Suspected AppendicitisJinu Janet Varghese

Group :4, Year: 6

Tbilisi State Medical University

• Appendicitis is inflammation of the appendix. Pain first, nausea and vomiting next, and fever last has been described as the classic presentation of acute appendicitis. Localization of the pain to the right lower quadrant. Coughing causes point tenderness in this area (McBurney's point). Severe pain on sudden release of deep pressure in the lower abdomen (rebound tenderness).

• The history taking and physical examination is the most important in evaluating pain in the right lower quadrant. The shorter duration of pain, is an important predictor. Usually in women it is misdiagnosed with pelvic inflammatory disease, gastroenteritis, abdominal pain of unknown origin, urinary tract infection, ruptured ovarian follicle, and ectopic pregnancy.

• Laboratory tests are performed as part of the initial evaluation to rule out or confirm specific disorders. In all women of reproductive age who present with acute abdominal pain, the serum b-human chorionic gonadotropin level should be measured to rule out uterine or ectopic pregnancy. Elevated leukocyte count is a common finding but has poor specificity as it is also characteristic of several other acute abdominal and pelvic diseases. A urinalysis may confirm or rule out urologic causes of abdominal pain.

• When the history and findings on physical examination are consistent with the diagnosis of appendicitis, appendectomy is often performed without further evaluation. Abdominal radiography has low sensitivity(75-90), Specificity(86-100) and and a positive predictive value of 89 to 93 percent for the diagnosis. Ultrasonography may identify alternative diagnoses. For patients with suspected appendicitis, spiral CT has a sensitivity of 90 to 100 percent, a specificity of 91to 99 percent, a positive predictive value of 95 to 97 percent, has also proved to be accurate in patients in whom the diagnosis is uncertain.

• CT has proved superiority over transabdominal US for identifying appendicitis, and alternative diagnoses. US can be used for the evaluation of women who are pregnant and women in whom there is a high degree of suspicion of gynecologic disease. If CT studies show the presence of another disorder or an absence of abnormalities, there is no need for appendectomy, and supportive care or appropriate alternative treatment can be provided. This strategy can reduce the cost of observation, since a normal CT scan rules out appendicitis with a high degree of accuracy also it will increase diagnostic accuracy, leading to timely intervention, while reducing the rate of unnecessary appendectomy, and largely eliminating the costs of unnecessary imaging or observation.

• After an uncomplicated appendectomy, recovery time can vary from 2 to 6 weeks. The individual may gradually resume a normal diet with restriction in physical activity for at least two to four weeks. The doctor will inspect the incision the following week to look for possible wound infection.

References

• http://www.nejm.org/doi/pdf/10.1056/NEJMcp013351• http://en.wikipedia.org/wiki/Appendicitis• http://www.emedicinehealth.com/appendicitis/page8_em.htm• http://www.aafp.org/afp/2010/0415/p1043.html