3. • In the continued absence of a 100% accurate
test for appendicitis, any investigation that can
contribute to its diagnosis is valuable.
• A variety of conditions can cause RIF pain,
which do not require surgery .
• When the diagnosis is not clear, further
investigations may include ultraound, CT scan,
or dignostic laparoscopy.
4. • A negative appendicectomy from an incorrect
diagnosis incurs the cost and potential
complications from an unnecessary operation.
• Preveous retrospective studies have all shown
evidence confirming the the high specificity
for hyperbilirubinaemia for perforated
appendicitis.
5. • Over all this research suggested that
hyperbilirubinemia may be an better
predictive marker for perforated appendicitis
then the WBC or CRP levels.
• Simple appendicitis can be difficult to
differentiate from other causes of RIF pain
that do not require surgery’
6. • LFT’S are a commonly requested blood test
• A safe, cheap, rapid, widely available, accurate
diagnostic marker for appendicitis would be
useful to the emergency general surgeon to
manage suspected appendicitis.
7. • This study seeks to investigate whether there
is a statistically significant association
between hyperbilirubinaemia and
appendicitis.
8.
9. • Bilirubin is not commonly known to be a
relevant marker in appendicitis.
• Hepatic dysfunction as a result of bacterial
infection or sepsis without direct invasion of
the liver.
• In appendicitis, compromised appendix wall
integrity leads to translocation of bacteria and
endotoxins from the appendix lumen in to the
portal system
10. • Inflammatory cytokines may then travel to the
liver, inducing intrahepatic cholestasis
• E COLI endotoxins shows the dose dependent
cholestasis
• It is possible that bilirubin may be raised in
other sources of gram negative related sepsis
11. • WBC and more recently CRP are
usefullaboratory blood tests and indeed have
a much higher sensitivity than bilirubin for
appendicitis, but lower specificity
• This confirms the use of huperbilirubinaemia
as a rule in. not rule out test for appendicitis.
12. • The diagnosis of appendicitis is still based on a
patients clinical presentation, and the
judgement of the emergent surgeon
• The most common investigative adjuncts are
blood tests , urinalysis and imagibg
• CT has a high diagnostic accuracy
13. • A correct pre operative diagnosis could reduce
the number of possibly unnecessary
operations with the cost of theatre time ,
hospital stay and time off work to recover, as
well as the risks of complications.
