Clinical Presentation of Acute Appendicitis: Clinical Signs—Laboratory Findings—Clinical Scores, Alvarado Score and Derivate Scores (original) (raw)
Related papers
Sudan Journal of Medical Sciences, 2009
Introduction: Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality. So, surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. Objective: This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis. Methods: The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender, clinical presentation (signs and symptoms) and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal, acutely inflamed and gangrenous. Results: Clinical diagnosis was made correctly in 807 (93.2%) of the patients. White blood cells count ranged from 3.70 to 45.30 /mm 3 (mean 17.5353 /mm 3). It was <10,000/mm 3 in 133 (15.4%) patients. Conclusions: Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it.
Acute appendicitis: R in establishing a preoperative diagnosis
Background: Acute appendicitis is one of the most common clinical diagnoses that comes to mind when a patient presents to the emergency department with acute onset of pain in abdomen. of USG and color Doppler in the diagno involving 78 patients was carried out in the Emergency department and the surgical outpatient department of NIMS university Hospital between October 2012 and October 2013. All the pati based on history, clinical examination, laboratory investigations and USG of the abdomen. underwent abdominal USG and colour Doppler, appendix was visualized in only 51 patients. F patients and negative in 29 patients. Total 23 patients underwent surgery and consequent Histopathological examination, which revealed acute appendicitis in 21 patients. The histopathology specimens of 2 patients were negative f appendicitis. Overall 30 patients did not have acute appendicitis. relatively easy to correlate the USG findings with the patients' anatomical site pain. A complete examinatio...
Non-appendicitis Diagnoses in Patients Operated Due to Acute Appendicitis
Medical Bulletin of Haseki, 2019
The aim of the present study was to evaluate patients who were operated due to acute appendicitis and who were later determined to have non-appendicitis pathologies. Methods: The demographic characteristics, histopathological results existence of perforation, complications and the length of hospital stay were recorded. The data of the patients who were determined to have histopathological results other than acute appendicitis were analyzed. Results: A total of 2112 patients, who underwent surgery due to acute appendicitis were included in the study. Sixty-seven-pointfive percent of the patients were male (n=1426). The average age was 33.6±12.9 years and the median age was 30 (19-90) years. The patients were divided into two groups as those under the age of 30 (Group 1) and above the age of 30 (Group 2). No significant differences were detected between the two groups in terms of histopathological diagnoses, perforation, complication and length of hospital stay. Normal appendix was found in 0.6% and non-appendicitis pathologies in 1.5% (n=33) of patients. Conclusion: Despite advances in radiological imaging a significant number of malignancies and other diagnoses might be detected in patients operated for acute appendicitis; therefore, histopathological analysis of appendicectomy specimens is of great importance.
Incidence of Acute Nonperforated and Perforated Appendicitis: Age-specific and Sex-specific Analysis
World Journal of Surgery, 1997
This prospective study was performed to investigate epidemiological characteristics in terms of the age-and sex-specific incidence in patients with perforated and nonperforated appendicitis. The study population comprised 1486 consecutive patients who underwent appendectomy for suspected acute appendicitis between 1989 and 1993. Two patient cohorts [n ؍ 544 (37%)] were analyzed with regard to prehospitalization duration of symptoms and in-hospital observation time. The crude incidence of acute appendicitis was 86 per 100,000 per year. Although the incidence of nonperforated appendicitis was highest among adolescents and young adults (13-40 years of age), perforated appendicitis occurred at almost the same incidence in all sex and age groups. The diagnostic accuracy was 76%. Perforated appendicitis occurred in 19%, with higher rates in small children and the elderly, irrespective of gender. A high diagnostic accuracy was not associated with an increased rate of perforation. In small children and the elderly, the diagnostic accuracy was low and the perforation rate high. Patients with perforation had a significantly longer duration of symptoms as well as in-hospital observation time than did patients with nonperforated appendicitis. Perforated appendicitis showed a different incidence pattern than nonperforated appendicitis and was associated with a significantly longer duration of symptoms and in-hospital observation time, probably due to patientrelated factors. We suggest this observation deserves attention regarding clinical diagnosis and treatment decision-making for patients with suspected acute appendicitis.
Presentation and Histopathology of Acute Appendicitis
INTRODUCTION: Acute appendicitis is on of the most common cause of acute abdomen. Acute appendicitis can be managed conservatively and surgery is also required in many cases. Appendectomy can be termed 'Negative' if histopathologic examination (HPE) is normal. In this study we try to find out what is the percentage of negative appendectomy. MATERIAL AND METHODS: 60 cases of acute appendicitis who underwent appendectomy were included in this research. Demography, presentation, surgery performed and HPE in all cases were recorded and evaluated. RESULTS AND DISCUSSION: Acute appendicitis and appendectomy is more common in males (56.6%) compared to females (43.4%). Most patients were in 20-30 years of age. HPE showed 61.6% cases were that of Acute appendicitis with periappendicitis, 20% cases showed features of Acute gangrenous appendicitis, 5% cases had Unusualhistologic report and 13.3% cases were termed Negative appendectomy. CONCLUSION: Histopathologic examination should be done in maximum possible number of appendectomy specimen.
Accuracies of Diagnostic Methods for Acute Appendicitis
The American Surgeon
The objectives were to evaluate the effectiveness of ultrasonography, computed tomography, and physical examination for diagnosing acute appendicitis with analyzing their accuracies and negative appendectomy rates in a clinical rather than research setting. A total of 2763 subjects were enrolled. Sensitivity, specificity, positive predictive value, and negative predictive value and negative appendectomy rate for ultrasonography, computed tomography, and physical examination were calculated. Confirmed positive acute appendicitis was defined based on pathologic findings, and confirmed negative acute appendicitis was defined by pathologic findings as well as on clinical follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 99.1, 91.7, 96.5, and 97.7 per cent, respectively; for computed tomography, 96.4, 95.4, 95.6, and 96.3 per cent, respectively; and for physical examination, 99.0, 76.1, 88.1, and 97.6 per cent, respecti...
Spectrum of Clinical Presentations in Different Variants of Acute Appendicitis
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.5\_May2019/Abstract\_IJRR0042.html, 2019
Acute appendicitis is the commonest abdominal emergency. It is mainly a disease of teenagers and young adults affecting the most productive section of the population. So prolongation of morbidity due to negative laparotomy is unwanted and at the same time delay in diagnosis of acute appendicitis is apprehended. The present study was conducted on 75 histologically proved cases of acute appendicitis. Detailed clinical, morphological and histopathological features were studied. Abdominal pain was present in all patients and right iliac fossa was the usual site of abdominal pain. A significant number of cases reported a migration of pain to right iliac fossa from periumbilical region. Nausea and vomiting were other common symptoms. Tachycardia and pyrexia were more prominent in advanced appendicitis cases. Other important clinical features were related with types of appendicitis. Routine histopathology is vital for surgeons to assess their clinical diagnosis, which in the long run will consolidate the base of their clinical experience and enrich the understanding of the pathologies of the appendix as a whole and improve their clinical judgment.
A practical score for the early diagnosis of acute appendicitis
Annals of Emergency Medicine, 1986
We conducted a retrospective study of 305 patients hospitalized with abdominal pain suggestive of acute appendicitis. Signs, symptoms, and laboratory findings were analyzed for specificity, sensitivity, predictive value, and joint probability~ The total joint probability, the sum of a true-positive and a true-negative result, was chosen as a diagnostic weight indicative of the accuracy of the test. Eight predictive factors were found to be useful in making the diagnosis of acute appendicitis. Their importance, according to their diagnostic weight, was determined as follows: localized tenderness in the right lower quadrant, leukocytosis, migration of pain, shift to the left, temperature elevation, nausea-vomiting, anorexia-acetone, and direct rebotmd pain. Based on this weight, we devised a practical diagnostic score that may help in interpreting the confusing picture of acute appendicitis. [Alvarado A: A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med May 1986;15:557-564.]
Acute Appendicitis and Its Management: A Hospital Based Study
https://www.ijrrjournal.com/IJRR\_Vol.8\_Issue.10\_Oct2021/IJRR-Abstract045.html, 2021
Background: Acute appendicitis is the most common acute surgical condition of the abdomen, which if complicated by perforation or peritonitis has high morbidity and mortality. Aim: The aim of this study is to analyze the presentation, diagnosis and management of acute appendicitis along with the role of conservative management in uncomplicated cases. Materials and Methods: This study was conducted in Govt. Medical College Jammu over a period of one year w.e.f. September 2017 to August 2018 and included 120 patients. Diagnosis in the suspected patients was based on history, clinical examination coupled with laboratory investigations and imaging modalities like ultrasound/ CT Scan wherever required. Results: 120 patients of acute appendicitis were treated over the period of one year at our center. Abdominal pain was the most common and constant presentation seen in 112 patients followed by vomiting (82), history of fever (60), history of constipation and distension (20) and another 12 had history of diarrhoea. Six patients (5%) responded favorably to conservative management. Conclusion: Acute appendicitis is a common surgical emergency requiring detailed history and meticulous examination coupled with X-ray and ultrasonography for diagnosis. Appendectomy is the standard procedure of choice and wherever feasible laparoscopic appendectomy offers the advantage of less pain, short hospital stay, earlier return to work and overall cost.
Prospective evaluation of diagnostic modalities in suspected acute appendicitis
Langenbeck's Archives of Surgery, 2004
Background: The aim of this prospective study was to evaluate different diagnostic modalities routinely employed in a district hospital. Method: Four hundred subsequent patients presenting with acute abdominal pain were included over a period of 18 months. Patient characteristics, diagnostic work-up, intraoperative findings, histology and clinical outcome were documented. Rectal temperature, white cell count (WCC), C-reactive protein (CRP), ultrasonography (US) and Ohmann score were analysed with relation to diagnostic value. Results: Negative appendicectomy rate and negative laparotomy rate on the day of admission were 22% and 21%, respectively. Sensitivity was highest for WCC and CRP (0.82 and 0.85) but US showed highest values for specificity (0.92), accuracy (0.85) and odds ratio (13.06). No patient with an Ohmann score below 6.5 suffered from acute appendicitis. With regard to different levels of training in US, experienced surgeons and radiologists had best values for specificity (1.00 and 0.98) and accuracy (0.90 and 0.94). Surprisingly, less-experienced sonographers also achieved good results with regard to specificity (up to 0.96) and positive predictive value (up to 0.89). Conclusion: Diagnostic accuracy of acute appendicitis remains insufficient, with an unacceptable high rate of unnecessary operations. Only the promotion of routine ultrasonography might contribute to an improvement in the near future.