Evaluation of RIPASA and ALVARADO Score for Diagnosis of Acute Appendicitis

Background:To evaluate RIPASA andALVARADO scores for the diagnosis of acuteappendicitis.Methods : In this cross sectional study, patientspresenting with features suggestive of acuteappendicitis and who had undergoneappendectomy, were included. All those patientswhose follow up was not possible withhistopathology reports were excluded .Samplingtechnique was non probability random samplingtechnique.Frequencies , percentages were calculatedfor categorical variables i.e. different parameters ofRIPASA and ALVARDO scoring system. Sensitivityand specificity of both scoring system was checkedkeeping histopathology reports as gold standard .Results :Mean age was 20.2 years. MinimumRIPASA score was 5.5 , maximum 14 ,mean 10.64 andrange turned out to be 8.50 with standard deviationof 1.639. P value for RIPASA score was 0.015 . 155cases had RIPASA score of 7.5 and above . MaximumALVARADO score was 9 and minimum 2 , mean of8.13 and standard deviation of 1.48. Majority(92.5%) had ALVARADO score more than 5 . P valuefor ALVARADO score was 0.001 .The gold standardfor diagnosing acute appendicitis washistopathology report which was positive in90.6%.Sensitivity of RIPASA score 95 %ALVARADO 88 % .Specificity of RIPASA was 21 %while of ALARADO 42 %.Conclusion: RIPASA score >7 and ALVARADO >6 are significant for diagnosing appendicitis.RIPASA is more sensitive but less specific thanALVARADO score for diagnosing acuteappendicitis

Clinicopathological presentation and management outcome of appendicitis in Gombe, north-east Nigeria: A 7-year retrospective audit

Background: Acute appendicitis is a common cause of acute abdomen and right iliac fossa pain in the study centre with attendant negative appendicectomies.Aim: To study the demographic pattern,aetiology,clinical presentation and management outcome of appendicitis.Methods: This is a retrospective study carried out on patients, who had appendicectomies between January 2007 and December 2014.A total of two hundred and thirteen (213) cases were operated during the study period. Only one hundred and forty one (141) folders retrieved. Relevant clinical information were entered in to a proforma designed for the study. Statistical analysis was done using Epi info (version 3.5.1). Quantitative data were presented in frequencies and percentages,mean and standard deviations were calculated.Result: Out of the 141 patients, 55(39.0%) were males while 86(61.0%) were females giving a M:F= 1: 1.6 .Their ages range from 8 to 65 years .The peak age group was 21-30 years.Acute inflammation was seen in 69 (48.9%) patients,lymphoid hyperplasia in 39 (27.7%) patients while parasitic appendicitis was seen in one (0.7%) patient. Post-operative complications observed include surgical site infection in 7 (5.0%) patients, delayed wound healing in 11( 7.8%) patients and enterocutaneous fistula in one( 0.7%) patient.Conclusion: The diagnosis of appendicitis still rests on the pillars of thorough clinical evaluation.The judicious use of modern diagnostic equipment will reduce the rate of negative appendicectomies.Keywords: Appendicitis,demography,aetiology,management outcom

Leucocitosis como factor asociado a perforación en pacientes con apendicitis aguda, Hospital de Emergencias José Casimiro Ulloa 2017 – 2018

Los pacientes con dolor abdominal representan entre el 5 y 10% de todas las consultas en los departamentos de emergencia en los hospitales estatales, de los cuales tan solo un 4.3% serán diagnosticados como portadores de apendicitis aguda. La apendicitis aguda es la afección quirúrgica más frecuente en los servicios de emergencia de un hospital y a la vez ocupa una gran parte de las intervenciones practicada

Ultrasonography-First Imaging Algorithm for Acute Appendicitis Diagnosis

Acute appendicitis (AA) is the most common cause of acute abdominal pain requiring surgery in pediatric, adult, and pregnant patients. Several etiologies are believed to trigger luminal obstruction, which causes mucus and bacteria proliferation, resulting in inflammation and wall tension with subsequent necrosis and rupture of the appendix. Most AA patients present with the primary complaint of abdominal pain, which Murphy first described the characteristic diagnostic sequence seen in approximately 50% of patients as colicky centralized abdominal pain with subsequent vomiting with the migration of pain to the right lower quadrant (RLQ), specifically, the right iliac fossa. The typical AA patient will complain of colicky, periumbilical pain, which has progressively worsened over the past 24 hours that has become persistently sharp in the RLQ. Diagnostic imaging is essential in diagnosing AA, and it is critical for medical providers to quickly and accurately diagnose AA to reduce perforated appendix and negative appendectomy rates. Yet, there is not a universally accepted, widely utilized diagnostic imaging protocol for suspected AA patients. Ultrasonography (USG) and computerized axial tomography (CAT) scans are used most in diagnosing AA in all ages. Current evidence-based practice (EBP) literature shows that USG should be the first-line imaging modality followed by CAT scan as the second line in diagnosing AA in children and adults, to reduce ionizing radiation and cost burdens. The purpose of this Doctor of Nursing Practice (DNP) project was to develop, implement, and evaluate an educational intervention and an evidence-based USG-first algorithm for medical providers who treat patients with suspected AA. Pre- and post-test assessment questions were used to evaluate the implementation of knowledge and the AA clinical practice change over a six-to-eight-week period. Descriptive statistics were used to analyze demographic data, tabulating frequencies, and percentages. Pre- and post-assessment scores were analyzed via a paired t-test for matched samples. This project’s results displayed a statistically significant change in provider knowledge and may have improved clinical practice and patient outcomes. This project’s USG-first imaging algorithm for diagnosing acute appendicitis can likely be sustained in clinical nursing practice

Leucocitosis como factor asociado a perforación en pacientes con apendicitis aguda, Hospital de Emergencias José Casimiro Ulloa 2017 – 2018

Los pacientes con dolor abdominal representan entre el 5 y 10% de todas las consultas en los departamentos de emergencia en los hospitales estatales, de los cuales tan solo un 4.3% serán diagnosticados como portadores de apendicitis aguda. La apendicitis aguda es la afección quirúrgica más frecuente en los servicios de emergencia de un hospital y a la vez ocupa una gran parte de las intervenciones practicada

G,WAS going on? Putative regulatory function of GWAS-identified markers of susceptibility to acute appendicitis

Appendicitis affects 7-9% of Americans and is the most common diagnosis requiring hospitalization of both children and adults. Several etiologies of appendicitis have been hypothesized, but definitive mechanisms remain elusive – a critical review of the literature does not support a primary role of fecaliths or lymphoid hyperplasia, as is commonly believed. It is known that appendicitis has heritable components, and so we collaborated with 23andMe Inc., a personal genomics company, to identify genetic determinants of susceptibility to acute appendicitis. 23andMe performed a genome-wide association study (GWAS) of 18,773 appendectomy cases and 114,907 controls, and identified one locus with genome-wide significance. In addition, the GWAS identified eight highly significant SNPs that did not reach genome-wide significance. Most of the SNPs identified using this analysis fell outside of protein-coding genes, thus bioinformatic analysis using RegulomeDB was done to interrogate the SNPs’ putative regulatory capacity of nearby or distant genes, or proteins. This analysis identified 921 targets of putative regulatory elements in the same LD blocks as the four of nine lead SNPs identified in the GWAS and chosen for follow-up study. Of these, 299 targets were unique when targets from all four genomic regions were combined. These targets were organized according to the distance of their putatively egulatory SNP from the given lead SNP, and based on overlap of elements’ targets within one region with targets of elements within the rest of the genomic regions. Ultimately, the following list of 17 proteins was generated for priority in further studies: CEBPB, CTCF, EP300, EVI-1, FOS, FOXJ3, FOXP1, GATA1, HNF4A, JUN, MYC, NFKB, PPARG, RAD21, SPI1, STAT1, and STAT3. This list includes several proteins that directly interact with, or influence the expression of very specific inflammatory markers known to be strongly associated with appendicitis, including IL-8, IL-1B, and IL-6. This outcome supports the utility of RegulomeDB in the interpretation of GWAS-generated non-coding variants. This compiled resource and the ongoing parallel studies born of the appendectomy GWAS may help to elucidate the pathogenesis of acute appendicitis, thereby providing opportunities to improve the diagnosis, treatment, and prevention of this extremely common disease. The public health significance of appendicitis and its genetics are addressed, and a theoretical public health program that integrates the multiple factors involved in appendicitis etiology is proposed

Apendicectomía transumbilical videoasistida: implantación de una nueva técnica quirúrgica para el tratamiento de la apendicitis aguda en niños y adolescentes en el Hospital Clínico San Carlos

La apendicitis aguda (AA) es una enfermedad común que requiere habitualmente una cirugía abdominal urgente en la edad pediátrica. En los últimos 20 años, la apendicectomía abierta ha ido siendo reemplazada en gran medida por la apendicectomía laparoscópica convencional (CLA). La apendicectomía laparoscópica transumbilical videoasistida (TULAA) surge en esta última década, como una técnica combinada laparoscópica y abierta, que incluye la movilización laparoscópica intraabdominal y la extirpación extracorpórea del apéndice. En el servicio de Cirugía Pediátrica del Hospital Clínico San Carlos (HCSC), desde al año 2014 hemos afianzado como primera elección el uso de este abordaje en todos los pacientes pediátricos que han precisado una apendicectomía como tratamiento de la AA..