Appendicitis: Difference between revisions
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The rates of unnecessary appendectomy and of perforation have not improved over time<ref name="pmid11594900">{{cite journal |author=Flum DR, Morris A, Koepsell T, Dellinger EP |title=Has misdiagnosis of appendicitis decreased over time? A population-based analysis |journal=JAMA |volume=286 |issue=14 |pages=1748–53 |year=2001 |month=October |pmid=11594900 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11594900 |issn=}}</ref><ref name="pmid4087950">{{cite journal |author=Scitovsky AA |title=Changes in the costs of treatment of selected illnesses, 1971-1981 |journal=Med Care |volume=23 |issue=12 |pages=1345–57 |year=1985 |month=December |pmid=4087950 |doi= |url= |issn=}}</ref> in spite of increased use of laboratory tests<ref name="pmid4087950">{{cite journal |author=Scitovsky AA |title=Changes in the costs of treatment of selected illnesses, 1971-1981 |journal=Med Care |volume=23 |issue=12 |pages=1345–57 |year=1985 |month=December |pmid=4087950 |doi= |url= |issn=}}</ref> and [[diagnostic imaging]]<ref name="pmid12620554">{{cite journal |author=Perez J, Barone JE, Wilbanks TO, Jorgensson D, Corvo PR |title=Liberal use of computed tomography scanning does not improve diagnostic accuracy in appendicitis |journal=Am. J. Surg. |volume=185 |issue=3 |pages=194–7 |year=2003 |month=March |pmid=12620554 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002961002013648 |issn=}}</ref>. <!-- Need to check PMID: 13865085 --> | The rates of unnecessary appendectomy and of perforation have not improved over time<ref name="pmid11594900">{{cite journal |author=Flum DR, Morris A, Koepsell T, Dellinger EP |title=Has misdiagnosis of appendicitis decreased over time? A population-based analysis |journal=JAMA |volume=286 |issue=14 |pages=1748–53 |year=2001 |month=October |pmid=11594900 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11594900 |issn=}}</ref><ref name="pmid4087950">{{cite journal |author=Scitovsky AA |title=Changes in the costs of treatment of selected illnesses, 1971-1981 |journal=Med Care |volume=23 |issue=12 |pages=1345–57 |year=1985 |month=December |pmid=4087950 |doi= |url= |issn=}}</ref> in spite of increased use of laboratory tests<ref name="pmid4087950">{{cite journal |author=Scitovsky AA |title=Changes in the costs of treatment of selected illnesses, 1971-1981 |journal=Med Care |volume=23 |issue=12 |pages=1345–57 |year=1985 |month=December |pmid=4087950 |doi= |url= |issn=}}</ref> and [[diagnostic imaging]]<ref name="pmid12620554">{{cite journal |author=Perez J, Barone JE, Wilbanks TO, Jorgensson D, Corvo PR |title=Liberal use of computed tomography scanning does not improve diagnostic accuracy in appendicitis |journal=Am. J. Surg. |volume=185 |issue=3 |pages=194–7 |year=2003 |month=March |pmid=12620554 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002961002013648 |issn=}}</ref>. <!-- Need to check PMID: 13865085 --> | ||
==Diagnosis== | |||
An Alvarado score (also called MANTRELS score) of less than 3<ref name="pmid17543650">{{cite journal |author=McKay R, Shepherd J |title=The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED |journal=Am J Emerg Med |volume=25 |issue=5 |pages=489–93 |year=2007 |month=June |pmid=17543650 |doi=10.1016/j.ajem.2006.08.020 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-6757(06)00415-3 |issn= |accessdate=2009-02-14}}</ref> or 5<ref name="urlBestBets: The Alvarado Scoring System is an accurate diagnostic tool for appendicitis">{{cite web |url=http://www.bestbets.org/bets/bet.php?id=1671 |title=BestBets: The Alvarado Scoring System is an accurate diagnostic tool for appendicitis |author=Haldane C |authorlink= |coauthors= |date=2008 |format= |work= |publisher=BestBets |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=2009-02-14}}</ref> 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 | |||
==Complications== | ==Complications== | ||
Revision as of 02:27, 14 February 2009
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
Complications
Abscess
Appendiceal abscess or phlegmon occurs in 4% of cases.[7] It is controversial whether these patients require and appendectomy.[7]
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.
- ↑ 7.0 7.1 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.