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Acute appendicitis: Difference between revisions
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A normal [[WBC]] count is unlikely in the case of acute appendicitis, as leukocytosis is present in > 80% of cases. The higher the WBC count, the higher the chance for gangrenous or perforated appendicitis. <abbr>CRP</abbr> is also frequently elevated. | A normal [[WBC]] count is unlikely in the case of acute appendicitis, as leukocytosis is present in > 80% of cases. The higher the WBC count, the higher the chance for gangrenous or perforated appendicitis. <abbr>CRP</abbr> is also frequently elevated. | ||
In some countries (like Norway), imaging is usually not performed if the clinical presentation is very suspicious for acute appendicitis. If imaging is to be performed, low-dose abdominal [[CT]] with contrast or abdominal [[ultrasound]] are the modalities of choice. These may reveal suspicious features such as thickening and enhancement of the appendiceal wall, and rule out other pathologies as well. Imaging will also reveal features of perforation if present, like faeces or air in the abdominal cavity. | In some countries (like Norway), imaging is usually not performed if the clinical presentation is very suspicious for acute appendicitis. If imaging is to be performed, low-dose abdominal [[CT]] with contrast or abdominal [[ultrasound]] are the modalities of choice. These may reveal suspicious features such as thickening and enhancement of the appendiceal wall, and rule out other pathologies as well. Imaging will also reveal features of perforation if present, like faeces or air in the abdominal cavity. Ultrasound cannot visualise a retrocoecal appendix, and is therefore not completely sensitive for acute appendicitis. The presence of bowel gas also reduces visibility. | ||
Only histology can confirm the diagnosis of appendicitis, although one can usually tell whether the appendix is inflamed or not during surgery. | Only histology can confirm the diagnosis of appendicitis, although one can usually tell whether the appendix is inflamed or not during surgery. | ||
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If one, suspecting acute appendicits, opens the patient's abdominal cavity and discovers that the appendix is not inflamed, some advocate for removing the (healthy) appendix anyway, seeing as you're already there and it will prevent appendicitis in the future, but others advocate for leaving it as there is no longer any indication for surgery. Removing the healthy appendix avoids the problem of assuming that the appendix is absent should the patient appear to present with appendicitis subsequently, althought this problem is easily avoided by the use of patient health records or patient history. | If one, suspecting acute appendicits, opens the patient's abdominal cavity and discovers that the appendix is not inflamed, some advocate for removing the (healthy) appendix anyway, seeing as you're already there and it will prevent appendicitis in the future, but others advocate for leaving it as there is no longer any indication for surgery. Removing the healthy appendix avoids the problem of assuming that the appendix is absent should the patient appear to present with appendicitis subsequently, althought this problem is easily avoided by the use of patient health records or patient history. | ||
Studies have shown that antibiotic therapy can be as effective as surgery for managing the initial presentation of appendicitis. However, these studies also conclude that this carries with it moderate risk of recurrence and missed neoplasms. As such, surgery remains the first choice.<noinclude>[[Category:Gastroenterology]] | Studies have shown that antibiotic therapy can be as effective as surgery for managing the initial presentation of appendicitis. However, these studies also conclude that this carries with it moderate risk of recurrence and missed neoplasms. As such, surgery remains the first choice.<noinclude> | ||
[[Category:Gastrointestinal surgery]]</noinclude> | [[Category:Gastroenterology]] | ||
[[Category:Gastrointestinal surgery]] | |||
</noinclude> | |||