Surgery
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
A 20-year-old man presents to A&E with abdominal pain. The pain started in the periumbilical region, but is now felt in the right iliac fossa. On examination, there is right iliac fossa tenderness with guarding and rebound tenderness. He also has a positive Rovsing’s sign. A diagnosis of acute appendicitis is made. Apart from abdominal pain, give two symptoms of acute appendicitis. (2)Why is the pain first felt in the periumbilical region? (1)Why does it then migrate to the right iliac fossa? (1)What is Rovsing’s sign? (1)Give two differentials of appendicitis. (2)What is the definitive treatment of appendicitis? (1)Give two possible complications of appendicitis. (2)
Acute appendicitis
Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan in Take Charge! General Surgery and Urology, 2020
Diagnosis of acute appendicitis is a clinical one. The investigations listed here will generally only serve to confirm the diagnosis in the presence of equivocal findings or to rule out an alternative diagnosis. Ultrasound abdomen This has a sensitivity of 86% and specificity of 81% in acute appendicitis.It is operator-dependant and should only be used in conjunction with high clinical suspicion and laboratory markers. Appendicitis is diagnosed when an aperistaltic non-compressible tubular structure is seen with a diameter >6 mm.CT AP This has a sensitivity and specificity of 95% in acute appendicitis.Appendicitis can be diagnosed when an abnormal appendix or calcified appendicolith are seen alongside localised inflammation, free fluid or appendix diameter >6 mm.
Appendicitis
Stephen M. Cohn, Peter Rhee in 50 Landmark Papers, 2019
The most controversial issue regarding the management of acute appendicitis in the twenty-first century, other than whether to employ the laparoscopic versus open surgical approach, is probably whether or not to treat this condition in a similar fashion to acute diverticulitis, with antibiotics alone. There is accumulating data in adults (and some in children) which suggests that uncomplicated acute appendicitis can be successfully managed with antibiotics alone in about 80% of patients, without an increased risk of perforation or complications (Salminen et al., 2015). The higher costs of surgery and the post-surgical risks of adhesive bowel obstruction and ventral hernia (trocar site hernia incidence is underappreciated) must be balanced with the danger of appendicitis recurrence. For individuals with uncomplicated appendicitis who are about to depart on travel expeditions to remote areas such as Antarctica or the Himalayas, it appears prudent to undergo an appendectomy to eliminate the likelihood of recurrent appendicitis in such austere environments. For the rest of us, while surgery is the mainstay in management of acute appendicitis, antibiotic management is looking like a favorable alternative to going under the knife.
Diagnostic Value of High-Mobility Group Box 1 (HMGB1) Protein in Acute and Perforated Appendicitis
Published in Journal of Investigative Surgery, 2018
Shabanali Alizadeh, Ali Ghazavi, Ali Ganji, Ghasem Mosayebi
Acute appendicitis is an inflammation of appendix tissue with usually unknown etiology [24]. Acute appendicitis is commonly associated with some clinical symptoms and variation in traditional biomarkers and pro-inflammatory cytokines. Recently, Albayrak et al. [25] have shown that serum levels of HMGB1 in patients with acute appendicitis were significantly higher than in normal individuals. In parallel, the results of this study showed that the serum levels of HMGB1 in patients with inflamed appendix (acute and perforated appendicitis) were significantly higher than in the patients with normal appendix. Also, there was significant difference in the levels of HMGB1 between patients with acute and perforated appendicitis. The results suggest that there is a correlation between the serum levels of HMGB1 and severity or type of appendicitis.
Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis
Published in Alexandria Journal of Medicine, 2020
Mahmoud Agha, Maha Sallam, Mohamed Eid
Another one 67 y male patient (0.1%) was presented with severe acute appendicitis like symptoms and signs. CT scan revealed showed a linear dense foreign body in the mesentery, in close relation to the tip of a pre-ileal inflamed appendix. There was an ileocecal mucosal hyperenhancement and submucosal edema and regional stranding of the right iliac fossa fat planes. This mesenteric foreign body was surrounded with a considerable ring-enhancing collection, which was reported as sealed appendicular perforation with periappendicular abscess Figure 11(a-b). The patient was first managed conservatively with intense broad-spectrum short antibiotic course, with repeated CT scan after 1 week. The second study revealed a significant resolution of the collection and clearly demonstrated the residual inflamed appendix. Figure 11 (C-D) Operative feedback history documented a sealed appendicular perforation with extra-appendicular fish bone foreign body.
Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis
Published in Journal of Investigative Surgery, 2018
Noha Boshnak, Mohamed Boshnaq, Hatem Elgohary
This prospective study was approved by the local ethical committee. A total of 200 patients who were presented with abdominal pain and underwent open or laparoscopic appendectomies with a pre-diagnosis of acute appendicitis were enrolled in this study. The diagnosis of acute appendicitis was made by means of complete history taking, physical examination, and routine laboratory tests that were done on hospital admission. Venous blood samples of 2 mL were collected in K3 tripotassium ethylene diamine tetraacetate (EDTA) vacutainers for CBC analysis. Samples were analyzed within 1 h of collection using an automated blood cell counter (Sysmex XT 1800, Kobe, Japan). Reference values were 4–10×109/L for WBC, 2–7×109/L for neutrophils, 1–3×109/L for lymphocytes, 150–410×109/L for platelets, 7.4–10.4 femtoliter (fL) for MPV, 10.5–16.4 fL for PDW, and 11.6–14% for RDW. Clotted blood samples were used for CRP analysis.