“COMPARATIVE STUDY OF SERUM
CHOLESTEROL, BILIRUBIN, CALCIUM
AND PHOSPHOROUS IN GALLSTONE
DISEASE”
A dissertation submitted to the
Atal Bihari Vajpayee Medical University UP, Lucknow
In partial fulfillment of the requirement for the degree
MASTER OF SURGERY
(GENERAL SURGERY)
By
DR. DEEPAK SINGH
B.R.D. MEDICAL COLLEGE
GORAKHPUR
2024
I
“COMPARATIVE STUDY OF SERUM
CHOLESTEROL, BILIRUBIN, CALCIUM
AND PHOSPHOROUS IN GALLSTONE
DISEASE”
A dissertation submitted to the
Atal Bihari Vajpayee Medical University UP, Lucknow
In partial Fulfilment of the requirement for the degree
MASTER OF SURGERY
(GENERAL SURGERY)
By
DR. DEEPAK SINGH
Dr. ANAND JAISWAL (MS,FAIS)
Professor
Department of General Surgery
B.R.D Medical College,
Gorakhpur
Dr. SANTOSH KUMAR (MS, FAIS) Dr. SHAILA MITRA (MD)
Assistant Professor Professor
Department of General Surgery Department of Pathology
B.R.D Medical College, B.R.D Medical College,
Gorakhpur Gorakhpur
B.R.D. MEDICAL COLLEGE
GORAKHPUR
2024
II
DECLARATION BY STUDENT
I, Dr. Deepak Singh, hereby declare that the entitled dissertation
“COMPARATIVE STUDY OF SERUM CHOLESTEROL, BILIRUBIN,
CALCIUM AND PHOSPHOROUS IN GALLSTONE DISEASE” is a bonafide
work carried out by me under the supervision of Dr. ANAND JAISWAL (MS,
FAIS) and Co Guide Dr. SANTOSH KUMAR (MS, FAIS) Dr. SHAILA MITRA
(MD)& at Atal Bihari Vajpayee Medical University, UP, Lucknow. I further declare
that to the best of my knowledge the dissertation proposal does not contain any
part of any work which has been submitted for the award of any degree either
in any college or university
Signature
Dr. Deepak Singh
MS final year
B.R.D. MEDICAL COLLEGE
GORAKHPUR
DATE:
III
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “COMPARATIVE STUDY OF
SERUM CHOLESTEROL, BILIRUBIN, CALCIUM AND PHOSPHOROUS IN
GALLSTONE DISEASE” is bonafide work done by DR. DEEPAK SINGH in
partial fulfilment of requirement for the award of MS degree of the Atal Bihari
Vajpayee Medical University, UP, Lucknow under the guidance of undersigned.
He has carried out the work at B. R. D. Medical College Gorakhpur.
Guide
Dr. ANAND JAISWAL (MS,FAIS)
Professor
Department of General Surgery
B.R.D Medical College,
Gorakhpur
Date
Co-Guide
Dr. SANTOSH KUMAR (MS, FAIS) Dr. SHAILA MITRA (MD)
Assistant Professor Professor
Department of General Surgery Department of Pathology
B.R.D Medical College, B.R.D Medical College,
Gorakhpur Gorakhpur
Date Date
IV
ENDORSEMENT BY HEAD OF DEPARTMENT & FORWARDED
BY THE PRINCIPAL
This is to certify that the dissertation entitled “COMPARATIVE STUDY OF
SERUM CHOLESTEROL, BILIRUBIN, CALCIUM AND PHOSPHOROUS
IN GALLSTONE DISEASE” is a bonafide research work done by Dr.
Deepak Singh under the guidance of Dr. Anand Jaiswal (MS,FAIS)
Professor Department of General Surgery BRD Medical College Gorakhpur.
Dr. Ashok Kumar (MS, FLCS, FAIS)
Professor and HOD
Department of General Surgery
B.R.D Medical College,
Gorakhpur
Date
Forwarded by:
Dr. RAM KUMAR (M.S.)
Principal
B.R.D. Medical College,
Gorakhpur
Date
V
ACKNOWLEDGEMENT
Words often fall short when it comes to expressing gratitude. Writing this
dissertation has been one of the most significant challenges of my life, and I
owe its completion to many generous hearts and minds.
First and foremost, I extend my deepest gratitude to my esteemed teacher and
guide, Dr. (Prof.) Anand Jaiswal (MS, FAIS), Professor, Department of
General Surgery, B.R.D. Medical College, Gorakhpur. His unwavering
support, patience, and insightful guidance have been the cornerstone of this
work. It is an honor to have learned under such a meticulous and disciplined
mentor, whose passion for teaching and dedication to the field will continue to
inspire me throughout my career.
My heartfelt thanks go to my co-guides, Dr. Santosh Kumar (M.S, FAIS),
Assistant Professor, Department of General Surgery, B.R.D. Medical
College, Gorakhpur, for their continuous support and encouragement
throughout this journey.
My heartfelt thanks go to my co-guides, Dr. Shaila Mitra (MD), Professor
Department of General Surgery, B.R.D. Medical College, Gorakhpur, for their
continuous support and encouragement throughout this journey.
Special thanks are due to Dr. Ashok Kumar (MS, FLCS, FAIS), Professor,
and Head of Department of General Surgery, B.R.D. Medical College,
Gorakhpur, for their continuous support and encouragement throughout this
journey.
VI
Dr. Sandesh Srivastava (MS), Professor, Department of General Surgery,
B.R.D. Medical College, Gorakhpur, for his constant inspiration and valuable
suggestions that have significantly enriched this work.
I am deeply appreciative of the assistance and encouragement provided by Dr.
Yogesh Kumar (MS, FAIS) Professor Department of General Surgery, B.R.D.
Medical College, Gorakhpur, Dr. Abhishek Jina (MS), Assistant Professor,
Department of General Surgery, B.R.D. Medical College, Gorakhpur, Dr.
Durgesh Kumar Tripathi (MS), Assistant Professor, Department of General
Surgery, B.R.D. Medical College, Gorakhpur; Dr. Anand Kumar Gautam (MS),
Assistant Professor, Department of General Surgery, B.R.D. Medical College,
Gorakhpur; Dr. Deepak Singh (MS) Assistant Professor Department of General
Surgery, B.R.D. Medical College, Gorakhpur Dr. Aquil Ahmed (MS), Assistant
Professor, Department of General Surgery, B.R.D. Medical College, Gorakhpur;
Dr. Rahul Sarin (MS), Assistant Professor, Department of General Surgery,
B.R.D. Medical College, Gorakhpur; and Dr. Juli Chand (MS), Assistant
Professor, Department of General Surgery, B.R.D. Medical College, Gorakhpur
for their unfailing support and inspiration.
I owe a special debt of gratitude to my parents, Mr. Ram Prakash Singh and
Mrs. Meena Devi , whose love and support have been a continual source of
motivation. My sincere thanks also go to my seniors, colleagues, juniors,
paramedical staff, and all those who have contributed directly or indirectly to this
endeavor.
I would like to extend my special thanks to Mr. Abhijeet Prajapati (Sakshi
Computer) for his assistance in formatting and printing my thesis, helping to bring
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it to its presentable form.
Above all, I thank GOD, whose grace has been most sufficient in every matter,
allowing this journey to reach its conclusion within a reasonable timeframe
despite the barriers along the way.
Lastly, I express my deepest gratitude to all the patients involved in this study,
whose participation made this research possible.
With sincere regards,
Dr. Deepak Singh
Date
VIII
LIST OF ABBREVIATIONS
DLC Differential Leukocyte Count
FTIR Fourier-transform infrared spectroscopy
GBC Gallbladder cancer
GBD Gallbladder Disorder
GS Gallbladder Stone
LIBS Laser-induced breakdown spectroscopy
OCP Oral contraceptive pills
SD Standard Deviation
SGOT Serum Glutamic Oxaloacetic Transaminase
SGPT Serum Glutamic Pyruvic Transaminase
SPSS Statistical Package of Social Science
TLC Total Leukocyte Count
TOF-SIMS Time-of-flight secondary ion mass spectrometry
USG Ultrasonography
XRF X-ray fluorescence
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ABSTRACT
Introduction: Gallstones are one of the most common problems associated with the
gallbladder, affecting millions of people throughout the world. Studies have shown that Indian
females shoulder the burden of 10-22 % of the worldwide prevalence of gallstones among
females. The problem of high incidence of gallstones with a rising rate of Gallbladder cancer
is a uniquely Indian problem.
Objective: To study the variables i.e. serum cholesterol, bilirubin, calcium and phosphorous
in relation to age and sex in gallstone diseases.
Methods: This study was conducted in the Department of Surgery, Nehru Hospital, BRD
Medical College, over a period of 12 months. 100 patients suffering from GSD and proven by
USG and undergoing cholecystectomy were recruited. A detailed clinical history, thorough
clinical examinations along with routine blood investigation Serum cholesterol, Bilirubin,
Calcium, Phosphorous recorded. Statistical analysis was done using (SPSS 25.00 for windows;
SPSS inc, Chicago, USA).
Results: Mean age of the study subjects was 46.77±12.03 years, 1. 86% study subjects were
females. Mean serum Serum cholesterol, Bilirubin, Calcium, Phosphorous values were
statistically significantly higher in patients with mixed type vs cholesterol type of stone,
pigmented type vs cholesterol type of stone and with pigmented type vs mixed type (p < 0.05).
Conclusion: Gallbladder stones are more common in female subjects with increasing age.
Risk of cholelithiasis is increased by a sedentary lifestyle and light physical activity. The most
prevalent form of gallstone comprises mixed gallstones.
Keywords: Gallbladder, Gallstones, Serum cholesterol, Serum Bilirubin, Serum Calcium,
Serum Phosphorous.
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TABLE OF CONTENTS
Table No. Title Page No.
1 Introduction 1-3
2 Aim and Objectives 4
3 Review of Literature 5-17
4 Materials and Methods 18-21
5 Results 22-62
6 Discussion 63-70
7 Conclusion & Recommendation 71-72
8 References 73-87
9 Annexures 88-94
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LIST OF TABLES
Table
Title Page No.
No.
Mean age distribution of subjects
1 22
Distribution of subjects based on age groups
2 23
Distribution of subjects based on gender
3 24
Mean height and weight of subjects
4 25
Distribution of subjects based on personal habits
5 26
Distribution of subjects based on type of comorbidities
6 27
Mean hematological parameters
7 28
Distribution of subjects based on history of weight loss
8 29
Distribution of subjects based on drug history
9 30
Distribution of subjects based on diagnosis
10 31
11 Distribution of subjects based on type of surgery 32
12 Distribution of subjects based on leak 33
Distribution of subjects based on biomarkers at different
13 34
time intervals
14 Distribution of subjects based on fever 37
Distribution of subjects based on absence of bowel sound
15 38
on day 4
16 Distribution of subjects based on diarrhoea before day 7 39
XII
Distribution of subjects based on drainage of feculent fluid
17 40
>400ml on POD 3
Association of presence or absence of leak with age
18 41
groups
19 Association of presence or absence of leak with gender 42
Association of presence or absence of leak with personal
20 43
habits
21 Association of presence or absence of leak with albumin 44
Association of presence or absence of leak with type of
22 45
surgery
Comparison of hS-CRP based on leak using independent
23 46
sample test
Comparison of procalcitonin based on leak using
24 48
independent sample test
Comparison of IL-6 based on leak using independent
25 50
sample T test
Comparison of TLC based on leak using independent
26 52
sample
ROC curve to predict the leak with biochemical marker hS-
27 CRP at different time intervals (pre-op, post op day 3,5 55
and 7)
ROC curve to predict the leak with biochemical marker
28 procalcitonin at different time intervals (pre-op, post op day 57
3,5 and 7)
ROC curve to predict the leak with biochemical marker IL-
29 59
6 at different time intervals (pre-op, post op day 3,5 and 7)
XIII
ROC curve to predict the leak with biochemical marker
30 TLC at different time intervals (pre-op, post op day 3,5 and 60
7)
XIV
LIST OF FIGURES40
Table
Title Page No.
No.
1 Distribution of the subjects based on age groups 23
2 Distribution of the subjects based on gender 24
3 Distribution of hs-crp at different time intervals 35
4 Distribution of pro-calcitonin at different time intervals 35
5 Distribution of il-6 at different time intervals 36
6 Distribution of tlc at different time intervals 36
7 Comparison of hs-crp based on leak 47
8 Comparison of procalcitonin based on leak 49
9 Comparison of il-6 based on leak 51
10 Comparison of tlc based on leak 53
Roc curve to predict the leak with biochemical marker hs-
11 crp at different time intervals (pre-op, post -op day 3, 5 and 54
7)
Roc curve to predict the leak with biochemical marker
12 procalcitonin at different time intervals (pre-op, post -op 56
day 3, 5 and 7)
Roc curve to predict the leak with biochemical marker il-6
13 58
at different time intervals (pre-op, post -op day 3, 5 and 7)
Roc curve to predict the leak with biochemical marker tlc at
14 60
different time intervals (pre-op, post -op day 3, 5 and 7)
XV
LIST OF APPENDICES
Annexure I: Ethical Approval Certificate
Annexure II: Informed Consent Form (English & Hindi)
Annexure III: Case Proforma
Annexure IV: Master Chart
Annexure VI: Plagiarism Report
XVI
