Appendicitis is inflammation of the appendix, which presents with pain localized to the right lower abdomen that increases with coughing (McBurney's sign) and rebound tenderness. A history and physical exam are most important for diagnosis, though blood tests and imaging like CT scans can also help by identifying appendicitis or alternative causes with high accuracy. When appendicitis is suspected based on symptoms, appendectomy is often performed to remove the inflamed appendix. Recovery from an uncomplicated surgery typically takes 2-6 weeks with restricted activity and follow up by a doctor.

1. Suspected Appendicitis
Jinu Janet Varghese
Group :4, Year: 6
Tbilisi State Medical University

2. • Appendicitis is inflammation of the appendix. Pain first, nausea and
vomiting next, and fever last has been described as the classic
presentation of acute appendicitis. Localization of the pain to the
right lower quadrant. Coughing causes point tenderness in this area
(McBurney's point). Severe pain on sudden release of deep pressure
in the lower abdomen (rebound tenderness).

4. • The history taking and physical examination is the most important in
evaluating pain in the right lower quadrant. The shorter duration of
pain, is an important predictor. Usually in women it is misdiagnosed
with pelvic inflammatory disease, gastroenteritis, abdominal pain of
unknown origin, urinary tract infection, ruptured ovarian follicle, and
ectopic pregnancy.

5. • Laboratory tests are performed as part of the initial evaluation to rule
out or confirm specific disorders. In all women of reproductive age
who present with acute abdominal pain, the serum b-human
chorionic gonadotropin level should be measured to rule out uterine
or ectopic pregnancy. Elevated leukocyte count is a common finding
but has poor specificity as it is also characteristic of several other
acute abdominal and pelvic diseases. A urinalysis may confirm or rule
out urologic causes of abdominal pain.

6. • When the history and findings on physical examination are consistent
with the diagnosis of appendicitis, appendectomy is often performed
without further evaluation. Abdominal radiography has low
sensitivity(75-90), Specificity(86-100) and and a positive predictive
value of 89 to 93 percent for the diagnosis. Ultrasonography may
identify alternative diagnoses. For patients with suspected
appendicitis, spiral CT has a sensitivity of 90 to 100 percent, a
specificity of 91to 99 percent, a positive predictive value of 95 to 97
percent, has also proved to be accurate in patients in whom the
diagnosis is uncertain.

7. • CT has proved superiority over transabdominal US for identifying
appendicitis, and alternative diagnoses. US can be used for the
evaluation of women who are pregnant and women in whom there is
a high degree of suspicion of gynecologic disease. If CT studies show
the presence of another disorder or an absence of abnormalities,
there is no need for appendectomy, and supportive care or
appropriate alternative treatment can be provided. This strategy can
reduce the cost of observation, since a normal CT scan rules out
appendicitis with a high degree of accuracy also it will increase
diagnostic accuracy, leading to timely intervention, while reducing the
rate of unnecessary appendectomy, and largely eliminating the costs
of unnecessary imaging or observation.

9. • After an uncomplicated appendectomy, recovery time can vary from 2
to 6 weeks. The individual may gradually resume a normal diet with
restriction in physical activity for at least two to four weeks. The
doctor will inspect the incision the following week to look for possible
wound infection.

10. References
• http://www.nejm.org/doi/pdf/10.1056/NEJMcp013351
• http://en.wikipedia.org/wiki/Appendicitis
• http://www.emedicinehealth.com/appendicitis/page8_em.htm
• http://www.aafp.org/afp/2010/0415/p1043.html