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liver, spleen, pancreas, gallbladder and both kidneys are normal in size and echogenicity with no evidence of focal lesions. Mild intrahepatic dilatation with borderline diameter of CBD but no obvious stone seen. Well distended unremarkable urinary bladder.
Impression: mild intrahepatic dilatation and CBD size further evaluation by CT is recommended.
-sensitivity:63 to 82%, specificity: 69 to 90%, respectively. (1 )
A positive cough sign has been found to be
80 to 95% sensitive in diagnosing acute peritonitis.
LRs for specific symptoms in appendicitis LR of 5–10, presence moderately increases probability of disease. LR of 2–5, may increase probability of the disease. LR of <2, not likely to change the probability of the disease. Negative LR Increase in posttest probability Positive LR Historical symptom 0-0.28 Moderate probability 7.31-8.46 RLQ pain 0.50 Small increase 3.18 Migration - Small increase 2.76 Pain before vomiting 0.323 Not helpful 1.50 No past similar pain 0.64 Not helpful 1.27 anorexia 0.70-0.84 Not helpful 0.69-1.20 nausea 1.12 Not helpful 0.92 vomiting
LRs for specific signs in appendicitis LR of 5–10, presence moderately increases probability of disease. LR of 2–5, may increase probability of the disease. LR of <2, not likely to change the probability of the disease Negative LR Increase in posttest probability Positive LR Physical sign 0.82 Small increase 3.76 Rigidity 0.0-0.1 Small increase 2.30 Tender RLQ 0.90 Small increase 2.38 Psoas sign 0.43 Small increase 3.70 Rebound tenderness 0.58 Not helpful 1.94 Fever 0.27 Not helpful 1.65-1.78 Guarding 0.76 Not helpful 0.83-5.34 Rectal tenderness
urinalysis can represent a potential pitfall, because the proximate location of the appendix to the ureter and bladder can cause microscopic pyuria or hematuria in up to a third of patients with appendicitis
A systematic review of 23 studies of CT in suspected appendicitis found a weighted sensitivity and specificity of 93% and 98%, respectively, for noncontrast CT compared with CT with IV and oral contras
Am J Surg 190. 474-478.2005
In a prospective randomized study compared 3 different techniques, CT with oral and IV contrast, CT with rectal contrast, and CT without contrast showed: - CT with oral and IV contrast was more sensitive than CT with rectal contrast and not significantly different from noncontrast CT. Dis Colon Rectum 50. 1223-1229.2007