FREQUENCY OF MULTIPLE CALCULI AND DETERMINING THE
ACCURACY OF ULTRSONOGRAPHY IN CHOLELITHIASIS PATIENTS
(A RETROSPECTIVE STUDY IN MERCY TEACHING HOSPITAL PESHAWAR FROM 2015 TO 2016)
PRINCIPAL INVESTIGATOR: MAHEEN HAQ, FINAL YEAR MBBS (PESHAWAR MEDICAL COLLEGE)
CO-INVESTIGATORS: Wagma Basir, Amra, Ruby Noor, Anisa, Sadia Gul, Sundas, Hoor Farooq.
Introduction
Cholelithiasis is the presence of the stones in
gallbladder or the diseases caused by the gallstones.
Gallstones may be asymptomatic but the characteristic
symptoms may experience colicky pain in the upper-
right side of the abdomen, nausea, vomiting and fever.
These can be cholesterol stones (6%), mixed stones
(90%) or pigment stones (4%). Complications include
inflammation of gallbladder, pancreas and liver. Major
risk factors of gallstones are obesity, high caloric diet,
female gender and advanced age (>40 years).
Preventive measures are maintaining a healthy weight
and high fiber and low carbohydrates diet. Gallstones
are more common in women than men and increase
with aging. Over 10% men and 20% women have
gallstones by the age of 60. The prevalence rates in
adult European is 10-15% while in African and Asian
populations prevalence is 3-5%.
Aims & Objectives
1. Gender based comparison of cholelithiasis among
patients of Mercy Teaching Hospital.
2. To correlate the clinical and ultrasonic findings of
the patients
3. To correlate the ultrasonic findings with operative
findings of the patients
Methods
A retrospective cross sectional study was conducted in
Mercy Teaching Hospital Peshawar from January 2015
to December 2016 using registered records. The data of
the patients was collected from the concerned patient
files. Keeping the ethical consideration in mind, the
confidentiality of the subjects was maintained. The data
was collected using self-administered questionnaires.
The data was analyzed by SPSS-19.
Results
Total 246 patients of cholelithiasis were admitted to
surgery ward of Mercy Teaching Hospital from January
2015 to December 2016. Among them 49(19.9%) were
male and 197(80.1%) were female. The mean age was
41.1 years with the standard deviation of 14.4 years.
165.3 patients had positive clinical findings (183
patients had Murphy’s sign, 155 patients had high fever
and 158 had high pulse) with major ultrasonic findings
of multiple and single calculi. The ultrasonic findings
shows that 38 patients were having single calculi and
178 had multiple calculi while operative findings
shows that 48 patients ha single calculi and 149
patients had multiple calculi (P< .000).
19.9%
80.1%
Conclusion References
1. Warttig S, Ward S, Rogers G. Diagnosis and management of
Our study reveals that cholelithiasis is more common
gallstone disease: summary of NICE guidance. BMJ: British
in females of fertile age as compare to males. The Medical Journal (Online). 2014 Oct 30;349.
clinical findings and operative findings significantly 2. Acalovschi M, Blendea D, Feier C, Letia AI, Ratiu N,
correlate with ultrasonic findings. It also shows that Dumitrascu DL, Veres A. Risk factors for symptomatic
gallstones in patients with liver cirrhosis: a case–control
frequency of multiple calculi is high as compare to
study. The American journal of gastroenterology. 2003 Aug
single calculi. This study gives knowledge to some
1;98(8):1856-60.
extent about the accuracy of ultrasonography in 3. 4 Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes
relation to the diagnosis of gallbladder diseases. around the world: implications for public health. International
journal of epidemiology. 2009 Jun 1;38(3):791-813.
4. Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. Dietary
carbohydrates and glycaemic load and the incidence of
ULTRASOUND FINDINDINGS symptomatic gall stone disease in men. Gut. 2005 Jun
1;54(6):823-8.
5. Gupta R, Sharma S, Chadha N, Gupta BM. Gallstones
Percent
Research: A Scientometric Assessment of Indian Publications
during 2006–15. International Journal of Information
Dissemination and Technology. 2016;6(1s):S54-8.
1%
7% 6. Darzi A. High quality care for all: NHS next stage review
4% 15% Valid final report. The Stationery Office; 2008.
7. Stogryn S, Ashley Vergis MMEd MD. Does ultrasonography
single calculi
predict intraoperative findings at cholecystectomy? An
multiple calculi institutional review. Canadian Journal of Surgery. 2016 Feb
1;59(1):12.
other findings
8. Gyedu A, Adae-Aboagye K, Badu-Peprah A. Prevalence of
cholelithiasis among persons undergoing abdominal
72% calculi with other findings
ultrasound at the Komfo Anokye Teaching Hospital, Kumasi,
Ghana. African health sciences. 2015;15(1):246-52.
9. Saqib A, Shaikh SS, Sodhar JM. GALL STONES;
FREQUENCIES OF GALL STONES IN THE PATIENTS
OPERATIVE FINDINGS ATTENDING SURGICAL OPD AT ISRA HOSPITAL
HYDERABAD. Professional Medical Journal. 2014 Apr
1;21(2).
2% Percentage
10. Gurusamy KS, Giljaca V, Takwoingi Y, Higgie D, Poropat G,
Štimac D, Davidson BR. Ultrasound versus liver function
tests for diagnosis of common bile duct stones. The Cochrane
16%
12%
Library. 2015 Jan 1.
10% Valid
Acknowledgements
single calculi
multiple calculi
First of all thanks to Allah Almighty who has given us strength
other findings
with knowledge and made us able to accomplish this study.
61%
calculi with other findings
Thanks to the Dr. Muhammad Aman Khan (Head of CHS
department, PMC), Dr. Farzeen Khan (supervisor), the MS of
Mercy Teaching Hospital, Peshawar KPK and being principal
investigator I am thankful to my co-investigators for
contributing their efforts to accomplish this study.