All are true about acute appendicitis except:
Ans: D (Ultrasound is...] Investigation L & B 26th/1206# The diagnosis of acute appendicitis is essentially clinicalThe premise that it is better to remove a normal appendix than to delay diagnosis does not stand up to close scrutiny, particularly in the elderly. A number of clinical and laboratory-based scoring systems have been devised to assist diagnosis. The most \videly used is the Alvarado score. A score of 7 or more is strongly predictive of acute appendicitis.In patients with an equivocal score (5-6), abdominal ultrasound or contrast-enhanced CTexamination further reduces the rate of negative appendicectomy. Abdominal ultrasound examination is more useful in children and thin adults, particularly if gynaecological pathology is suspected, with a diagnostic accuracy in excess of 90 per centContrast-enhanced CT scan is most use fid in patients in whom there is diagnostic uncertainty, particularly older patients, in whom acute diverticulitis, intestinal obstruction and neoplasm are likely differential diagnoses. Selective use of CT scanning may be cost-effective by reducing both the negative appendicectomy rate and the length of hospital stayImaging Harrison 19th/1987-88The effectiveness of ultrasonography as a tool to diagnosis appendicitis is highly operator dependent. Even in very skilled hands, the appendix may not be visualized. Its overall sensitivity is 0.86, with a specificity of 0.81.Ultrasonography, especially intravaginal techniques, appears to be most useful for identifying pelvic pathology in wo men. Ultrasonographic findings suggesting the presence of appendicitis include wall thickening, an increased appendiceal diameter, and the presence of free fluid.The sensitivity and specificity' of computed tomography (CT) are 0.94 and 0.95, respectively. Thus, CT imaging, given its high negative predictive value, may be helpful if the diagnosis is in doubt, although studies performed early in the course of disease may not have any typical radiographic findings."Pain is initially felt in umbilical region. After a few hours, the pain localizes to the right iliac fossa. This is called sh ifting pain of acute appendicitis"-blanipal 4A/828"Lymphoid hyperplasia narrows the lumen of the appendix, leading to luminal obstruction & later culminates to acute appendicitis'"- L& 3 26V1202Symptoms of appendicitis l&b 26th/1203Periumbilical colicPain shifting to the right iliac fossaAnorexiaNauseaCHILD REM L & B 26th/1203The diseases most commonly mistaken for acute appendicitis are acute gastroenteritis and mesenteric fymphadenitis. In mesenteric lymphadenitis, the pain is colicky in nature and cervical lymph nodes may be enlarged.It may be impossible to clinically distinguish Meckel's diverticulitis from acute appendicitis. The pain is similar; however, signs may be central or left sided. Occasionally, there is a history of antecedent abdominal pain or intermittent lower gastrointestinal bleeding."The sequence of abdominal discomfort and anorexia associated with acute appendicitis is pathognomonic. The pain is described as being located in the periumbilical region initially and then migrating to the right lower quadrant. This classic sequence of symptoms occurs in only 66% of patients Harrison 18th/2516"The classical features of acute appendicitis begin with poorly localised colicky abdominal pain. This is due to mid-gut visceral discomfort in response to appendiceal inflammation and obstruction. The pain is frequently first noticed in the periumbilical region and is similar to, but less intense than, the colic of small bowel obstruction."-L, & B 25th/ 1208-09Table (L & 3 26th ): The Alvarado (MANTRELS) score ScoreSymptomsMigratory RIF painAnorexiaNausea and vomitingTenderness (RIF)Rebound tendernessElevated temperatureLeukocytosisShift to left1112112110 Signs Total
Clinically indifferent from Meckel diverticulum in children
Lymphoid hyperplasia may causes acute appendicitis
Pain shift to right iliac fossa
Ultrasound is more diagnostic than CT scan
Acute Appendicitis