PROFORMA

 
FOR THESIS OF MASTER OF INTERNAL MEDICINE
Dr. B.R AMBEDKAR UNIVERSITY, AGRA (U.P)
 
CORRELATION BETWEEN PORTAL VEIN DOPPLER INDICES AND NAFLD
FIBROSIS SCORE IN NON OBESE PATIENTS OF NAFLD

DR B.V SURYA MANIKYAM

Department of Medicine,

FH Medical College,

Agra, Uttar Pradesh.

  UNDER THE EXPERT GUIDANCE OF

 
GUIDE CO–GUIDE

DR.ANIL KUMAR SHARMA DR. A K GUPTA

M.D. MEDICINE D,MNAMS,FICR,FICMU
Professor, Department of Medicine Professor and Head
F.H. Medical College, Agra Department of Radiodiagnosis

F.H. Medical College, Agra

 

CO-GUIDE CO–GUIDE

Dr. MOHAMMAD JAVED DR. WASEEM AKHTAR

M.D. MEDICINE M.D (RADIODIAGNOSIS)
Assistant Professor, Department of Medicine Associate Professor,
 CERTIFICATE
This is to certify that the thesis topic entitled “CORRELATION BETWEEN PORTAL VEIN DOPPLER INDICES
AND NAFLD FIBROSIS SCORE IN PATIENTS OF NON OBESE NAFLD” for the award of MD Internal
Medicine shall be done under our direct supervision and guidance.
   GUIDE CO–GUIDE

DR.ANIL KUMAR SHARMA DR. A K GUPTA

M.D. MEDICINE MD,MNAMS,FICR,FICMU
Professor, Department of Medicine Professor and Head

F.H. Medical College, Agra Department of Radiodiagnosis

F.H. Medical College, Agra

CO-GUIDE CO–GUIDE

Dr. MOHAMMAD JAVED DR. WASEEM AKHTAR

M.D. MEDICINE M.D (RADIODIAGNOSIS)
 INTRODUCTION
Non-alcoholic fatty liver diseases is a common chronic disorder characterized
by fatty degeneration of hepatocytes which is not caused by excessive
consumption of alcohol [1]. NAFLD starts as simple steatosis followed by its
progression to non-alcoholic steatosis which may lead to development of
cirrhosis/liver cancer [2]. It is the most common cause of elevated liver
enzymes, so it has become a major epidemiology concern [3]. The
pathophysiology of NAFLD and its progression to NASH and to liver fibrosis
is influenced by both genetics and environmental factors with oxidative stress
as a prominent promoter of large to hepatic parenchyma [4].
 Aim and Objectives
AIM

 The aim of the present study is to correlate the portal vein doppler indices and
NAFLD fibrosis score in non obese patients of NAFLD.
OBJECTIVES 
• Primary objective:

To assess the correlation between portal vein doppler indices and NAFLD fibrosis
score in non obese patients of NAFLD.

• Secondary objective:

To study prognosis value of portal vein doppler in non obese patients of NAFLD.
 MATERIALS AND METHODS

Study place:Department of General Medicine F.H. Medical College

and Hospital, Agra.
Study design:Observational Study
Study duration: 2 years
Study population:Non-obesePatients with NAFLD diagnosed
ultrasonographicallywill be included as per inclusion-exclusion
criteria.
Sample size:100(50 cases and 50 controls
Inclusion Criteria:(CASE)
• Patients of either gender of age between 18-65 years.
• Non-obese patients diagnosed with NAFLD ultrasonographically (USG).
• Body mass index (BMI) < 30.

 
Inclusion Criteria: (CONTROL)
• Participants of either gender of age between 18-65 years.
• Non-obese patients diagnosed with normal LARI and USG findings.
• Body mass index (BMI) < 30.
Exclusion Criteria:
• Obese Patients with NAFLD
• Alcohol consuming patients (>140 gm/week)
• Chronic liver (infectious, metabolic, toxic auto-immune) diseases and heart
diseases.
• Drug induced fatty liver disease.
• Patients on anti-Inflammatory drug within 6 months
• Patients with Malignant or infectious diseases(viral hepatitis)
• Not willing patients.
Study Groups:

CASES (n=50) Non-obese patients diagnosed with NAFLD

CONTROL (n=50) Non-obese patients diagnosed with normal
ultrasonografic findings
 • Age
• Gender
• BMI
VARIABLE • Waist / Hip Ratio
S •
•
Lipid Profile
HbA1c
• Smoker/Non smoker
• SGOT, SGPT
Methodology
• Ethical clearance and informed consent will be taken.

• In the present study, 50 cases and 50 controlswill be enrolled as per inclusion-exclusion criteria.

• All the clinico-demographical parameters will be recorded as per predesign Questionnaire.

• Blood sampling (3ml venous blood) will be done and CBC,Lipid profile (TG, TC, HDL-C, LDL-C
VLDL-C), HbA1c, Fasting, post prandial blood sugars, USG WHOLE ABDOMEN, Viral Markers,
will be measured as per standard manual protocol.

• In healthy controls, Doppler ultrasound of the portal vein will reveal a wide range of flow patterns
and velocities. We shall normalise every measurement to compensate for this constraint.
The sample gate for each duplex scanning will be set between 6 and 10 mm (depending on the
diameter of the vessel).
In addition, spectral evaluations of the portal vein will always be recorded for at least two to three
cycles.
A paramedian or somewhat oblique plan will be used to align the transducer along the longitudinal
axis of the major portal vein. During silent inspiration by the same sonographer, the site of
measurement will be midway between the confluence of the splenic and superior mesenteric veins
and the bifurcation of the portal vein.
The Doppler angle will always be 60 degrees. The greatest (Vmax) and minimum (Vmin)
velocities (cm/s) will be measured and photographed for each cases and controls.
As a parameter of biphasic (slightly pulsing) or monophasic oscillation, the difference between
Vmax and Vmin will be determined.
Portal vein Dopplerindices andNAFLD fibrosis score will be calculated and noted in cases.
All data will be collected and send for statistical analysis.
NAFLD SCORE (HARRISONS)

-1.675+ 0.037 x age (years) + 0.094 x BMI (Kg/m2) + 1.13 x IFG/ diabetes (Yes=1;
No=0) + 0.99 x AST/ALT- 0.013 x platelet count (x 109/L)-0.66 x albumin (g/dl)
Statisticalanalysis:
 

 Data will be entered in Microsoft excel and analyzed using statistical software SPSS version25(Chicago,
IL, USA).

 Student's t test will be used to analyses parametric data, while the Mann-Whitney U test was applied to
non-parametric data and Fisher's test to categorical data.

 Spearman or Pearson correlation will be used to assess the correlation analysis.

 P values < 0.05 will be considered statistically significant.

Ethical approval:
It will be taken from the Ethics Committee of FHMC,
Etmadpur, Agra.
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