Rajiv gandhi university of health sciences, karnataka, bangalore proforma for registration of subjects for dissertation



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE




PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION




1. Name of the candidate and Address : RAMNEIK MANGLIK

1,SAKET ROORKEE

DIST.HARIDWAR

UTTARAKHAND

2. Name of the Institution : Kempegowda Institute Of Medical

Sciences & Research Centre,Banglore




3. Course of Study and Subject : M.S. (GENERAL SURGERY)




4. Date of admission to course : 01/06/12




5. Title of the Topic : Study of perforated peptic ulcer and its complications and correlation with s. amylase and peritoneal fluid amylase.








6. BRIEF RESUME OF THE INTENDED WORK:




6.1 NEED FOR THE STUDY:

The common complications of peptic ulcer are perforation, bleeding and stenosis. perforation being an urgent surgical emergency. Sudden release of gastric or duodenal contents into the peritoneal cavity though a perforation leads to a devastating sequence of events which if not properly managed, if likely to cause death.Patient presents with pain upper abdomen sudden and severe in onset associated with tenderness initially, later with rigidity and shock.Treatment of the perforated peptic ulcer is primarily surgical.clinically perforated peptic ulcer may be difficult to distinguish from acute pancreatitis which is managed mainly conservatively. The need for study is to show that s. amylase can be elevated in both acute pancreatitis and perforated peptic ulcer . Thus s . amylase should not be relied on to make a diagnosis and futher work up is mandatory in pt. presenting with upper abdomen pain, tenderness and guarding. Also to show the correlation of s. amylase and peritoneal fluid amylase in relation to duration of perforation,size,site,amount of spillage of perforation and number of perforation.


6.2 REVIEW OF LITERATURE:

The knowledge of perforation dates back to over 2000 yrs remote past when “sushrutha” the great Indian surgeon described it as “parinamashula” giving the relation of the food, pain and vomiting.

The history of knowledge of peptic ulcer perforation was reviewd by Jordan in 1985. Rawlison is credited with the first published report in 1727 of a perforated ulcer , which happened to be gastric .In 1939, probstein, wheeler, and gray reported the death of a patient who was treated non operatively because of a diagnosis of acute pancreatitis which had been made based on the findings of a serum amylase concentration of 600 somogyri units autopsy revealed a perforated gastric ulcer without evidence of acute pancreatitis. Hughes demonstrated an increased excretion of amylase in the urine in 4 of 40 patients with an acute perforation of a duodenal ulcer.wapshaw, Musgrove,mckenzie and others reported additional observation that a false positive elevation in the serum amylase level might result from perforated peptic ulcers. The elevation was found more frequently after the lapse of several hours , in the presence of a large perforation , or after the leakage of a considerable quantity of duodenal fluid.


6.3 AIMS AND OBJECTIVES OF THE STUDY:





To study signs, symptoms ,mode of presentation and post operative complications in

perforated peptic ulcer.
 

S.amylase level and peritoneal fluid amylase level and their correlation between time of

presentation, hemodynamic status of patient, amount of spillage, size, site, number of

perforation.





7. MATERIAL AND METHODS:







7.1 SOURCE OF DATA




All patients of perforated peptic ulcer presenting to department of surgery of KIMSH, Bangalore







7.2 METHOD OF COLLECTION OF DATA




a. Patient data collection and evaluation.

Patient data will be collected from all patients attending KIMS general Surgery OPD, and inpatient department, irrespective of their age/gender/ background /socio economic status. The patients will be evaluated and followed up according to protocol.

  • Detailed history of patient will be entered in proforma.

  • Clinical examination of patient

  • Preliminary investigations – Blood routine,biochemical routine and urine analysis

  • Patient will be informed about any surgical procedure and consent will be taken.

Follow up of patients:

Patients will be followed up daily until discharged then once a week for 2 week and once after 3 months.

b. Inclusion Criteria:

1. All cases of perforated peptic ulcer diagnosed intra operatively.







c. Exclusion Criteria:



1. perforation other than peptic ulcer perforation.

2. Perforation secondary to blunt trauma or penetrating trauma abdomen.

3. Peptic ulcer perforation patients who are managed conservatively.







d. Sample size: 30 cases.




e. Study design: Prospective study




f. Sample design: Purposive sampling.




g. Duration of study: 1 1/2 years.

Case selection for the study will be done in the initial 1year followed by follow up totally for 6 months.




h. Study place: KIMS Hospital, Bangalore.




7.3 Does the study required any investigations or interventions to be conducted on patients ? If so, please describe briefly.

1.) serum amylase

2.) pancreatic fluid amylase

3.) x ray erect abdomen




7.4 Has ethical clearance been obtained from your institution, in case of 7.3.

YES




LIST OF REFERENCES:

  • · Sarath Chandra S, Siva Kumar S. Definitive or conservative surgery for perforated gastric ulcer? - An unresolved problem. Int J Surg. Dec 25 2008.  

  • · Langell JT, Mulvihill SJ. Gastrointestinal perforation and the acute abdomen. Med Clin North Am. May 2008;92(3):599-625, viii-ix.

  • 1. Paimela H, Paimela L, Myllykangas-Luosujarvi R, et al. Current features of peptic

  • ulcer disease in Finland: incidence of surgery, hospital admissions and mortality

  • for the disease during the past twenty-five years. Scand J Gastroenterol 2002;

  • 37(4):399–403.

  • 2. Schwesinger WH, Page CP, Sirinek KR, et al. Operations for peptic ulcer disease:

  • paradigm lost. J Gastrointest Surg 2001;5(4):438–43.

  • 3. Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for

  • peptic ulcer disease in the United States, 1993 to 2006. Ann Surg 2010;251(1):

  • 51–8.

  • 4. Sarosi GA Jr, Jaiswal KR, Nwariaku FE, et al. Surgical therapy of peptic ulcers in

  • the 21st century: more common than you think. Am J Surg 2005;190(5):775–9.

  • 5. Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet 2009;

  • 11. Groenen MJ, Kuipers EJ, Hansen BE, et al. Incidence of duodenal ulcers and

  • gastric ulcers in a Western population: back to where it started. Can J Gastroenterol

  • 2009;23(9):604–8.

  • 12. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations

  • on the management of patients with nonvariceal upper gastrointestinal

  • bleeding. Ann Intern Med 2010;152(2):101–13.





9. SIGNATURE OF THE CANDIDATE:









10. REMARKS OF THE GUIDE:








11. NAME AND DESIGNATION OF:




11.1. GUIDE: Dr. K. Venu gopal

Associate Professor

General Surgery,KIMS




11.2 SIGNATURE:









11.3. HEAD OF THE DEPARTMENT: Prof. Dr.V.Satish

HOD-General Surgery,KIMS




11.4. SIGNATURE:









12. REMARKS:





12.1. CHAIRMAN AND PRINCIPAL:







12.2. SIGNATURE:



From

Dr. Ramneik manglik

PG in General surgery

Kims hospital banglore
To,

THE PRINCIPAL

KIMS, BANGLORE


Sub: forwarding of synopsis of dissertation topic to the Rajiv Gandhi university of health sciences Bangalore for registration

Ref: Through proper channel

Respected sir,

With reference of the above subject here in I submit my synopsis for the registration of dissertation topic that is “STUDY OF PERFORATED PEPTIC ULCER AND ITS COMPLICATIONS AND CORRELATION WITH S. AMYLASE AND PERITONEAL FLUID AMYLASE.”

Hence I request your kind self to forward the same to the Rajiv Gandhi university of health sciences , Bangalore , for registration and do the needful.

Thanking you

Yours sincerely


(Dr. Ramneik manglik)



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