Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Prevalence and some selected characteristics of asymptomatic gallstones among pregnant women. A retrospective chart review(Sri Lanka College of Obstetricians & Gynaecologists, 2022) Abeysuriya, V.; Dodampahala, S.H.; Chandrasena, L.Introduction During pregnancy, it is often associated with gallstones and biliary sludge. Gallstone disease is the second most common indication for non-obstetric surgical intervention in pregnancy. Methods A retrospective chart review was carried out to determine the prevalence and characteristics of asymptomatic gallstones among selected sample of pregnant women in a private hospital in Colombo, Sri Lanka. Data was retrieved form the available records at hospitals from 2016 to 2022.There were 329 patients recode during the study period. An exclusion criteria was applied to select the subjects. Data pertains to demographic, haematological, bio-chemical and hepatobiliary sonography was retrieved. The study data were analysed using STATA (StataCorp LLC Texas, USA) software version 16 for Windows. Normality was determined using the Kolmogorov-Smirnov’s test. Categorical variables like gallbladder status and blood group were presented using frequency tables. The mean values of age, gestational age, and gravidity were compared t-test and ANOVA. Gallbladder status was compared to age group, gravidity, trimester, and blood group using Chi-squared test. P values of <0.05 were considered significant. Results The study sample consists of 300 pregnant women records. The means age of pregnant mother with gall stone and sludge was statistically higher than the normal gallbladder. Multigravida was higher among the study sample (63%).The most of the study subject were in third trimester (68%). Majority (97%) had normal gallbladder, 2% had gallstones and 1% had sludge. A higher proportion of gallstones were identified among mothers age more than 30 years. Muliti-gravid had higher proportion of gallstones and sludge. The third trimester was identified as higher proportion of gallstones and sludge. All the cases who had gallstone and sludge were Blood group type “O”. Conclusion This sample shows that a higher proportion of gallstones and sludge were identified among mothers whose age more than 30 years, muliti-gravid, in their third trimester and blood group of type “O”. Further studies are needed to generalized this study finds to Sri Lankan setting.Item Gallstone-related complications and evidence base treatments. A scoop review(Sri Lanka College of Obstetricians & Gynaecologists, 2022) Abeysuriya, V.; Dodampahala, S.H.The incidence of gallstones is 10-15%, making it one of the most common causes of surgical admissions. The number of admissions and operations for gallstone disease is increasing. Commonly gallstones are formed in the gallbladder but can also develop in the biliary tree. Commonly, gallstones are made of cholesterol. Even though the exact cause of supersaturation of bile is not known, there are multiple associate factors for gallstone formation. Most patients with gallstones never experience any symptoms, but the risk of presenting with complications related to gallstones is 1%-4% a year. Patients with gallstones can present with pain or other more severe complications that demand surgical treatment and follow-up. This article looks into epidemiology, basic pathophysiology, complications, pregnancy and gallstones, diagnosis and recent evidence base treatment of gallstone disease.Item Histological analysis of chronic inflammatory patterns in the gall bladder(International Organization of Scientific Research (IOSR), 2016) Hasan, R.; Abeysuriya, V.; Hewavisenthi, J.; Wijesinghe, J.A.A.S.INTRODUCTION: Cholecystectomy is a common surgical procedure. Inflammatory disease is the most common pathology of the gallbladder. OBJECTIVE: To assess the different morphological changes of chronic cholecystitis in cholecystectomy specimens. METHODS: Thirty histological specimens from cholecystectomies from patients clear clinical history of biliary lithiasis were histologically evaluated with Haematoxylin-Eosinstaining. Three samples were obtained from fundus, middle third and the neck respectively from each gallbladder. RESULTS: 76% of the specimens had metaplastic epithelial changes. Hyperplasia showed a positive correlation (1.0000) with chronic inflammation. Regenerative morphology of epithelial cells was found in 73% of the cases. Regenerative epithelium showed a positive correlation (1.0000) with presence of neutrophils and was significantly associated with mucosal erosions (P=0.005). Fibrosis was observed in all cases (26% mild, 62% moderate, 12% severe). Moderate degree showed a positive correlation (0.999) with severe chronic inflammation. Activity was present in 29% of the cases. Muscular thickness was considered mild in 55% of cases, moderate in 37%, and severe in 8%. Adipose tissue deposits were mild in 47% of cases, moderate in 38%, and severe in 15%. Evolution of the chronic inflammatory cholecystitis was observed in four stages. Initial stage is characterized by mild fibrosis, often with cellular foci, admixed with granulation type tissue in superficial portions of the wall, mild to moderate mononuclear infiltrate and absence of Rockitansky Aschoff sinus(RAS). The second stage consisted of moderate fibrosis and inflammatory infiltrate, often with mild amounts of adipose tissue with RAS extending in to one-third of the length of the specimen. The third stage showed severe fibrosis and chronic inflammation, with moderate to severe adipose tissue deposits with RAS extending in to two-third of the length. The final stage was that of severe fibrosis, often laminated, with reduction of adipose tissue, a moderate to severe inflammatory infiltrate with RAS extending almost entire length of the specimen. CONCLUSION: Staging of chronic inflammatory changes in the gallbladder might help in evaluation of the cholecystectomy specimen, to give a rational, systematic, and reproducible diagnosis of different patterns of the inflammatory process.