Register now or log in to join your professional community.
Appendicitis is:
- An inflammation of the inner lining of the vermiform appendix that spreads to its other parts and it occurs when bacteria invade and infect the wall of the appendix (a small, worm-like appendage attached to the colon).
- This condition is a common and urgent surgical illness with protean manifestations, generous overlap with other clinical syndromes, and significant morbidity, which increases with diagnostic delay.
- No single sign, symptom, or diagnostic test accurately confirms the diagnosis of appendiceal inflammation in all cases, and the classic history of anorexia and periumbilical pain followed by nausea, right lower quadrant (RLQ) pain, and vomiting occurs in only50% of cases.
- However, the differential diagnosis of appendicitis is often a clinical challenge because appendicitis can mimic several abdominal conditions.
- The treatment for appendicitis usually is antibiotics and appendectomy(surgery to remove the appendix), but complications may persist due to this including wound infection and abscess.
- Diagnosis: Appendicitis usually is suspected on the basis of a patient's history and physical examination; however, a white blood cell count, urinalysis, abdominal X-ray, barium enema, ultrasonography, CT scan, andlaparoscopy also may be helpful in diagnosis.
- Tests and procedures used to diagnose appendicitis include:
1- Physical exam to assess your pain.
n Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed.
n Other signs your doctor may watch for include abdominal rigidity and a tendency to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding).
n The diagnosis of appendicitis begins with a thorough history and physical examination. Patients often have an elevated temperature, and there usually will be moderate to severe tenderness in the right lower abdomen when the doctor pushes there.
n If inflammation has spread to the peritoneum, there is frequently rebound tenderness. Rebound tenderness is pain that is worse when the doctor quickly releases his or her hand after gently pressing on the abdomen over the area of tenderness.
2- Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.
n The white blood cell count in the blood usually becomes elevated with infection. In early appendicitis, before infection sets in, it can be normal, but most often there is at least a mild elevation even early in the process.
n Unfortunately, appendicitis is not the only condition that causes elevated white blood cell counts. Almost any infection or inflammation can cause this count to be abnormally high.
n Therefore, an elevated white blood cell count alone cannot be used to confirm a diagnosis of appendicitis.
3- Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain. If it is a kidney stone, red blood cells are usually seen during microscopic examination of the urine.
n Urinalysis is a microscopic examination of the urine that detects red blood cells, white blood cells and bacteria in the urine.
n Urinalysis usually is abnormal when there is inflammation or stones in the kidneys or bladder.
n The urinalysis also may be abnormal with appendicitis because the appendix lies near the ureter and bladder.
n If the inflammation of appendicitis is great enough, it can spread to the ureter and bladder leading to an abnormal urinalysis.
n Most patients with appendicitis, however, have a normal urinalysis. Therefore, a normal urinalysis suggests appendicitis more than a urinary tract problem.
4- Imaging tests. Your doctor may also recommend an abdominal X-ray, an ultrasound scan or a computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain.
- Notes:
1)- There is no one test that will diagnose appendicitis with certainty. Therefore, the approach to suspected appendicitis may include a period of observation, tests as previously discussed, or surgery.
2)- Appendicitis can be tricky to diagnose unless you have the typical symptoms.However, around one in two people with appendicitis do not have typical symptoms.
3)- Moreover, some people's appendix may be located in a slightly different part of their body, such as the pelvis, behind the large intestine or behind the liver.
4)- Some people develop pain similar to appendicitis, but it's caused by something else, like a bladder or urine infection, Crohn's disease or gastritis.
Laboratory test. Blood tests are used to check for signs of infection, such as a high white blood cell count. Blood chemistries may also show dehydration or fluid and electrolyte disorders. Urinalysis is used to rule out a urinary tract infection. Doctors may also order a pregnancy test for women of childbearing age (those who have regular periods).
Imaging tests. X rays, ultrasound, and computed tomography (CT) scans can produce images of the abdomen. Plain x rays can show signs of obstruction, perforation (a hole), foreign bodies, and in rare cases, an appendicolith, which is hardened stool in the appendix. Ultrasound may show appendiceal inflammation and can diagnose gall bladder disease and pregnancy. By far the most common test used, however, is the CT scan.
None. It is diagnosed based on history, clinical evaluation, physical exam, and imaging studies. The standard of care is a CT scan of the abdomen. However, new ultrasound machine can provide good enough image that CT may not be needed in some cases avoiding radiation exposure. However, when in doubt, use a CT. Labs are of no clinical value except as a pre-operative evaluation
Elevated wbc
Appendicitis largest index in medical diagnosis after clinical laboratory is a white blood cell count WBCcount>>>
