Talk:Appendicitis

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Ambiguity[edit]

The second sentence of the blood sentence says, "Half of the time, the blood test is normal, so it is not foolproof in diagnosing appendicitis." If that is supposed to say half of blood tests performed for people with appendicitis produce false negatives, then it needs to be clearer. If it is supposed to mean something else, it needs to be much clearer. -Rrius (talk) 01:17, 9 June 2012 (UTC)

This section is very poorly written and contains several errors. It presently reads:

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Blood and urine test

Most people suspected of having appendicitis would be asked to do a blood test. Half of the time, the blood test is normal, so it is not that useful in diagnosing appendicitis.

Two forms of blood tests are commonly done: Full blood count (FBC), also known as complete blood count (CBC), is an inexpensive and commonly requested blood test. It involves measuring the blood for its richness in red blood cells, as well as the number of the various white blood cell constituents in it. The number of white cells in the blood is usually less than 10,000 cells per cubic millimeter. An abnormal rise in the number of white blood cells in the blood is a crude indicator of infection or inflammation going on in the body. Such a rise is not specific to appendicitis alone. If it is abnormally elevated, with a good history and examination findings pointing towards appendicitis, the likelihood of having the disease is higher. In pregnancy, elevation of white blood cells may be normal, without any infection present.

C-reactive protein (CRP) is an acute-phase response protein produced by the liver in response to any infection or inflammatory process in the body. Again, like the FBC, it is not a specific test. It is another crude marker of infection or inflammation. Inflammation at ANY site can lead to a rise in CRP. A significant rise in CRP, with corresponding signs and symptoms of appendicitis, is a useful indicator in the diagnosis of appendicitis. If the CRP continues to be normal after 72 hours of the onset of pain, the appendicitis likely will resolve on its own without intervention. A worsening CRP with good history is a sure signal of impending perforation or rupture and abscess formation.

A urine test in appendicitis is usually normal. It may, however, show blood if the appendix is rubbing on the bladder, causing irritation. It is important to rule out an ectopic pregnancy in women of childbearing age.

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I have skipped the CRP info all together since with no reference, and considering how bad the rest of the section was, I have my doubts about it. I did find this: [1] If anyone feels differently, of course they may want to put it back in, with a reference. No where did I find info suggesting that "Half of the time, the blood test is normal", and I changed that. This statement, "the appendix is rubbing on the bladder, causing irritation" is just absolutely laughable--I removed it. Gandydancer (talk) 01:08, 24 November 2013 (UTC)

x-ray section[edit]

The x-ray section presently reads:

In 10% of patients with appendicitis, plain abdominal X-ray may demonstrate hard formed feces in the lumen of the appendix (fecolith). It is agreed that the finding of Fecolith in the appendix on X-ray alone is a reason to operate to remove the appendix, because of the potential to cause worsening symptoms. In this respect, a plain abdominal X-ray may be useful in the diagnosis of appendicitis, though plain abdominal X- ray is no longer requested routinely in suspected cases of appendicitis. An abdominal X-ray may be done with a barium enema contrast to diagnose appendicitis. Barium enema is whitish fluid that is passed up into the rectum to act as a contrast. It will usually fill the whole of the large bowel. In normal appendix, the lumen will be present and the barium fills it up and is seen when the X-ray film is shot. In appendicitis, the lumen of the appendix will not be visible on the barium film.

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I did a web search and found this info:

Although they are commonly obtained, the indiscriminate use of plain abdominal radiographs in the evaluation of patients with acute abdominal pain is unwarranted. In one study of 104 patients with acute onset of right lower quadrant pain, interpretation of plain x-rays changed the management of only 6 patients (6%), and in one case contributed to an unnecessary laparotomy.[6] A calcified appendicolith is visible on plain films in only 10% to 15% of patients with acute appendicitis; however, its presence strongly supports the diagnosis in a patient with abdominal pain. Plain abdominal films may be useful for the detection of ureteral calculi, small bowel obstruction, or perforated ulcer, but such conditions are rarely confused with appendicitis. Failure of the appendix to fill during a barium enema has been associated with appendicitis, but this finding lacks both sensitivity and specificity because up to 20% of normal appendices do not fill.[2] I also found this study: [3]

It is my impression that this section needs to be rewritten to reflect the source information. Also, I see no reason to get into an explanation of a barium enema here. Thoughts? Gandydancer (talk) 14:49, 24 November 2013 (UTC)

I went ahead and rewrote this section to make it very clear that x-ray is not a good dx tool for appendicitis. Apparently it is still being done--per the text book I used: "Although they are commonly obtained, the indiscriminate use of plain abdominal radiographs in the evaluation of patients with acute abdominal pain is unwarranted". This reminded me of a TV program that I watched that looked at all the tests that were run on a woman that was admitted and eventually died a week or so later. She was very old, she was clearly terminal, and yet the tests ran into the hundreds of thousands of dollars. They even did a PAP smear on her... Gandydancer (talk) 17:44, 25 November 2013 (UTC)

First described discrepancy[edit]

I noticed that in the James Parkinson article, it says, "In 1812 Parkinson assisted his son with the first described case of appendicitis in English, and the first instance in which perforation was shown to be the cause of death", with no citation. In this article (Appendicitis), it says, "Appendicitis was first described by Reginald Fitz in 1886", with a citation to the primary source. Anyone know which (if any) of these is accurate? Or maybe they mean slightly different things? — RockMFR 01:40, 12 May 2014 (UTC)

Type of pain[edit]

You should nick some stuff from the WikiHow article (http://www.wikihow.com/Recognize-the-Symptoms-of-Appendicitis), surprising because it's even more detailed than this Wiki page! e.g. Starts as dull pain near belly button, becomes sharp as moves into LRQ. And also, include some info on pathophys of pain, e.g. pain starts due to innervation of appendix enters the spinal cord at the same level as the belly button. But as belly button becomes swolen, it rubs on the overlying wall (parielta peritoneum), and thus localizeds into the RLQ 129.180.158.153 (talk) 14:41, 11 September 2014 (UTC)

Lead Section[edit]

As noted, the lead section appears to be sparse with lots of room for improvement. I'll be working on this section trying to bring it inline with the Lead section standard in the Manual of Style. Any comments or edits would be greatly appreciated. --Plm234 (talk) 18:29, 29 October 2014 (UTC)

Lead Section feedback[edit]

I really like the lead. It give a good summary of appendicitis in a few short paragraphs. It’s readable, understandable to a general audience, accurate, and well cited.

Some thoughts:

-First paragraph: "Severe complications of a ruptured appendix include inflammation of the inner lining of the abdominal wall and sepsis." While I certainly recognize that peritonitis is a severe complication of appendicitis, stating that it is "inflammation of the inner lining of the abdominal wall" makes it sound not particularly severe to me. Since a sign of appendicitis is RLQ pain that occurs from the inflamed appendix irritating the abdominal wall which is not particularly severe, these seem too similar and downplaying to me. This is super nit picky but a thought.

Agreed. Added the phrase "wide spread, painful"--Plm234 (talk) 00:41, 20 November 2014 (UTC)

-I really like that fecalith and other terms are described in understandable terms but also have links to the medical term

-3rd paragraph: With this wording, I get the sense that imaging plays a small role in diagnosis. In my experience, rarely does someone not get imaged. I feel like the importance of imaging could be stressed more. That being said, worldwide, I wouldn't be surprised if it is much more common for someone to go to the operating room without imaging. I have no data to back up these thoughts.

Agree with your point as my clinical experience is similar re: use of imaging. I don't have data or studies to back it up. Will add it if I find some.--Plm234 (talk) 00:48, 20 November 2014 (UTC)

-4th paragraph: "Antibiotics may be equally effective in certain cases." While I realize this is the lead and you shouldn't expand too much, I feel like this is too much of a cliffhanger. I'm curious to know which certain cases antibiotics could be used instead. Is there any way to elaborate concisely? (talk)

A great point. This is certainly an active area of research. I added the phrase "in certain cases of non-ruptured appendicitis" as this is where most of the literature has been published around. The whole question about which cases can or should be treated with antibiotics needs to be flushed out in the body of the article as well.--Plm234 (talk) 00:46, 20 November 2014 (UTC)