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)
Appendectomy
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Acute appendicitis is usually diagnosed on the basis of the classical clinical symptoms of migratory right iliac fossa pain, nausea, right lower quadrant tenderness, and fever. Children aged over 5 years more often experience a longer delay in diagnosis and higher incidence of perforation. Every effort should be made to confirm the diagnosis of appendicitis before surgery. Formerly reported rates of negative explorations (20–40%) are no longer acceptable. Repeated clinical examinations and appropriate imaging should reduce the negative rates below 10%. Abdominal US is an excellent and accurate screening tool for acute appendicitis. Computed tomography (CT) has slightly higher sensitivity and specificity than US, but the radiation dose remains a significant concern. Therefore, CT with minimized radiation dose is preserved for special situations and complicated patients with an unclear diagnosis and increased operation risk. Significant medical conditions causing appendicitis-like symptoms should be ruled out by clinical examination, laboratory tests, and imaging. These include right basal pneumonia, cholecystitis, meningitis, urinary tract infections, Henoch–Schönlein purpura, and acutely presenting ketoacidosis of type 1 diabetes.
AI and the Bioscience and Clinical Considerations for Immunology
Louis J. Catania in AI for Immunology, 2021
Diagnosis of acute appendicitis is challenging, especially due to the frequently unspecific clinical picture. Inflammatory blood markers and imaging methods like ultrasound are limited as they have to be interpreted by experts and still do not offer sufficient diagnostic certainty. A recent study presents a method for automatic diagnosis of appendicitis as well as the differentiation between complicated and uncomplicated inflammation using values/parameters which are routinely and unbiasedly obtained for each patient with suspected appendicitis. A total of 590 patients (473 patients with appendicitis in histopathology and 117 with negative histopathological findings) were analyzed retrospectively with modern algorithms from machine learning (ML) and artificial intelligence (AI). Results revealed the capability to prevent two out of three patients without appendicitis from useless surgery as well as one out of three patients with uncomplicated appendicitis. The presented method has the potential to change the current therapeutic approach for appendicitis and demonstrates the capability of algorithms from AI and ML to significantly improve diagnostics even based on routine diagnostic parameters.15
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.
Brief Commentary on the Article “Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis”
Published in Journal of Investigative Surgery, 2019
Appendicitis has always remained the major subgroup among patients suspected of acute abdomen in emergency departments all over the world. Due to the potential catastrophic events that might ensue if left unattended, surgical removal of the vermiform appendix is the ideal treatment in a case of diagnosed appendicitis. However, there are a large number of clinical conditions which can mimic the clinical features of acute appendicitis, especially in the paediatric population. To diagnose a case of acute abdomen as appendicitis requires astute clinical examination skills as well as an array of investigations in the form of blood counts and imaging modalities like Ultrasonography and Computed Tomography(CT). In spite of all the preoperative investigations, a significant percentage of people(as high as 10%) who undergo emergency appendicectomy still turn up negative histology.1 Also, the adverse effects associated with CT scan preclude its routine prescription in all suspected cases, especially in the younger population. Over the years, clinicians have been on the hunt for the right blood marker that can differentiate a case of acute appendicitis from other causes of acute abdomen which don't mandate surgical treatment.