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Appendicitis: Conditions
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Appendicitis is a common condition. In the UK, 7% of people will experience appendicitis at some point in the life. The condition is more common in men than in women, and normally occurs in those between 10-30 years of age.
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CT KUBs are used to screen for a variety of intra-abdominal conditions, including appendicitis, kidney stones, diverticulitis, and others. Just as with the KUB, finding an appendicolith confirms the diagnosis with CT. When they are dense enough, appendicoliths are seen on abdominal x-rays and may be seen on ultrasound, but they are easier to detect using CT KUB. CT is more sensitive in picking out the density and showing it on the image. Also, because it is cross-sectional, overlapping and confusing shadows are eliminated. Anything that looks like an appendicolith in the right lower quadrant probably is just that.
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CT is not routinely used in pregnancy, but pregnant women may undergo CT to detect suspected life-threatening conditions such as bleeding in the brain, blood clots in the lungs or appendicitis. Since CT exposes the developing fetus to radiation, concerns are often raised regarding overuse. The majority of CT examinations (approximately 75 percent) analyzed in the study were performed in areas of the mother's body separate from the uterus, so the fetus was not exposed to any direct radiation. Even low levels of radiation have been shown to carry a small risk of harm to a developing fetus.
An acute appendicitis is often the first thought to the layperson when a sharp onset of pain in the right lower abdominal quadrant occurs. This relatively common disease is usually diagnosed by the surgeon. However, the pathologist plays an important role not only in confirming the diagnosis but in ruling out other conditions which may mimic the disease.
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The differential diagnosis of appendicitis is broad, but the patient's history and the remainder of the physical examination may clarify the diagnosis (Table 4). Because many gynecologic conditions can mimic appendicitis, a pelvic examination should be performed on all women with abdominal pain. Given the breadth of the differential diagnosis, the pulmonary, genitourinary and rectal examinations are equally important. Studies have shown... that the rectal examination provides useful information only when the diagnosis is unclear and, thus, can be reserved for use in such cases.5
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Typical acute appendicitis responds quickly to appendectomy and occasionally will resolve spontaneously. If appendicitis resolves spontaneously, it remains controversial whether an elective interval appendectomy should be performed to prevent a recurrent episode of appendicitis. Atypical appendicitis (associated with suppurative appendicitis) is more difficult to diagnose and is more apt to be complicated even when operated early. In either condition prompt diagnosis and appendectomy yield the best results with full recovery in two to four weeks usually. Mortality and severe complications are unusual but do occur, especially if peritonitis persists and is untreated.
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