RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE DR. BASAVARAJU

ADDRESS PG IN GENERAL SURGERY

#205, PG HOSTEL FOR MEN,

MMC & RI,

MYSORE.

2. NAME OF THE INSTITUTION MYSORE MEDICAL COLLEGE &

RESEARCH INSTITUTE,MYSORE.

3. COURSE OF THE STUDY M.S. GENERAL SURGERY

AND SUBJECT

4. DATE OF ADMISSION TO 20-07-2013

THE COURSE

5. TITLE OF THE TOPIC A STUDY ON CLINICAL,

RADIOLOGICAL & OPERATIVE

FINDINGS IN “ACUTE ABDOMEN”

AT K.R.HOSPITAL,MYSORE


BRIEF RESUME OF INTENDED WORK:

6.1 Need for the study:

" The term acute abdomen is loosely defined as a clinical course of abdominal symptoms that can range from minutes to hours to weeks, and often used synonymously for a condition that requires immediate operation.

‘Acute abdomen' encompasses a spectrum of surgical, medical and gynecological conditions ranging from the trivial to life threatening conditions, which require hospital admission, investigations and treatment. Acute abdominal conditions occupy one of the few areas of medical practice where the surgeon often reaches a diagnosis without resorting to numerous investigations. The accurate diagnosis and management of patients with acute abdominal pain remains one of the most challenging tasks for the surgeons. The wide range of causes and the varied spectrum of patient presentation pose a formidable diagnostic and therapeutic challenge.

Today, ultrasonography (USG) of abdomen is one of the commonly asked investigations by the surgeon in case of acute abdomen. Advantage of USG over other radiological investigation is that it is easily available, cost effective, portable, no known side effects, non invasive and requires minimal patient preparation.

In this dissertation, our objective is to study atraumatic acute abdomen, the various clinical patterns that help to make a clinical diagnosis and effectiveness of radiological investigation in diagnosing acute abdomen and its influence on clinical decision making. The emphasis laid here is whether a proper history and clinical examination, coupled with cost effective investigations like plain x-ray or ultrasound can help prove the diagnosis as later confirmed by operative findings.

6.2 Review of Literature:

  1. Gupta K, Bhandari RK, Chander R1 did a comparative study of plain x-ray film abdomen and ultrasound in non-traumatic acute abdomen in 50 patients with acute abdominal pain during the year 2000-2001. Ultrasound was highly accurate in diagnosing the exact cause of acute abdomen with high overall predictive accuracy of 98.3% and sensitivity of 90%. Plain x-ray abdomen was 100% diagnostic in GIT perforation, GIT obstruction, psoas abscess (caries spine) and renal colic with overall predictive accuracy of 4.1% and sensitivity of 60%.
  1. The study was done by HariPrasad,GabrielRodrigues &RajgopalShenoy2 which comprised of patients presenting with non-traumatic acute pain abdomen. A total of 148 patients were included in this study and underwent abdominal ultrasonography. Definite diagnosis was made in 116 cases (78.4%). The sensitivity and specificity for ultrasound in diagnosing acute appendicitis, ureteric colic, acute pancreatitis and acute cholecystitis was around 66.6% and 100%, 84.6 % and 98.4%, 73.6% and 97.7%, 92.3% and 100% respectively.

3.  A study was conducted by Naidu VV, Kate V, Koner BC, Ananthakrishnan N3 to access the usefulness of Diagnostic peritoneal lavage (DPL) in decision making process for management of the equivocal acute abdomen. . After preliminary X-ray and ultrasound, DPL was performed in 50 patients with an equivocal acute abdomen (18 trauma, 32 non-trauma). It was found that overall sensitivity, specificity, accuracy, and positive and negative predictive values were high for patients with trauma. All the above parameters except specificity and negative predictive value (NPV) were also found to be high for the non-trauma group. DPL was found to be a bedside investigation, which helped in taking the decision to operate on patients with both traumatic and non-traumatic acute abdomen.

  1. Riesener KP,Klever P,Truong SN,Schumpelick V4 did a prospective study of 584 consecutive patients presenting with acute abdominal pain to evaluate the role of ultrasonography as a first-line diagnostic tool for differentiating between surgical and nonsurgical diseases. The study reveals a high sensitivity and specificity for the diagnosis of diverticulitis, cholecystitis, and bowel obstruction. In acute appendicitis the method is highly specific, but the sensitivity is rather low. Taking into account the high rate of specific results, routine ultrasonography can be recommended as a screening method in patients suffering from acute abdominal pain.
  1. Allemann F, Cassina P,Rothlin M,Largiader F5 did a study to evaluate the routine use of abdominal ultrasonography (US) in patients admitted to the surgical emergency unit with acute abdominal pain over a 12-month period. 496 patients (male/female = 234/262; mean age 45 years) presented with acute abdominal pain. Every patient underwent routine investigations and had an abdominal ultrasound by the attending surgeon. Ultrasound improved the correct diagnostic rate from 348 (70%) to 414 (83%). The diagnostic accuracy for acute appendicitis and biliary tract disease improved after ultrasound from 455 (92%) to 488 (98%) and from 463 (93%) to 490 (99%), respectively; the corresponding sensitivities and specificities were 91% and 99% and 94% and 99%. Ultrasonography should be part of routine surgical investigation and should be mastered and used by surgeons.
  2. Dhillon S, Halligan S, Goh V, Matravers P, Chambers A, Remedios D6 undertook a study to determine the therapeutic effect of abdominal ultrasound in the investigation of acute abdominal pain. Study group included 100 adult patients. : The leading diagnosis was either confirmed or rejected in 72 patients and a new diagnosis provided where no prior differential diagnosis existed in 10. Diagnostic confidence increased significantly following ultrasound (mean score 6.5 pre-ultrasound vs. 7.6 post-ultrasound, P < 0.001). Intended management changed following ultrasound in 22 patients; 15 intended laparotomies were halted and a further seven patients underwent surgery where this was not originally intended. Ultrasound was rated either 'very' or 'moderately' helpful in 87% of patients, with 99% of clinicians finding it either 'very' or 'moderately' helpful generally. Abdominal ultrasound has considerable diagnostic and therapeutic effect in the setting of acute abdominal pain. Copyright 2002 The Royal College of Radiologists.

6.3 Objectives of the study:

  1. To assess the association between clinical, radiological and operative findings and thus evaluate clinical diagnostic accuracy and radiological diagnostic accuracy.
  2. To assess the effectiveness of radiological investigations in diagnosing acute abdominal conditions

7. MATERIALS AND METHODS:

7.1  Source of Data:

All patients admitted to the surgery wards at K.R.HOSPITAL,MYSORE, with acute pain abdomen (of non traumatic origin).

Sample Size:

o  100 patients form the basis of this study

o  These patients include those who presented with acute abdominal pain (of non traumatic origin) at the emergency department, surgical out patient department.

7.2  Methods of collection of data;

Inclusion Criteria:

a)  Only patients undergoing surgery will be included.

Exclusion Criteria:

a)  Paediatric age group(12 years and below).

b)  Traumatic cases(blunt and penetrating)

c)  Acute abdomen in pregnancy and gynecological causes of acute abdomen.

d)  Conservatively managed cases.

Methods:

a)  Patients admitted with acute pain abdomen ( of non traumatic origin) at K.R.HOSPITAL,MYSORE from November 2013 to June 2015.

b)  Patients will be subjected to detailed history and through physical examination

c)  Patients will undergo necessary investigations.

d)  Relevant procedures like four quadrant aspiration will be carried out in some cases

e)  All the final diagnosis will be operative.

f)  In all cases operative findings and post operative diagnosis will be recorded

g)  Final outcome will be evaluated.

Tests of significance:

The following tests of significance will be applied.

·  Chi-square test

·  ‘t’ Test

7.3 Does the study require any investigation or interventions to be conducted

on patients or other human or animals? If so, please describe briefly.

Yes
  1. Blood counts, biochemical analysis and urine analysis.

2.  Diagnostic peritoneal lavage (as and when required).

  1. X-Ray Abdomen
  2. USG abdomen / pelvis (as and when required).

7.4 Has Ethical clearance been obtained from ethical committee of your

Institution in case of 7.3?

Yes, clearance has been obtained from Ethical Committee,Mysore Medical College,Mysore.

8. LIST OF REFERENCES:

  1. Gupta K, Bhandari RK, Chander R Comparative study of plain abdomen and ultrasound in non-traumatic acute abdomen GASTROINTESTINAL RADIOLOGY Year : 2005 | Volume : 15 | Issue : 1 | Page : 109-115
  1. HariPrasad,GabrielRodrigues &RajgopalShenoy:Role Of Ultrasonography In Non Traumatic Acute Abdomen:The Internet Journal of Radiology. 2007;Volume5,Number2.
  1. Naidu VV, Kate V, Koner BC, Ananthakrishnan N Diagnostic peritoneal lavage (DPL)--is it useful decision making process for management of the equivocal acute abdomen?
  1. Riesener KP, Klever P, Truong SN, Schumpelick V Role of sonography as primary diagnostic method in acute abdomen--a prospective study] : Langenbecks Arch Chir Suppl Kongressbd. 1997;114:1196-8.
  1. Allemann F, Cassina P, Rothlin M, Largiader F Ultrasound scans done by surgeons for patients with acute abdominal pain: a prospective study. Eur J Surg. 1999 Oct;165(10):966-70.

6.  Dhillon S, Halligan S, Goh V,Matravers P,Chambers A,Remedios D The therapeutic impact of abdominal ultrasound in patients with acute abdominal symptoms. Clin Radiol. 2002 Apr;57(4):268-71