DOI: https://doi.org/10.53350/pjmhs211592327 ORIGINAL ARTICLE P J M H S Vol. 15, NO.9, SEP 2021 2327 Acute Cholecystitis: A comparative study of hematological and ultrasonography findings among middle aged and elderly NAILA IKRAM 1 , SABAHAT GUL 2 , NATASHA ZAHID 3 , FARHEEN HAMEED 4 , MAZHAR UL HAQUE 5 1,3 Department of Physiology, Al Ameen Medical College Lahore 2 Associate Professor Anatomy, QAMC, Bahawalpur 4 Associate Professor Pharmacology, Shahida Islam Medical & Dental College, Lodhran 5 Associate Professor Anatomy, Shahida Islam Medical & Dental College, Lodhran Correspondence to Dr. Mazhar ul Haque, Email: drmazhar79@gmail.com, Cell No: 03313565277 ABSTRACT Aim: To determine the differences in-between hematological and ultrasonography findings of acute cholecystitis (AC) among middle-aged versus elderly patients. Methodology: This retrospective study was carried out after ethical approval. Patients diagnosed as case of acute cholecystitis was included and patients without findings consistent with acute cholecystitis or with pancreatitic gall stones, co- existing hepato-biliary or intestinal malignancy or with autoimmune biliary disease were excluded. Patients were divided into two groups, one being patients between 30 to 59 years and other group 60 and above year olds. Results: From total of 153 patients included, 87 patients were between 30 and 59 years (middle aged) while 66 patients were 60 years and older (elderly). In both the groups, higher ratios of females persisted (p-0.03). A significant differences between the values were observed only in WBC count (p-0.005) and CRP levels (p<0.001) between middle aged and older age group while all other laboratory variables were found to have an insignificant difference between both the groups. Conclusion: WBC count and CRP level which were observed to be higher among older age patients, compared with middle aged patients. Such alterations in older aged patients ought to be considered when deciding treatment protocols which will have major influence on the prognosis. Keywords: Acute Cholecystitis, C-reactive protein, Systemic Inflammatory Response, Aging Physiology INTRODUCTION The term acute cholecystitis (AC) is referred to as inflammation of the gall bladder due to either an infection, chemical stimulation or commonly by gall bladder duct obstruction due to stone. Among abdominal conditions, AC is the most commonly encountered clinically 1 . The criteria for diagnosing AC include a local inflammatory sign at right upper quadrant with tenderness, also called Murphy’s sign 2 . In addition to local sign, systemic inflammatory sign includes fever, elevated levels of white blood cells (WBC) or C-reactive protein (CRP) 3 . Ultrasonography findings that are consistent with AC are either a thickened wall of gall bladder, pericholecystic fluid or stone in the gall bladder 4 . Even though the clinical course of AC might be self- limiting, but it can lead to dire consequences, i.e. sepsis, peritonitis secondary to the perforation of gall bladder and cholecystoenteric fistulas might result from being either untreated or under treated AC 5 . The reported mortality rate from AC is around 0.6 % 6 . Gall bladder disease frequency is observed to increase with increasing age. As it is known, aging of the most of the poor prognostic factors for any disease 7 . With aging, alterations in physiology is observed, therefore disease might reported different characteristics among elderly patients 8 . To define physiology of aging and indicate the similarities or differences in different age groups are vital for managing a disease especially in geriatric patients 9 . The objectives of this study was to determine the differences in-between main characteristic findings of AC among middle-aged versus elderly patients. METHODOLOGY This retrospective study was carried out in-between March 2019 February 2020. After the approval from institute review board, patients diagnosed as a case of acute cholecystitis were included in the study. All paper and electronic record confirming AC in patients by checking their detailed evaluation including history, findings on clinical examination, laboratory diagnosis and ultrasonography finding were confirmed. Patients without -------------------------------------------------------------------------------------- Received on 07-04-2021 Accepted on 17-08-2021 findings consistent with acute cholecystitis or with pancreatitic gall stones, co-existing hepato-biliary or intestinal malignancy or with autoimmune biliary disease were excluded. All patients were divided into two groups, one being patients in-between 30 to 60 years and above 60 years in other group. Patient’s data included their information from time of admission, including baseline demographics, laboratory investigations such as complete blood count, liver function tests and C-reactive protein (CRP) levels, findings on ultrasonography indicating thickened wall of gall bladder and gall stones. White blood cell (WBC) count above 10,000 mm 3 was considered as elevated and CRP levels above 3 mg/dl were also regarded as above normal limit. Both were termed after Tokyo Guidelines 10 . All the findings of the patients were compared in-between both the groups. Data was analyzed using SPSS version 23.0. For qualitative variables, frequency and percentages were reported. Chi-square test was applied between the findings of both the groups keeping p-value of <0.05 as statistically significant. RESULTS From the total of 153 patients included in the study, 87 patients were between 30 and 59 years (middle aged) while 66 patients were 60 years and older (elderly). In both the groups, higher ratios of females persisted (p-0.03). The ultrasonography findings in both the groups together were observed to have gall bladder wall’s thickness >4 mm in 105(68.6%) of patients. 57 were in middle age group while 48 in older age group having an insignificant difference of p-0.18. Presence of gall stones was seen in 123(80.4%) of patients, among which 72 were middle aged while 51 old age, having an insignificant difference of 0.19 [Table I]. With regards to the laboratory investigations of patients in both the groups, significant differences between the values were observed only in WBC count (p-0.005) and CRP levels (p<0.001) between middle aged and older age group while all other laboratory variables were found to have an insignificant difference between both the groups [Table II, Figure I].