INTRODUCTION:
The most common cause of acute abdomen is Appendicitis. The
diagnosis of acute appendicitis is based on clinical history and physical
examination. It is difficult to diagnose in cases of retrocaecal or retro
ileal appendix. Appendicectomy is the most commonly performed
abdominal surgery. 15-30% of appendicectomy specimen found to be
normal. In order to decrease the number of unnecessary appendicectomy,
significance of labarotory investigations like White Blood Cells, CReactive
Protein, etc have been emphasised. Ultrasonagram abdomen
has been widely accepted as the diagnostic tool for appendicitis. Many
number of scoring system were developed to arrive the diagnosis. These
scoring systems are based on clinical features, laboratory
investigations. Some examples are Alvarado, Modified alvarado, Ripasa.
Still there is no definitive laboratory marker for acute appendicitis
and appendicular perforations. Studies show that serum bilirubin is raised
in acute appendicitis and appendicular perforations. But the siginificance
of which is not stressed. On bacterial invasion of the appendix, there is
transmigration of bacteria and release of proinflammatory cytokines like
TNF α,.IL6. The cytokines reach the liver through the superior mesentric vein and
may lead to inflammation, abscess and liver dysfunction.
OBJECTIVES:
The objectives of the study were-
1. To study the relationship between hyperbilirubinemia and acute
appendicitis; and to evaluate its credibility as a diagnostic marker for acute
appendicitis.
2. To evaluate whether elevated bilirubin levels have a predictive potential
for the diagnosis of Appendicular perforation.
MATERIALS AND METHODS:
The study was conducted in the Department of General
Surgery, Govt. Stanley Medical College, Chennai during the period of
November 2013 to November 2014.
Study design -
A prospective non randomised study.
Source -
The present study was conducted in the Department of
Surgery, Govt. Stanley Medical College, Chennai
Study period -
One year from November 2013 to November 2014.
Source of data -
Patients admitted with clinical diagnosis of acute appendicitis or
appendicular perforation under the Department of Surgery,
Govt.stanley medical college,chennai during the study period.
Sample size -
A total of 100 patients with clinical diagnosis of acute
appendicitis or appendicular perforation were studied.
Selection criteria:
Inclusion criteria -
• All patients diagnosed as acute appendicitis clinically on admission.
• All patients diagnosed as appendicular perforation clinically
on admission.
• For both these groups, only patients with histopathological report suggestive of acute appendicitis or appendicular perforation were included.
Exclusion criteria -
• All patients documented to have a past history ofo
Jaundice or Liver disease.
o Chronic alcoholism (that is intake of alcohol of > 40 g/day for
Men and > 20 g/day in Women for 10 years).71
o Hemolytic disease.
o Acquired or congenital biliary disease.
• All patients with positive HBsAg.
• All patients with cholelithiasis.
• All patients with cancer of hepato-biliary system.
RESULTS:
A total of 100 patients with clinical diagnosis of acute appendicitis
or appendicular perforation admitted in the Department of General
surgery, Govt.stanley medical college,chennai were studied.
As per the study, the age group 11-20years is most
commonly affected (44%) followed by age group 21-30 (32%). The
youngest patients of this study were of 8 years old while the oldest
patient was a 70 year lady.
CONCLUSION
The present study suggests-
Serum bilirubin levels appears to be a promising new
laboratory marker for diagnosing acute appendicitis, however
diagnosis of appendicitis remains essentially still - clinical. Its
level come out to be a credible aid in diagnosis of acute
appendicitis and would be helpful investigation in decision
making.
Patients with clinical signs and symptoms of appendicitis
and with hyperbilirubinemia higher than the normal range
should be identified as having a higher probability of
Appendicular perforation suggesting, serum bilirubin levels
have a predictive potential for the diagnosis of
Appendicular perforation
