Presented during Surgical Grand Round in Clonmel Hospital in 2011. The purpose of this presentation is to educate junior doctors on appendicitis. This presentation was presented in 2011. So the content may be outdated. So please keep yourself updated. WanYusof Wan Jeffery zenslides.com [Eng] presentasipukau.com [Malay]

1. Evaluation of clinical scoring in
acute appendicitis: articles review
Wan Yusof Wan Jeffery
Surgical Intern to Mr Naeem

3. as an adjunct
suggest a general algorithm

4. to reduce the negative
appendectomy rate

5. alvarado score

6. M
A
N
T
R
E
L
S
igration to RIF
norexia-acetone
ausea
enderness
ebound tenderness
levation of T
eukocytosis
hifts of WBC

7. Diagnostic
indicants
Sensitivity Specificity
Migration 0.69 0.84
Anorexia-acetone 0.61 0.72
Nausea-vomiting 0.74 0.36
Tenderness 1.00 0.12
Rebound pain 0.55 0.78
Elevation 0.73 0.50
Leukocytosis 0.93 0.38
Shift 0.71 0.68
Rectal tenderness 0.53 0.41

8. Diagnostic
indicants
Diagnostic weight
Migration 0.72
Anorexia-acetone 0.63
Nausea-vomiting 0.66
Tenderness 0.84
Rebound pain 0.59
Elevation 0.69
Leukocytosis 0.83
Shift 0.70
Rectal tenderness 0.49

9. Diagnostic
indicants
Value
Migration 1
Anorexia-acetone 1
Nausea-vomiting 1
Tenderness 2
Rebound pain 1
Elevation 1
Leukocytosis 2
Shift 1
Rectal tenderness 1

10. Diagnostic
indicants
Value
Migration 1
Anorexia-acetone 1
Nausea-vomiting 1
Tenderness 2
Rebound pain 1
Elevation 1
Leukocytosis 2
Shift 1
Rectal tenderness 1
5-6 possible
7-8 probable
9-10 very
probable

11. Diagnostic
indicants
Value
Migration 1
Anorexia-acetone 1
Nausea-vomiting 1
Tenderness 2
Rebound pain 1
Elevation 1
Leukocytosis 2
Shift 1
Rectal tenderness 1
<5 unlikely
>5 likely

12. 13 y.o , female
abdominal pain mainly in the RIF since 4/7
+ nausea +anorexia

13. o/e:
• Tender
• Rebound tenderness
• + rovsing’s sign

14. Diagnostic indication Value
Migration 0
Anorexia 1
Nausea 1
Tenderness 2
Rebound 1
Elevation of T 0
Leukocytosis 0
Shift of WBC 0
Total score 5

15. modified alvarado score

16. M
A
N
T
R
E
L
igration to RIF
norexia-acetone
ausea
enderness
ebound tenderness
levation of T
eukocytosis

17. Evaluation of the modified Alvarado
score in the diagnosis of acute
appendicitis: a prospective study
M. Kalan, A. J Rich, D. Talbot, W.J Cunliffe

18. No of pt Score >= 7 Appendicitis Sensitivity
Men 21 15 14 93%
Women 17 15 10 67%
Children 11 11 11 100%
Score < 7
Men 6 4 67%
Women 2 1 50%
Children 0 0 0%

19. MAS carries a false-positive rate
which varies according to group
MAS simple to use and easy to apply

20. MAS is effective in children and men
Diagnostic laparoscopy is advised to
minimise the unacceptably high false-negative
rate in women

21. Evaluation of the Alvarado score in
acute appendicitis
T.D Owen, H. Williams, G. Stiff, L.R Jenkinson, B.I Rees
University Hospital of Wales, Heath Park, Cardiff

22. Final diagnosis Men Women Children
Acute Appendicitis 94% 78% 88%
Normal appendix 6% 22% 12%
Mesenteric adenitis 1% 2% 8%
Gastroenteritis 4% 2% 3%
Carcinoid tumor - 1% -
Appendix fibrosis - 1% -
PID - 6% -
Salpingitis - 2% -
Ruptured ovarian cyst - 1% -
UTI - 2% -
No diagnosis 1% 4% 1%
Final diagnosis of patients with Alvarado Score >7 having appendicectomy

23. MAS >= 7
<7 active obs
MEN CHILD WOMEN
Rule out
mesenteric
adenitis+UTI
Rule out
gynae
pathology
Laparoscopic Appendicectomy +/- open