Appendicitis: Difference between revisions
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imported>Howard C. Berkowitz |
imported>Robert Badgett (→Diagnosis: Started X-ray computed tomography) |
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* Fever of 37.3 °C or more | * Fever of 37.3 °C or more | ||
* Left shift or an increase in the number of immature leukocytes in the peripheral blood | * Left shift or an increase in the number of immature leukocytes in the peripheral blood | ||
===X-ray computed tomography=== | |||
Spiral [[x-ray computed tomography]] ''without'' radiocontrast has accuracy of:<ref name="pmid19733421">{{cite journal| author=Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD| title=Diagnostic Accuracy of Noncontrast Computed Tomography for Appendicitis in Adults: A Systematic Review. | journal=Ann Emerg Med | year= 2009 | volume= | issue= | pages= | pmid=19733421 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19733421 | doi=10.1016/j.annemergmed.2009.06.509 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
* [[sensitivity and specificity|sensitivity ]] 92.7% | |||
* [[sensitivity and specificity|Specificity]] 96.1% | |||
==Complications== | ==Complications== | ||
Revision as of 08:34, 17 January 2010
Appendicitis is defined as "Acute inflammation of the appendix. Acute appendicitis is classified as simple, gangrenous, or perforated."[1]
The rates of unnecessary appendectomy and of perforation have not improved over time[2][3] in spite of increased use of laboratory tests[3] and diagnostic imaging[4].
Diagnosis
An Alvarado score (also called MANTRELS score) of less than 3[5] or 5[6] makes appendicitis very unlikely:
Two points each:
- Abdominal pain that migrates to the right iliac fossa
- Leukocytosis (more than 10000 white blood cells per microliter)
One point each:
- Anorexia (loss of appetite) or ketones in the urine
- Nausea or vomiting
- Pain on pressure in the right iliac fossa
- Rebound tenderness
- Fever of 37.3 °C or more
- Left shift or an increase in the number of immature leukocytes in the peripheral blood
X-ray computed tomography
Spiral x-ray computed tomography without radiocontrast has accuracy of:[7]
- sensitivity 92.7%
- Specificity 96.1%
Complications
Abscess
Appendiceal abscess or phlegmon occurs in 4% of cases.[8] It is controversial whether these patients require an appendectomy.[8]
References
- ↑ National Library of Medicine. http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?term=appendicitis
- ↑ Flum DR, Morris A, Koepsell T, Dellinger EP (October 2001). "Has misdiagnosis of appendicitis decreased over time? A population-based analysis". JAMA 286 (14): 1748–53. PMID 11594900. [e]
- ↑ 3.0 3.1 Scitovsky AA (December 1985). "Changes in the costs of treatment of selected illnesses, 1971-1981". Med Care 23 (12): 1345–57. PMID 4087950. [e]
- ↑ Perez J, Barone JE, Wilbanks TO, Jorgensson D, Corvo PR (March 2003). "Liberal use of computed tomography scanning does not improve diagnostic accuracy in appendicitis". Am. J. Surg. 185 (3): 194–7. PMID 12620554. [e]
- ↑ McKay R, Shepherd J (June 2007). "The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED". Am J Emerg Med 25 (5): 489–93. DOI:10.1016/j.ajem.2006.08.020. PMID 17543650. Retrieved on 2009-02-14. Research Blogging.
- ↑ Haldane C (2008). BestBets: The Alvarado Scoring System is an accurate diagnostic tool for appendicitis. BestBets. Retrieved on 2009-02-14.
- ↑ Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD (2009). "Diagnostic Accuracy of Noncontrast Computed Tomography for Appendicitis in Adults: A Systematic Review.". Ann Emerg Med. DOI:10.1016/j.annemergmed.2009.06.509. PMID 19733421. Research Blogging.
- ↑ 8.0 8.1 Andersson RE, Petzold MG (2007). "Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis". Ann. Surg. 246 (5): 741–8. DOI:10.1097/SLA.0b013e31811f3f9f. PMID 17968164. Research Blogging.