Download rajiv gandhi university of health sciences, karnataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
Name of the Candidate
Address (In Block Letters)
ADARSH.V.B
S/O CHANDRASHEKHAR RAMPURE
COLONY H. NO. 9-10-21 BVB COLLEGE
ROAD BIDAR KARNATAKA
2.
Name of the Institution
MVJ MEDICAL COLLEGE &
RESEARCH HOSPITAL,
HOSKOTE, BANGALORE
3.
Course of study and subject
M.D. (GENERAL MEDICINE)
4.
Date of admission to course
5.
Title of the topic
22.05.2008
EVALUATION OF GALLBLADDER
VOLUME IN DIABETICS
BY ULTRASONOGRAPHY
6.
Brief resume of the intended work:
6.1 Need for the study:
Diabetes Mellitus is most common endocrine disorder in humans characterized by
metabolic abnormalities leading to long term complications involving kidney, G.I.T,
nerves and vessels. Various studies point towards the increased prevalence of gall
bladder diseases in diabetics. This has been attributed to cholecystomegaly & impaired
gall bladder contraction, mainly due to autonomic neuropathy seen in diabetics.
Though gall bladder stasis is the most necessary prerequisite for gall stone formation,
other risk factors include sex, genetic factors, obesity, parity, diet, drugs and
hyperlipidemia.
6.2 Review of literature:
1. A.K.Agarwal, S.Miglani, S.Singla et al conducted a randomized study on 91
diabetic patients enrolled in Diabetic Clinic of Dept. of Medicines, Dr. Ram
Manohar Lohiya Hospital, New Delhi to determine the gall bladder volume in
diabetic patients, its comparison with control group, its correlation with age,
sex, body mass index, parity, hyperlipidemia and autonomic neuropathy by
using real time ultrasonography and concluded that cholosystomegaly to a
significant degree was found in Type 2 diabetic patients. When Type 2
diabetics were sub grouped according to presence of autonomic neuropathy,
higher gall bladder volumes were seen in patients with autonomic neuropathy.
2. S.Singh, R.Chandar, A.Singh et al conducted a randomized prospective study at
Govt. Medical College, GND Hospital, Amritsar, to determine gall bladder
volume in Type 2 diabetic patients, comparison of gall bladder disorders in
patients with or without autonomic neuropathy as well as normal individuals.
For the study 50 diabetic patients, out of which 25 had autonomic neuropathy,
and 25 without autonomic neuropathy and 25 healthy non diabetic are matched
(age, sex). Ultra sonography abdomen was performed to measure size of gall
bladder, gall bladder thickness, presence of gall stones, gall bladder volume
was calculated by ellipsoid method.
Results: Fasting gall bladder volume in diabetics with autonomic neuropathy
was found to be higher than that of controls.
3. Guliter.S, Yilmaz.S, Karakan.T Dept. of Gastroentorology, University of
Kirikkale Faculty of Medicine, Turkey conducted a randomized study to
determine gall bladder volume and prevalence of cholelthiasis in diabetic
patients especially in a group of patients with NIDDM. For the study 41 males
and 47 females of NIDDM with mean age 53.5 +/- 11 were compared with
control group, which included health volunteers 33 males and 34 females mean
age 50.3 +/- 18 years, all patients investigated after 12 hours of fasting & 30
min after standard test meal. Pre-meal & post-meal gall bladder volumes were
used for calculation of the ejection fraction and gall bladder volume. The study
concluded that increasing gall bladder and impaired ejection fraction in
NIDDM patients. This may be the initiator of bile stasis in the gallbladder &
subsequent cholesterol crystal formation.
4. Raman.P.G., Patel.A, Mathew.V Dept. of Medicine, MGM Medical College &
MY Hospital, Indore conducted a randomized study to know the prevalence of
gall bladder disorder in Type 2 diabetic patients and their correlation with
patient factors like age, sex, weight, duration of diabetics and autonomic
neuropathy. For the study 50 Type 2 diabetics and 30 healthy controls
underwent real time ultrasonography. The fasting gall bladder volume and
contraction 60 minutes after a fatty meal of the study group and controls were
compared. The study
concluded that type 2 diabetics have increased
prevalence of gall bladder disorder attributed to autonomic neuropathy leading
to increased fasting gall bladder volume.
5. Kayacetin, Guracan Kisakol et al Selcuk University, Meram Medical faculty,
Dept. of Internal Medicine, Division of Gastro Enterology, Turkey conducted a
randomized study on 51 diabetics and 28 controls to determine gall bladder
volume, function and its relationship with peripheral and autonomic
neuropathy. They measured fasting and post prandial gall bladder volume and
ejection fraction by a real time ultrasonography. The study concluded that no
significant difference in biochemical parameters between diabetics and control
group could be found, but fasting gall bladder volumes were higher in diabetic
group compared to control group.
6. Chapman.T.M, Chapman.B.A, Frampton.C.M et al conducted a study at
Netherlands to know whether diabetics have increased gall bladder volume that
would predispose to stasis, nucleation of cholesterol crystals. For the study 271
diabetics and 271 normal controls were chosen. Gall bladder volume
determined by real time ultrasonography and ellipse formula. The study
concluded that there is significance difference between IDDM and NIIDM.
NIIDM is independent predictor of increased gall bladder volume.
6.3
7.
Objective of the study
1. To determine the Gall bladder volume in diabetic patients.
2. Comparison of gall bladder volume in both study group and control group.
3. Correlation of gall bladder volume in diabetics with parameters such as age,
sex, body mass index, parity, hyperlipidemia and autonomic neuropathy.
4. Correlation of gall bladder volume with duration of diabetes.
Material and methods
7.1 Source of Data:
M.V.J Medical College & Research Hospital
falling into the inclusion criteria of the present
study.
7.2 Method of collection of data A study group of 100 patients (50 males and 50
(including sampling procedure, if females) , the diagnosis of diabetes in these
any):
patients is in accordance with WHO criteria, i.e.
fasting blood glucose concentration
>/=126mg/dl and >/=200mg/dl 2hrs after
ingestion of standard test meal 75gm of
carbohydrate load.
50 healthy (25 males and 25 females), nonpregnant volunteers without gastrointestinal,
renal and cardiac diseases were recruited to
control group, after obtaining informed consent.
USG abdomen will be done for both study and
control group, in both fasting level and after
ingestion of standard test meal.
The data will be analysed by dividing the study
group into two groups i.e., Type 1diabetes and
Type 2 diabetes, all relevant details including
history, examination, investigations, etc. were
enlisted in the proforma.
The gall bladder volumes in study group will be
compaired with age and sex matched healthy
volunteers.
Correlating the gall bladder volume with
parameters such as age, sex, body mass index,
parity, hyperlipidemia and autonomic
neuropathy and with duration of diabetes.
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.
7.4 Has ethical clearance been
obtained from your institution in
case of 7.3
8.
Inclusion Criteria :
 Duration of diabetes > 5 years
 Functioning gall bladder
 No evidence of gastro intestinal and hepato
biliary disease
Exclusion Criteria:
 Diabetic patients taking antihypertensive
drugs which interferes with autonomic
functions
 Those with history of major cardiac
arrhythmias
 Obese subjects ( BMI >25)
 Pregnant ladies
 With history of CVA
Yes
 Fasting blood sugar levels
 Post prandial blood sugar levels
 Glycosylated Hb
 Serum lipid profile
 Microalbuminuria
 Ultrasonography
YES
List of references:
1) A.K.Agarwal, S.Miglani, “Evaluation of gall bladder volume in diabetics by
ultrasonography” J Assoc Physicians India 2004;52:962-5
2) S.Singh, R.Chandar, A.Singh, “Ultrasonographic evaluation of gall bladder
diseases in diabetes mellitus type 2” Ind J Radiol Imag 2006 16:4:505-508
3) Guliter.S, Yilmaz.S, Karakan.T, “Evaluation of gall bladder volume in NIDDM
using ultrasonography” J Clin Gastroenterol 2003 Oct, 37(4), 288-91
4) Raman.P.G, Patel A, Mathew.V “Gall bladder disorder and type 2 diabetes
mellitus – a clinical base study” JAPI 50: 887-889, 2002
5) Kayacetin, Guracan Kisakol, “Real time sonography for screening of gall bladder
motility in diabetic patients: relation to autonomic and peripheral neuropathy ”,
NEL 2003; 24:73–76
6) Chapman.T.M, Chapman.B.A, Frampton.C.M, “Gall bladder volume (comparison
of diabetes and controls)” Dig Dis Sci 1998 Feb;43(2):344-8.
9.
Signature of the Candidate
10. Remarks of the Guide
Diabetes mellitus , which is the most common
endocrine disorder leads to various long term
complications affecting the kidney, GIT, heart,
nervous system & peripheral vascular system.
Gall bladder is increasingly affected in diabetes
mellitus as a long term complication as shown
in various studies. There is cholecystomegaly
and impaired gall bladder contraction essentially
due to autonomic neuropathy seen in diabetics.
By using real time ultrasonography, gall bladder
volume and impaired contraction can be studied.
The study will provide the exact incidence and
the nature of gall bladder pathology.
11. Name & Designation of
(in block letters)
11.1 Guide
Dr. P.V. VENKATARAMANAPPA, M.D.
PROFESSOR,
DEPT. OF MEDICINE,
MVJ MEDICAL COLLEGE & RESEARCH
HOSPITAL, HOSKOTE, BANGALORE
11.2 Signature
11.3 Co-Guide (if any)
11.4 Signature
Dr. GEETHA S. SHANKAR
PROFESSOR,
DEPT. OF RADIOLOGY, MVJ MEDICAL
COLLEGE & RESEARCH HOSPITAL,
HOSKOTE, BANGALORE
11.5 Head of Department
DR.K.S.KESHAVA, M.D
PROFESSOR & HOD,
DEPARTMENT OF MEDICINE,
MVJ MEDICAL COLLEGE & RESEARCH
HOSPITAL, HOSKOTE, BANGALORE
11.6 Signature
12. 12.1 Remarks of the chairman & principal
12.2 Signature