throughout the Globe. Last century was the most fruitful era for the treatment of the biliary tract disease as it has already proved the progress from the open to laparoscopic surgery with a single port surgery. Methods: The purpose of our study is to grading of the Laparoscopic Cholecystectomy in Acute Cholecystits and has been studying the outcome of problematic and challenging Laparoscopic Cholecystectomy cases, its’ complication (s) and management to decide when to converting Laparoscopic Cholecystectomy to Open Cholecystectomy. The study analyzes the conversion rate of Laparoscopic Cholecystectomy in the Ibn Sina Medical College, Kallyanpur, Dhaka, Bangladesh. This is a retrospective study of 150 patients (Male - 75% and Female - 25%) which was conducted during the period from January 2015 to January 2017. Results: Out of the 150 cases 140 (93%) had been successfully operated by Laparoscopic Cholecystectomy. And, only 10 (7%) cases (out of a total of 150) got converted from the Laparoscopic to Open Cholecystectomy and they belonged to Grade - E with severely contracted gallbladder, morbid adhesion, short cystic duct and bile duct injury. Conclusions: The Laparoscopic Cholecystectomy has familiar as a unique procedure of choice for the management of symptomatic gall bladder. Laparoscopic Cholecystectomy intra operatively for grade A to E where Grade A is very easy level to perform Gall Bladder Surgery to Grade E where conversion is 115% due to bad. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.318-322

Evaluation of clinical profile of acute pancreatitis in a tertiary centre

Background: Acute pancreatitis is a disease for which patients are in large numbers, etiology, clinical presentation and examinations are varied. Disease may be mild or severe, may lead to multi organ failures and death. Most common cause is biliary tract diseases. Other causes are alcohol consumption, post ERCP, trauma, idiopathic and drugs, viral infections, genetic mutations and connective tissue disorders.Methods: This is a prospective observational study conducted at SGT medical college, Budhera, Gurugram, Haryana, from January 2017 to June 2019 in 100 consecutive patients. Data collection included detailed recording of demography of patient, clinical presentation, any history of biliary tract disease, alcohol consumption, trauma, ERCP, comorbidities. Data was also collected about investigations done, treatment, recovery, complications and any intervention. Results: Most of the patients were from age group 41-55 years. Female patients were more than male patients. Etiology was mostly gall stone, alcohol, idiopathic, post ERCP and trauma. Pain, distention abdomen, vomiting, fever and jaundice were presenting features. Serum amylase, serum lipase, USG abdomen and CECT abdomen were diagnostic investigations. Complications included local and systemic. Mortality was 7%. Conclusions: Acute pancreatitis is mild in most of the cases and recovery is good. Severe cases should be meticulously treated as mortality rates are higher. They should be treated in ICU under the guidance of intensivist. Our study results show that patients with severe diseases should be meticulously monitored clinically, biochemically, haemodynamically and radiologically.

A study of clinical profile of patients with acute pancreatitis at a tertiary health care centre

Background: Acute pancreatitis is one of the most common diseases affecting the exocrine pancreas. The incidence of acute pancreatitis has increased during the past 20 years. The overall mortality rate of acute pancreatitis ranges from 1% in mild acute pancreatitis to 30% in severe acute pancreatitis. Aim and objective: To study the clinical profile of patients with acute pancreatitis at a tertiary health care centre Methodology: Present study was a prospective study carried out on patients with acute pancreatitis admitted in department of surgery. Data collected was sociodemographic data, clinical history and clinical examination. All patients underwent biochemical investigations, Radiological investigations. All the patients were treated with conservative treatment. Results: Most commonly affected age group was 21-40 year males. Male to female ratio was 5:1. Most common etiological factor was alcohol 21(70%). 5(16.67%) patients had history of biliary tract disease. Epigastric pain (100%) was most common followed by Nausea vomiting (83.33%).