This study aims to establish the role of hyperbilirubinemia as a laboratory marker in prediction of acute appendicitis in the early diagnosis and complicated appendicitis, as well as to compare laboratory markers such is C - reactive protein, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) and WBC together with Alvarado scoring model. Even though appendicitis has been known since two centuries ago, acute appendicitis presents a diagnostic challenge for the majority of general surgeons during their work, regardless of several diagnostic modalities applied.
This is a cross-sectional study, conducted in the University Clinical Center of Prishtina in the Department of Abdominal Surgery and in General Hospital of Mitrovica. The prospective data collection included 201 patients admitted in the emergency ward with suspicion for acute appendicitis, in which the preoperative diagnosis of acute appendicitis was established and appendectomy was performed, during the period from September 2016 up to October 2017.
Table of Contents
1. INTRODUCTION
2. LITERATURE REVIEW
2.1. Historical Background
2.2. Embryology, anatomy and histology of the appendix
2.3. Epidemiology of Appendicitis
2.4. Ethiopatogenesis and Classification of Appendicitis
2.4.1. Non-complicated acute appendicitis
2.4.2. Complicated acute appendicitis
2.5. Diagnosis of Acute Appendicitis
2.5.1. Clinical manifestation and physical evaluation
2.6. Scoring Systems
2.7. Laboratory Markers in Evaluation of Acute Appendicitis
2.7.1. Leucocytes
2.7.2. C - reactive protein (CRP)
2.7.3. Production, metabolism, storage and excretion of the bilirubin
2.7.4. Clinical relevance of hyperbilirubinemia in acute appendicitis
2.7.5. Liver Enzymes
2.8. Imaging Methods in Diagnosis of Acute Appendicitis-Characteristic Features
2.9. Ultrasound Examination
2.10. Computed Tomography (CT)
2.11. Magnetic Resonance (MRI) in Diagnostic Approach of Acute Appendicitis
2.12. Surgical Exploration
2.13. Differential Diagnosis
2.13.1. Meckel's diverticulitis
2.13.2. Acute ileitis
2.13.3. Cecal diverticulitis
2.13.4. Crohn's disease
2.13.5. Urologic Disorders
2.13.6. Gynecologic Disorders
2.13.7. Tubo-ovarian abscess
2.14. Treatment
2.15. Outcomes, Risks and Complications after Appendectomy
3. AIM OF THE STUDY
4. MATERIALS AND METHODS
4.2. Study Design
4.3. Study sample
4.4. Inclusion criteria
4.5. Exclusion criteria
4.6. Data Collection
4.7. Statistical Analysis
5. RESULTS
5.1. Gender Distribution
5.2. Age Distribution
5.3. WBC in complicated and non-complicated appendicitis
5.4. Bilirubin level between two groups of studies
5.5. Comparison of CRP level in complicated and non-complicated appendicitis
5.6. Level of liver transaminase in complicated vs non-complicated appendicitis
5.7. Alvarado scoring model between complicated vs non-complicated appendicitis
5.8. Histopathology
6. DISSCUSION
7. CONCLUSION
Research Objectives and Focus
This study aims to establish the role of hyperbilirubinemia as a laboratory marker for the prediction and early clinical diagnosis of complicated versus non-complicated appendicitis, while evaluating and comparing other markers like WBC, CRP, and liver enzymes in conjunction with the Alvarado scoring system.
- Predictive value of inflammatory markers in appendicitis severity.
- Clinical differentiation between complicated and non-complicated cases.
- Diagnostic utility of bilirubin levels in appendicular perforation.
- Efficacy of the Alvarado scoring model in clinical decision-making.
- Correlation between laboratory parameters and histopathological findings.
Except from the Book
2.7.4. Clinical relevance of hyperbilirubinemia in acute appendicitis
Despite the fact that the level of serum bilirubin is not routinely measured in the clinical setting, several studies reported convincing evidence concerning the elevated levels of bilirubin during the acute appendicitis (91-93).
Recently, several studies focused their attention on the elevated serum bilirubin as a low cost and useful laboratory marker for the diagnosis of the complicated appendicitis. Hyperbilirubinemia was found in 87 % of patients with acute appendicitis (94) while in the retrospective study from Sand and colleagues total serum bilirubin was found to be much higher in gangrenous/perforative appendicitis (95).
Hyperbilirubinemia occurs as a result of bilirubin hyper-production, insufficient bilirubin utilization by the liver, insufficient conjugation, hepatocellular disease or biliary obstruction (96, 97).
Association between systemic infection and liver dysfunction was previously reported in numerous studies (98, 99). In this regard, multiple infective causes, including bacterial, viral, fungal and parasitic agents, via direct and indirect mechanisms can cause liver damage (98, 99). In bacterial infections, particularly, in abdominal infections, liver function is severely affected.
Summary of Chapters
1. INTRODUCTION: This chapter highlights the diagnostic challenges of acute appendicitis and the need to differentiate between complicated and non-complicated forms to minimize unnecessary surgeries.
2. LITERATURE REVIEW: This chapter provides an historical overview and discusses various diagnostic methods, laboratory biomarkers, and imaging techniques currently used in managing appendicitis.
3. AIM OF THE STUDY: Defines the research objectives, focusing on the predictive role of hyperbilirubinemia and comparing it with other standard laboratory markers and scoring systems.
4. MATERIALS AND METHODS: Details the cross-sectional study design, participant inclusion and exclusion criteria, and the statistical methods utilized for analysis.
5. RESULTS: Presents empirical data on the demographics and laboratory marker levels, demonstrating statistical significance between complicated and non-complicated groups.
6. DISSCUSION: Critically analyzes the findings in the context of recent literature, explaining the clinical implication of the markers studied.
7. CONCLUSION: Synthesizes the final results, reaffirming the role of hyperbilirubinemia and other markers as reliable tools for early diagnosis of acute appendicitis.
Keywords
acute appendicitis, C - reactive protein, total/direct bilirubin, white blood cell, appendectomy, complication, hyperbilirubinemia, Alvarado score, differential diagnosis, surgical assessment, diagnostic markers, peritoneal irritation, gangrenous appendicitis
Frequently Asked Questions
What is the primary scope of this dissertation?
The dissertation investigates the clinical association between laboratory markers—specifically hyperbilirubinemia, leukocyte count, and CRP—and the severity of acute appendicitis, aiming to improve early diagnostic accuracy.
What are the main thematic pillars of this research?
The main themes include laboratory diagnostics of inflammation, surgical outcome prediction, differential diagnosis of abdominal pain, and the validation of existing scoring systems like the Alvarado scale.
What is the central research question?
The research asks whether specific laboratory markers, particularly hyperbilirubinemia, can reliably discriminate between complicated (e.g., gangrenous/perforating) and non-complicated appendicitis in an emergency clinical setting.
Which scientific methodology was employed?
It is a prospective, cross-sectional observational study analyzing clinical and laboratory data from 201 patients who underwent appendectomy, utilizing statistical tests like the Mann-Whitney U test and ROC analysis.
What topics are analyzed in the main body?
The study covers the pathophysiology of appendicitis, the metabolism of bilirubin, the role of inflammatory markers, imaging modalities, differential diagnosis, and the correlation between these markers and surgical outcomes.
Which keywords define this study?
Key terms include acute appendicitis, hyperbilirubinemia, leukocyte count, C-reactive protein (CRP), appendectomy, Alvarado score, and diagnostic predictive markers.
How does bilirubin levels correlate with appendicitis severity?
The research suggests that elevated total and direct bilirubin levels are statistically significantly associated with complicated forms of appendicitis and can serve as a predictive adjunct in diagnosis.
What is the clinical significance of the Alvarado score in this study?
The study finds the Alvarado scoring model to be a statistically significant, effective predictor when used as part of the clinical assessment to identify patients requiring urgent surgery for complicated appendicitis.
- Quote paper
- Dr. Valon Zejnullahu (Author), 2018, Association of hyperbilirubinemia, leukocyte count and CRP value in the early clinical diagnosis of complicated and non-complicated appendicitis, Munich, GRIN Verlag, https://www.grin.com/document/1268301
