Place: Bellary

Date:27/11/09

From,

Dr.Mohammed Faheem Inamdar

Post Graduate Student in M.S GENERAL SURGERY.

Dept. of Surgery,

VIMS, Bellary.

To,

The Principal,

Vijayanagar Institute of Medical Sciences,

Bellary.

THROUGH PROPER CHANNEL

Respected sir,

Subject: Acceptance of registration and forwarding of dissertation topic,

In accordance with the above cited subject, I undersigned studying Post Graduate Course in M.S. General surgery have been allotted the dissertation topic “AN APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF ACUTE APPENDICITIS AT VIMS BELLARY.”under the guidance of Dr. Prabhu Hubli, Professor and Unit Chief Department of surgery, VIMS, Bellary.

I request you to kindly forward the dissertation topic in the prescribed form to the University for Approval.

Thanking you,

Yours faithfully,

DR.MOHAMMED FAHEEM

Signature of the guide INAMDAR

DR.PRABHU HUBLI

Professor and Unit Chief

Department of surgery,

VIMS, Bellary.

Place: Bellary

Date:27/11/09

From,

The Professor & Head of the Department,

Department of surgery,

VIMS, Bellary.

To,

The Registrar,

RajivGandhiUniversity of Health Sciences,

Bangalore.

THROUGH PROPER CHANNEL

Respected sir,

As per the regulations of the University for Registration of Dissertation topic, the following Post Graduate in M.S. in General Surgery has been allotted the dissertation topic as follows, by the Official Registration Committee of all qualified and eligible guides of the Department of surgery.

NAME / TOPIC / GUIDE
DR.MOHAMMED FAHEEM INAMDAR Post Graduate Student in M.S in GENERAL SURGERY.
Dept. of Surgery,
VIMS, Bellary. / “AN APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF ACUTE APPENDICITIS AT VIMSBELLARY”. / DR.PRABHU HUBLI
Professor and Unit Chief
Department of surgery,
VIMS, Bellary.

Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG student at an early date.

Thanking you,

Yours faithfully,

Signature of the guide DR. VIDYADHAR KINHAL.

DR.PRABHU HUBLI Professor & Head of the Department,

Professor and Unit Chief Department of Surgery, VIMS, Bellary

Department of surgery,

VIMS, Bellary .

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE—II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS (in block letters) / DR. MOHAMMED FAHEEM INAMDAR
Post Graduate Student in M.S GENRAL SURGERY.
Dept. of Surgery, VIMS, Bellary
2. / NAME OF THE INSTITUTION / VIJAYANAGAR INTITUTE OF MEDICAL SCIENCES, BELLARY
3. / COURSE OF STUDY AND SUBJECT / MS in GENERAL SURGERY
4. / DATE OF ADMISSION TO THE COURSE / 08-06-2009
5. / TITLE OF THE TOPIC:“ AN APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF ACUTE APPENDICITIS AT VIMS BELLARY”.
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Acute appendicitis is the most common cause of acute abdomen in young adults and, as such,the associated symptoms and signs have become a paradigm for clinical teaching1. No single sign, symptom, or diagnostic test accurately confirms the diagnosis of appendiceal inflammation in all cases.
The accurate diagnosis of acute right iliac fossa pain remains a difficult clinical problem as the differential diagnosis of such a pain is not straight forward.
Even after years of tremendous progress, it is difficult to predict which patient will develop appendicitis. Till today, we don’t have any means of preventing appendicitis, though one can definitely prevent dangerous complications by timely surgical intervention.
Negative appendicectomy rates at 25-30% are not uncommon, and morbidity rates of a negative appendicectomy parallel those ofsurgery for acute appendicitis. On the other hand a delay in diagnosis is associated with a risk of perforation and increased morbidity and mortality.
Ultrasound has been proposed as an ideal non invasive adjunct to diagnosis in suspected appendicitis cases.
This study has included the current approach in diagnosis and management of acute appendicitis, the use of ultrasound along with other investigations which have emerged useful in improving the accuracy in diagnosis of acute appendicitis and thereby reducing negative appendicectomies.
6.2 REVIEW OF LITERATURE:
The existence of appendix is known for a very long time.
Berengas Da Corpi2(1524) gave the first full account of appendix and appendicular perforation.
Mc Burney3 1889, gave a lucid description of the clinical features of acute appendicitis and pioneered the removal of acutely inflamed appendix before perforation occurs and devised muscle-splitting incision.
In 1910 Albert Oschner and James Sherren4 advocated conservative line of treatment in late cases.
With the advent of safer anesthetic techniques, better antibiotics and a better understandingof physiology, the advocates of early appendicectomy found favor ‘when in doubt, take it out’. Others advocate conservative management of acute appendicitis with interval appendicectomy to reduce morbidity of emergency surgery5.
Currently all cases with suspected appendicitis can be included in two categories- where the diagnosis is certain and surgery can be done, and where the diagnosis is in doubt, calling for intensive observation.
Deutsh et al6 were the first to report ultrasonic visualization of the inflamed appendix in 1981.
Today many fascinating investigations have entered in the diagnosis of appendicitis. Ultrasound of abdomen,radioisotope scanning, C- reactive protein, computed tomography and others.
Most methods aim at reducing frequency of uncertain diagnosis and preventing complications from a delay in diagnosis.
6.3 OBJECTIVES OF THE STUDY:
  1. To study the different modalities of presentation of acute appendicitis, the diagnosis and management.
  2. To study the role of ultrasound and to evaluate the sensitivity and specificity of sonography in diagnosis of acute appendicitis.
  3. To study various complications of acute appendicitis and their management.

7. / MATERIALS AND METHODS
7.1SOURCE OF DATA:
All the patients admitted in the department of General surgery, at VIMS, Bellarywith clinical suspicion of acute appendicitis were included in the study. The study will conduced during the period for Jan 2010 to Jan 2011.
INCLUSION CRITERIA FOR THE STUDY
  1. Patients admitted with acute abdomen irrespective of age and sex.
  2. Patients diagnosed to be suffering from acute appendicitis with the help of Alvarado’s score and ultrasonography.
EXCLUSION CRITERIA FOR THE STUDY
  1. Patients admitted with hollow viscus perforation with peritonitis.
  2. Patients proved to have other causes of pain in right iliac fossa like renal colic, PID, ovarian cyst, appendicular abscess, appendicular mass.
  3. Patients not willing for admission or surgery.
7.2 METHOD OF COLLECTION OF DATA (including sampling procedure, if any):
Data will be collected from a specially designed proforma case recording proforma (CRF) pertaining to patients particulars, proper history, clinical examinations, investigations, diagnosis & surgical procedures.
In our study patients with clinical suspicion of acute appendicitis will be subjected to rourine investigations and ultrasonography. Treatment will be planned depending upon type of appendicitis and presence or absence of complications.
It will then be subjected to statistical analysis with the help of biostatistician of our institute. All the surgical procedures & medical management and investigations will be conducted under direct guidance and supervision of our guide. Before start of our study a written/informed consent will be obtained in local vernacular in each patient.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO DESCRIBE BRIEFLY.
YES. Our study requires the following investigations
  • Routine Investigations:
  • Haemoglobin
  • Total leucocyte count
  • Differential count
  • Erythrocyte sedimentation rate
  • Random blood sugar
  • Blood urea
  • Serum creatinine
  • Blood grouping and Rh typing
  • urine
  • X-ray erect abdomen
  • Ultrasound abdomen
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM ETHICAL COMMITTEE OF YOUR INSTITUTION IN CASE OF 7.3
Yes. Clearance has been obtained for Ethical Clearances Committee, VIMS, Bellary.
8. / LIST OF REFERENCES:
  1. Norman S. Williams, Christopher J.K Bulstrode &P. Ronan O’ Connell, Bailey and love’s Short practice of surgery,Arnold Publishers 25th edition 2008 pp 1204-1218.
  2. Richard. A Williams and Paul myers-MONOGRAPH-PATHOLOGY OF THE APPENDIX, first edition,Chapman and Hall Inc. 1994.
  3. Townsend C.M., Beauchamp R.D., Evers B.M., and Mattox K.L., in Sabiston Text book of surgery, Saunders International ,15th edition 1997 :964-970 and 17th edition 2005:1381-1397.
  4. DetmerDE, Nevere LE, Sikes Ed et al. Regional results of acute appendicitis care. JAMA 1981; 246; 1318-20.
  5. Thomas HJ, Jones PF. Active observation in acute abdominal pain Am J Surg 1986: 152;522-5.
  6. Deutsh A, Leopold GR. Ultrasonic Demonstration of the inflamed appendix-case report. Radiology 1981; 140; 163-164.

9. / SIGNATURE OF THE CANDIDATE: / (DR.MOHAMMED FAHEEM
INAMDAR)
10. / REMARKS OF THE GUIDE: / Recommended and forwarded for the needful
11. / NAME AND DESIGNATION OF
(in block letters)
11.1 GUIDE / Dr. PRABHU HUBLI,
PROFESSOR AND UNIT CHIEF
DEPARTMENT OF SURGERY,
VIMS, BELLARY.
11.2 SIGNATURE
11.3 CO.GUIDE (if any)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT: / DR.VIDYADHAR KINHAL
PROF. & HEAD OF THE DEPARTMENT,
DEPARTMENT OF SURGERY,
VIMS, BELLARY.
11.6 SIGNATURE
12. / 12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL
12.2 SIGNATURE