Study of Gall bladder
contractility in patients of asymptomatic Gall stone
Dugar D1, Khadanga S2, Satapathy S3,Tim HT4, Ghata S5
1Dr Dharmendra Dugar, M.S. Assistant professor, Department of General
surgery, 2Dr Sagar Khadanga, M.D. Assistant professor,
Department of General Medicine,3Dr Tim Houghton T, P.G
Student, Department of General surgery,4Dr Swarupjit Ghata,
P.G Student, Department of General surgery all are affiliated to
Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha,
India,5Dr Shakti Satapathy Consultant Radiologist, Care
Hospital, Bhubaneswar, Odisha, India.
Address of corresponding
author: Dr Dharmendra Dugar, E mail:dddugar@gmail.com
Abstract
Introduction:
The prevalence of gall bladder stone varies widely in different parts
of world. Worldwide gall stone disease is increasing. A knowledge of
the predictive factors of the development and persistence of symptoms
in gall stone patients play a key role in clinical decision making. The
aim of this study is to evaluate the presence of predictive factors for
biliary pain development in gall stone, stressing the role of gall
bladder motility. Aims
and objective: To study gall bladder contractility in
patients of asymptomatic gall stone by ultrasound and to correlate with
normal individuals. Material and methods: A hospital based
observational study was conducted from January 2012 to march 2013. A
total of 25 patients with asymptomatic gall stones (group 1) and 25
controls (group 2) were included in the study. Results:
Ultrasonography volume was found to be significantly more in group 1,
both during fasting and after fatty meals, suggesting decreased gall
bladder motility in asymptomatic patient. Inter group comparison of
gall bladder thickness was statistically significant both during
fasting and after fatty meal in group. Conclusion: Gall
bladder volume was found to be significantly more in asymptomatic
cases, both during fasting and after fatty meal. Mean gall bladder wall
thickness and mean alkaline phosphatase level was significantly more in
patients with gall stones.
Key words:
Alkaline phosphatase (ALP), Gall stone disease (GSD), Ultrasonography
(USG).
Manuscript received:
4th July 2014, Reviewed:
17th Aug 2014
Author Corrected:
24th Aug 2014, Accepted
for Publication: 25th Aug 2014
Introduction
The prevalence of gall bladder stone varies widely in different parts
of world. Worldwide gall stone disease is increasing [1, 2]. An
epidemiological study restricted to rail road workers showed that north
Indians have 7 times higher occurrence of gall stone as compared with
south Indians [3]. Presence of gall stones detected incidentally in
patient who do not have any abdominal symptoms related to gall stone is
known as asymptomatic cholelithiasis. The diagnosis is made during
routine ultrasound for other abdominal condition. The consideration of
gall bladder motility and further risk factors (small stones, younger
age and female gender) may help to predict the clinical course of gall
stone patients, define atypical complaints as biliary related and
select patients for treatment. Knowledge of the predictive factors of
the development and persistence of symptoms in gall stone patients play
a key role in clinical decision making. The aim of this study is to
evaluate the presence of predictive factors for biliary pain
development in gall stone, stressing the role of gall bladder motility.
Gall bladder motility evaluation is a useful diagnostic tool in
clinical decision making for gall stone in symptomatic patients; a
progressive reduction of gall bladder motility could suggest a
“wait and watch” management policy instead of an
immediate surgical approach [4]. In this study we compared the effect
of presence of gall stone over contractility in case and control group
of asymptomatic gall stone patients. Patients with asymptomatic gall
stone has less than 20% chances of ever developing symptoms, and the
risk associated with prophylactic operation overweigh the potential
benefit of surgery in most patients [4,5].
Aims
and Objectives
To study gall bladder contractility in patients of asymptomatic gall
stone by ultrasound and to correlate with normal individuals. We
compared gallbladder volume and wall thickness in patient of
asymptomatic cholelithiasis and of normal individuals (control).
Methodology
A hospital based observational study was conducted from January 2012 to
march 2013. A total of 25 patients with asymptomatic gall stones (group
1) and 25 controls (group 2) were included in the study. Consecutive
type of convenience sampling was used during the study period to select
patients with asymptomatic gall stones.
Inclusion criteria
All patients coming to Hitech medical college and hospital who had
asymptomatic gall stone diagnosed on ultrasonography.
Exclusion criteria
1. Asymptomatic gall stones with abnormal gall bladder on
ultrasonography
2. Symptomatic gall stone disease
3. Complications of gall stone disease
Observation
and Result
An ultrasonographic evaluation of fasting gall bladder volume and
post-prandial volume was done in all subjects using 3.5 or 5 MHz
transducer. The probe was placed on the right subcostal area while the
patients were in supine position and angled to obtain images showing
largest longitudinal diameter of gall bladder. The greatest length (L),
the greatest width (W) and anteroposterior (H) dimensions and presence
of gall stone were recorded. Gall bladder images were obtained after a
standard breakfast consisting of egg, milk and pastry (695 kcal, 19.2
gm carbohydrate and 9 gm fat). The gall bladder volume was calculated
by ellipsoid (π x L x W x H).
In our study out of 25 asymptomatic patients 12 were female. The age of
the subject ranged from 10–80 years. The mean age in group 1
and group 2 was 48.36±19.15 and 44.28±16.31 years
respectively. Age difference was statistically non significant. None of
the patient in group 1 had past history of any biliary tract
involvement, jaundice, fever, pain or flatulent dyspepsia. In
group–1, 13 patients presented with vague abdominal
discomfort, 2 with umbilical hernia, 3 with benign hypertrophy of
prostrate, 5 had renal calculi and 2 patients with appendicitis. None
of the patients had symptoms pointing towards biliary tract involvement
and were diagnosed with gall stones incidentally during ultrasonography.
Table 1: Intra group
comparison of gall bladder wall thickness
|
Group
|
Wall
thickness in mm
|
Mean
|
p-value
|
|
Group
1
|
Fasting
|
2.41
|
<0.01
|
|
After
fatty meal
|
2.57
|
|
Group
2
|
Fasting
|
2.21
|
0.95
|
|
After
fatty meal
|
2.23
|
There was significant increase in wall thickness in patients
with asymptomatic gall stone disease as compared to control.
Ultrasonography volume was found to be significantly more in group 1,
both during fasting and after fatty meals (21.9 vs 12.9ml and13.1 vs
4.6 ml), suggesting decreased gall bladder motility in asymptomatic
patient [Table 2]. Fasting gall bladder volume is significantly more in
group 1 with p-value <0.01 [Table 3]. Intergroup comparison of
gall bladder volume was statistically significant (p-value
<0.01), with higher volume after fatty meal, in group 1 [Table
4]. Gall bladder wall thickness was more in group 1, both in fasting
[Table 3] and after fatty meal [Table 4], with p-value <0.05.
Intragroup comparison of gall bladder wall thickness shows that the
wall thickness is more in group 1 as compared to group 2 (2.41 vs 2.21
mm and 2.57 vs 2.23 mm) [Table 1].
Table 2: Intra group
comparison of ultrasonography volume
|
Group
|
Volume
in ml
|
Mean
|
p-value
|
|
Group
1
|
Fasting
|
21.9
|
<0.01
|
|
After
fatty meal
|
13.1
|
|
Group
2
|
Fasting
|
12.9
|
<0.01
|
|
After
fatty meal
|
4.6
|
Ultrasonography volume was found to be significantly more in
group 1, both during fasting and after fatty meals.
Table 3: Inter-group
comparison of gall bladder thickness and ultrasonography volume
(fasting)
|
Overnight
fasting
|
Group
|
Mean
|
Standard
deviation
|
P
- value
|
|
Gall
bladder thickness
|
1
|
2.41
|
1.62
|
<0.05
|
|
2
|
2.21
|
0.5
|
|
Gall
bladder volume
|
1
|
21.9
|
8.9
|
<0.01
|
|
2
|
12.9
|
3.7
|
Both volume and wall thickness is significantly higher in
group 1 during fasting
Table 4: Inter-group
comparison of gall bladder thickness and ultrasonography volume (after
fatty meal)
|
After
fatty meal
|
Group
|
Mean
|
Standard
deviation
|
P
value
|
|
Gall
bladder thickness
|
1
|
2.57
|
1.58
|
<0.05
|
|
2
|
2.23
|
0.5
|
|
Gall
bladder volume
|
1
|
13.1
|
8.2
|
<0.01
|
|
2
|
4.6
|
2.0
|
Both volume and wall thickness is significantly higher in
group 1 after fatty meal
Discussion
In our study 12 patients in group 1 (48%) were females. Bhattacharya
series [6] showed 71.4% were females while 28.6% were male. Similar sex
preponderance in favour of females was noted in other studies. In the
present study mean age in group 1 was 48.36±19.15 years and
group 2 was 44.28±16.31 years. We found increased incidence
of gall stones in the 6th decade of life. Similar incidence is seen in
the studies of Hamdani et al (65 years). Ultrasonography volume was
found to be significantly more in group 1 both during fasting and fatty
meals (21.9 vs 12.9 ml and 13.1 vs 4.6ml). Gall bladder motility in
asymptomatic patients is decreased as compared to controls (P value of
<0.01). Brandt et al, in cross sectional study found that
sluggish gall bladder motility was more frequent in asymptomatic
patients [7]. Similar results were seen in studies by Colecchia et al
[8] and Nieves MA et al [9]. Brandt et al in a study on symptomatic and
asymptomatic gall stone patients along with controls concluded that
asymptomatic cholelithiasis is associated with impaired gall bladder
function [10]. Intergroup comparison of gall bladder thickness was
statistically significant both during fasting and after fatty meals
(2.41 vs 2.21mm and 2.57 vs 2.23mm). A study was conducted by Handler
SJ et al to evaluate ultrasound of gall bladder wall thickening and its
relation to gall bladder disease. The result showed that a thickened
gall bladder wall is associated with gall stones [11]. A statistically
significant increase in mean alkaline phosphatase was seen in patient
with gall stone disease. Naseem A et al [12] found similar result.
Conclusion
Gall bladder volume was found to be significantly more in asymptomatic
cases, both during fasting and after fatty meal, suggesting decreased
gall bladder motility in asymptomatic gall stone patients compared to
controls. Mean gall bladder wall thickness and mean alkaline
phosphatase level was significantly more in patients with gall stones.
Funding: Nil
Conflict of interest:
Nil
Permission from IRB:
Yes
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How to cite this article?
Dugar D, Khadanga S, Satapathy S, Tim HT, Ghata S. Study of Gall
bladder contractility in patients of asymptomatic Gall stone. Int J Med
Res Rev 2014;2(5):435- 438.doi:10.17511/ijmrr.2014.i05.06