When acute appendicitis is suspected, it can be confirmed by -
1.Clicical examination
2.USG
3.CT scan
4.Blood counts
5.All of the above
Explanation
The diagnosis of appendicitis is primarily clinical, assisted by blood counts. Ultrasound and CT can be utilized to make the diagnosis in equivocal cases.
Lets also see the management of appendicitis:
Management of appendicitis: [Ref: Sabiston 18/e p1339; Schwartz 9/e p1084]
The treatment of appendicitis is appendectomy. (It can be done open or laparoscopically) Prophylactic antibiotics are indicated preoperatively. Postoperative antibiotic coverage is of no use in simple (uncomplicated) acute appendicitis. If perforated or gangrenous appendicitis is found, antibiotics are continued until the patient is afebrile and has a normal white blood cell count.
Perforated Appendicitis (Maginot’s 11/e p603)
Rupture is suspected in the presence of fever with a temperature of >39°C (102°F) and a white blood cell count of >18,000 cells/mm3
The management of perforation depends on the nature of the perforation.
If the perforation is free causing intraperitoneal dissemination of pus and fecal material, urgent laparotomy is done for appendectomy and irrigation and drainage of the peritoneal cavity.
If the perforation is contained it would result in an appediceal mass or abscess. This is managed as described under.
Appendiceal Abscess/Mass
Patients who present late in the course of appendicitis with a palpable or radio graphically documented mass (abscess or phlegmon) are treated with
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conservative therapy and interval appendectomy 6 to 10 weeks later. (conservative management includes intravenous antibiotics and fluids as well as bowel rest.)
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Patients with large abscesses, greater than 4 to 6 cm in size, and especially those patients with abscess and high fever, benefit from abscess drainage.
Patients who continue to have fever, persistent pain and leukocytosis or develop complications like bowel obstruction after several days of nonoperative treatment are likely to require immediate appendectomy during the same hospitalization, whereas those who improve promptly may be considered for interval appendectomy.
Bailey lists Criteria for stopping conservative treatment and going for appendectomy
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A rising pulse rate
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increasing or spreading abdominal pain
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increasing size of the mass