Appendicitis Background

Considered as one of the most common diseases in emergency abdominal surgery, acute appendicitis affects approximately seven percent of the population with an estimate of eighteen percent of perforation rates. Checking a patient who has suspicion of acute appendicitis primarily depends on the patient’s history of disease and physical signs. Clinical manifestation, however, is rare evidence when deciding to check an individual for acute appendicitis.

2871 adults who were suspected of having appendicitis were sent to an academic medical center. At the center, they received nonspecific multidetector computed tomography or CT scanning of their abdominal and pelvic areas.

These procedures took place within 24 to 48 hours of patient arrival. Radiologists reviewed the computed tomography images and concluded which patients displayed manifestations of acute appendicitis and which patients did not. Once no signs or symptoms of acute appendicitis were found, the radiologists proposed alternative diagnosis for patients without signs. A procedure referred to as appendectomy was administered for those patients in which the radiologists diagnosed with acute appendicitis.

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Surgeons recorded whether or not acute appendicitis was actually the accurate analysis. These doctors followed up with patients who did not require surgery for a minimum of one year to dismiss a postponed diagnosis.

The radiologists concluded that seven hundred and eight patients displayed enough signs to be diagnosed with acute appendicitis. However, the surgeons involved in the case study verified that only six hundred and sixty five patients were actually suffering from acute appendicitis. The radiologists also concluded that the diagnosis of acute appendicitis in 2163 of the participating patients could be excluded.

Out of the large amount of patients who were not diagnosed with acute appendicitis, ten of them were later diagnosed with the inflammatory condition. Along with the increasing use of computed tomography, there has been a correlation of decreasing perforations of the appendix in patients with acute appendicitis. Perforations of the appendix coincide with delayed treatment. Therefore, according to The Role of Multidetector Computed Tomography for Diagnosing Acute Appendicitis, the fact that computed tomography scanning is capable of detecting early diagnosis of appendicitis suggests that the increasing use of multidetector computed tomography is the reason for the decrease in perforations of the appendix in patients suffering from acute appendicitis (Pickhardt, Lawrence, Pooler & Bruce, 2011).

Considered as one of the most common diseases in emergency abdominal surgery, acute appendicitis occurs approximately seven percent in a lifetime with an estimate of eighteen percent of perforation rates. Checking a patient who has suspicion of acute appendicitis primarily depends on the patient’s history of disease and physical signs. Clinical manifestation, however, is rare evidence when deciding to check an individual for acute appendicitis. Occasionally, a patient will not be diagnosed with acute appendicitis because more evidence is needed to determine whether or not the patient’s condition is, in fact, acute appendicitis. Unfortunately, when this delay is in process, patients may suffer from other severe complications of another condition such as peritonitis. Mortality and morbidity rates for patients that undergo this occurrence are much higher than patients who are diagnosed with acute appendicitis in a timely fashion. In other words, diagnosis and treatment of acute appendicitis must be accurate and completed within an appropriate time frame to decrease the chances of unnecessary diagnostic procedures.

Proper therapeutic measures and clinical management strategies must be identified and implemented in an appropriate time frame as well. Significant factors that contribute to acute appendicitis are difficult to identify due to the plethora of considerations that are consistently available. For instance, patient medical history and laboratory data are both significant factors when diagnosing an individual with acute appendicitis (“A Hybrid Decision”, 2011) According to “Alvarado Scoring in Acute Appendicitis-A Clinicopathological Correlation”, accurate diagnosis of acute appendicitis can only be accomplished at operation and histopathologic examination of the patient. Therefore it would be unrealistic to have a specific preoperative diagnosis that adheres to gold standard which will likely lead to a significant rate of negative appendectomy.

These statistics are stated in the world literature. Several different scoring systems have been developed and set in place to support the accurate diagnosis of acute appendicitis. These scoring systems are also utilized in order to reduce the negative appendectomy rates associated with late diagnosis of acute appendicitis (Dey et al, 2010). In 1986, A. Alvarado established eight factors that were useful in predicting and accurately diagnosing acute appendicitis. Several different studies were administered in an attempt to validate the usefulness of Alvarado’s system. The Alvarado scoring system is now a useful tool utilized in preoperative diagnosis of acute appendicitis.

This scoring system also works effectively in routine practice. Scores that are found in a range higher than seven generate a fundamental confirmation of the diagnosis of acute appendicitis. Early detection of the condition yields early operation that allows the patient to avoid complications such as perforation of the appendix. Patients who score between the range of five and six on the Alvarado scoring system must be re-evaluated for the possibility of deterioration of clinical condition and earliest possible intervention. The Alvarado scoring system has significantly improved the diagnostic accuracy of acute appendicitis as well as reduced complication rates (Dey et al, 2010).

According to Barreto et al (2010), the incidence of complicated acute appendicitis, despite availability of modern technology, remains high around twenty eight or twenty nine percent. Although appendectomy for acute appendicitis is the most common intra-abdominal surgical procedure executed by general surgeons, rates of morbidity recorded in the post-operative time frame remain between nine and eighteen percent. There has been an increasing trend to delay “uncomplicated” acute appendicitis cases that present after hours to be performed the next morning in order to avoiding disrupting operating room schedules and to reduce the number of patients being operated on after hours on the premise that sleep deprivation and fatigue were associated with technical errors.

However, the importance of an urgent appendectomy cannot be understated especially because of the disparity in morbidity and mortality rates between perforated and non-perforated appendicitis (Barreto et al, 2010) Age and sex as a risk factor for appendix perforation in patients suffering from acute appendicitis has been previously reported. Old advancing age and male gender have a higher risk of perforation of the appendix. The reason has been placed on delayed diagnosis but there is no data that supports this claim. Blood investigations assist clinical findings in the diagnosis of acute appendicitis. Tests directed at complete blood count and C - reactive protein are the most commonly performed blood exams. Often, acute appendicitis is the case if there is an elevation of neutrophil count and C-reactive protein use (Barreto et al, 2010).

Conclusively, acute appendicitis is a very common condition that can be diagnosed and treated with early detection from computed tomography scanning. CT scanning is very significant in the decrease of perforations of the appendix in patients who suffer from acute appendicitis. Clinical manifestation is insignificant in the diagnosis of acute appendicitis because this particular condition depends primarily on the patient’s history of disease. Delayed diagnosis of acute appendicitis is associated with higher rates of perforation of the appendix.

Acute appendicitis must be diagnosed and managed within an appropriate amount of time or the patient may be at risk of suffering from other severe conditions. Alvarado’s scoring system is very useful and accurate in the diagnosis of acute appendicitis. The system has high potential for early detection of acute appendicitis. Many doctors and surgeons practice the utilization of Alvarado’s scoring system to detect the onset of acute appendicitis early so that proper treatment can be administered. Acute appendicitis is a common illness and more research is being conducted to better the outcome.

References

Pickhardt, P. J., Lawrence, E. M., Pooler, B. D., & Bruce, R. J. (2011).

The Role of Multidetector Computed Tomography for Diagnosing Acute Appendicitis.

Annals Of Internal Medicine, 154(12), I36.

A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis. (2012).

BMC Medical Informatics & Decision Making,12(1), 17-30. doi:10.1186/1472-6947-12-17

Dey, S., Mohanta, P., Baruah, A., Kharga, B., Bhutia, K., & Singh, V. (2010).

Alvarado Scoring in Acute Appendicitis-A Clinicopathological Correlation.

Indian Journal Of Surgery, 72(4), 290-293. doi:10.1007/s12262-010-0190-5

Barreto, S. G., Travers, E., Thomas, T., Mackillop, C., Tiong, L., Lorimer, M., & Williams, R. (2010).

ACUTE PERFORATED APPENDICITIS: AN ANALYSIS OF RISK FACTORS TO GUIDE SURGICAL DECISION MAKING.

Indian Journal Of Medical
Sciences, 64(2), 58-65. doi:10.4103/0019-5359.94401