Sivapragash, S (2017) A Descriptive study on Outcomes and Efficacy in Managing Acute Cholangitis and Acute Cholecystitis based on Tokyo Guidelines 2013. Masters thesis, Stanley Medical College, Chennai.
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Abstract
BACKGROUND: Acute biliary sepsis which includes Acute cholecystitis and Acute Cholangitis are life threatening surgical emergencies which needs early recognition and prompt institution of appropriate management strategies. Except for some well known clinical signs like Murphy’s sign and Charcot’s triad there are no well defined criteria for the diagnosis of above said biliary infections. Tokyo Guidelines 2013 is expert panel formulated Diagnostic and severity assessment criteria guidelines is the only guidelines available till date which aids in the diagnosis and management of the same. More number of patients can be diagnosed at an early stage of infection and appropriate treatment instituted at the earliest by using this guidelines ,thus avoiding any foreseen complications. In this study, we have assessed the feasibility of using TG 13 guidelines in diagnosing and managing acute biliary infections in Stanley Medical College. OBJECTIVE: This study sought to analyse the outcome of managing acute biliary sepsis and comparing it in lines with TG 13 Guidelines. MAIN OUTCOME MEASURES: The Pattern of presentation, clinical features and contributing factors of Acute cholecystitis and Acute Cholangitis. STUDY DESIGN: Descriptive study. SETTING: Department of General Surgery, Govt. Stanley Hospital (GSH) a tertiary hospital in Tamilnadu. STUDY DURATION: JUNE 2016 TO SEPTEMBER 2016. METHODS AND MATERIALS: Patients who had been diagnosed as a case of acute Cholecystitis and acute cholangitis were followed up and assesed using the TG 13 guidelines criteria and the outcomes were analysed. The efficacy of Using the guidelines in our setup and reproducibility of guideline demanding parameters were analysed that were appropriate in our setup. Clinical details and lab and imaging findings were recorded using a well detailed clinical proforma that included detailed description of analysis of a case of acute cholecystitis and cholangitis. Also other contributing factors, clinical patterns, presentation, treatment outcomes were analysed in detail. Data analysis and master charting was done using Microsoft Excel software And the results interpreted. RESULTS: Acute Cholecystitis with most common etiology being gallstone disease is more common in males (56%), While Acute cholangitis is more common among elderly females.(58%).> 52 % patients diagnosed with Acute cholecystitis presented to us only after >72 hours of symptom onset. 43 % of cholecystitis and > 50% cholangitis patients were Diabetics Under treatment for the same. Diabetic Males more than 50 years of age with duration of diabetes less than 5 years had increased incidence of cholecystitis and present with a higher grade. CONCLUSION: Elderly patients in the 5th decade with diabetes mellitus as comorbid illness are at high risk for acute biliary sepsis. Routine screening for contributing factors of the disease for these patients may be considered. • Early laparoscopic cholecystectomy can be considered within 72 hours, if patient is young and without any co-morbid illness. • TOKYO GUIDELINES 2013 is an appropriate tool that can be used in our setup without any fallbacks as most of parameters. In the guidelines can be analysed and reproduced in our population group. • Availability of trained radiologist/intervention radiologist in our Setup needed to be overlooked as early biliary drainage is vital in the outcome of cholangitis and makes us complete in adopting the guidelines. • A Large multicentre analytical study may be needed to analyse the guideline demanding parameters and other factors that can be added positively as recommendations to the guidelines formulating committee.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Tokyo guidelines, acute biliary sepsis, diagnostic criteria Early cholecystectomy. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 18 Mar 2020 03:21 |
| Last Modified: | 18 Mar 2020 03:21 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12315 |
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