The document discusses the diagnosis of acute appendicitis in a 22-year-old male patient, emphasizing the need for a combination of clinical findings and imaging tests for accurate diagnosis. It identifies CT scans as the most effective imaging study for suspected appendicitis, noting their high sensitivity and specificity, especially when using intravenous contrast. The document concludes that no single diagnostic test exists, and it recommends using CT scans when appropriate or ultrasonography if CT is unavailable or contraindicated.

2. AGENDA
1- Scenario
2- Background
3- PICO and foreground question.
4- search terms and strategy.
5- visited sites.
6- answers
7- conclusion

3. SCENARIO
A 22-year-old male presents to the emergency department
with abdominal pain, anorexia, nausea, and low-grade
fever. Pain started in the mid-abdominal region 6 hours
ago and is now in the right lower quadrant of the abdomen.
The pain was steady in nature and aggravated by
coughing. Physical examination reveals a low-grade fever
(38°C; 100.5°F), pain on palpation at right lower quadrant
(McBurney's sign), and leukocytosis (12 x 10^9/L or
12,000/microlitre) with 85% neutrophils.
You suspect acute appendicitis and advice the patient to
undergo appendectomy but he asks if there is more
definitive diagnostic test to diagnose acute appendicitis?

4. BACKGROUND
What is the diagnostic tests for acute appendicitis and
which is suitable for this case?
What is the gold standard for acute appendicitis?

5. BACKGROUND
-
Combination between diagnostic tests and clinical findings is
required for accurate diagnosis of acute appendicitis.
-
There is many diagnostic tests including laboratory and
imaging tests.
-
35% of wrong diagnosis for acute appendicitis result in
appendectomy for normal appendix is accepted percent !
-
The world search for a definitive diagnostic test for acute
appendicitis and also the patient in my lucky scenario .

6. BACKGROUND ANSWERS
- Gold Standard is exploratory laparotomy (Histological
result from the surgery).
- Imaging diagnostic tests is suitable to decrease –VE
appendectomy rates.
- One Size doesn't fits all rule .
- Our case is for adult non complicated patient with high
Alvarado score ensure high possibility to have acute
appendicitis.
- According to our Scenario and background question
answers, we choose CT scan test to compare with the
gold standard.

7. PICO
PICO: (Diagnosis)
P: 22 year old male with suspected Acute Appendicitis
I: CT scan on abdomen and pelvic
C: exploratory laparotomy (Histological result from the
surgery).
O: Diagnosis of Acute appendicitis

8. FOREGROUND QUESTION
“In adult male with suspected acute appendicitis
is CT scan on abdomen and pelvic, as
compared with exploratory laparotomy
(Histological result from the surgery), will
diagnose Acute appendicitis? “

9. SEARCH TERMS AND STRATEGY
Search terms used alone and/or in combination using Boolean
strategies:
Acute Appendicitis.
Appendectomy
Diagnostic test
right lower quadrant pain
McBurney's sign
Abdominal pain
Computed tomography (CT).

10. VISITED SITES
1. Cochrane
2. UpToDate
3. Best Practice
4. National Guide lines clearing house
5. Essential evidence plus
6. Dynamed
7. Trip database
8. Sum Search
9. Pubmed

11. ANSWERS SUMMARY
- Appendicitis may be diagnosed clinically; however, imaging increases
sensitivity and specificity for diagnosis.
- In general, CT is the most accurate imaging study for evaluating suspected
appendicitis and alternative etiologies of right lower quadrant abdominal
pain.
- higher accuracy was reported when IV contrast is used in the CT scan .
However, if IV contrast is contraindicated, non-contrast enhanced CT has
been shown to have sensitivity of 96%, specificity of 99%, and accuracy of
97%.

12. CONCLUSION
- There is no unique test for diagnosis of acute appendicitis as we should
combine between clinical and laboratory findings with imaging test to
decrease negative appendectomy rates.
- CT scan has high sensitivity and specificity for evaluating suspected
acute appendicitis .
- CT scan should be used in patients presenting with unclear findings.
- If there is contraindication to contrast media enhanced CT is used.
- Ultrasonography is recommended if CT scan is unavailable or
contraindicated.

13. THANK YOU FOR YOUR ATTENTION