ACCURACY OF CLINICAL AND LABORATORY PARAMETERS IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Abstract

Introduction: The diagnosis of acute appendicitis is generally clinical and once it is diagnosed, operative management ensues. Abdominal pain is the main presenting complaint of patients with acute appendicitis. The diagnostic sequence of colicky central abdominal pain which is followed by vomiting with migration of the pain to the right iliac fossa. The site of maximal tenderness is often said to be over McBurney's point. Specialist investigations are rarely needed to confirm a diagnosis of acute appendicitis, and the diagnosis is predominantly a clinical one. Judicious use of urine and blood tests, for inflammatory response variables, allow exclusion of other pathologies and provide additional evidence to support a clinical diagnosis of appendicitis.

Material and Methods: Every patient with acute onset of right lower quadrant abdominal pain and without previous history of appendectomy was considered as suspected of having acute appendicitis. Every patient with right iliac fossa pain and without history of appendectomy is suspected of having appendicitis until proven otherwise were included in the study. All Clinical and laboratory tests relevant to acute appendicitis were done among study participants. In Clinical parameters appetite, diarrhea, dysuria, vomiting, signs of localized peritonitis i.e. rebound tenderness and or guarding and pain migration was observed.in laboratory parameters, CRP, complete blood count (CBC) were measured and analysed. Patient’s demographic characteristics were noted.

Results: A total of 100 patients were included in the study of which 50 were included in the control and 50 in case group. Mean age in control group was 29±7.23 years while in acute appendicetomy group was 29 ±8.77 years. In control group 44% were male and 56 % were female while in acute appendicitis 42% were male and 58 % were female. All clinical presentations were statistically significant in case and control group. CRP was positive in 8 (16%) in control group while in Acute appendicitis group it was 21 (42%)  (P=0.0071).

Conclusion: CRP did not contribute to the overall diagnostic accuracy. The successful diagnosis of acute appendicitis can be done through proper clinical examination and adequate evaluation of laboratory parameters

Keywords: Acute Appendicitis, CRP, appendicetomy