LYCOS RETRIEVER 
Appendicitis: Patients
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AspenBio's AppyScore is the first blood-based Screen/Triage Test for human appendicitis. An estimated 5% to 7% of the world's population will get appendicitis in their lifetime. Annually, in the U.S. alone, an estimated 6 million patients enter hospital emergency rooms (ERs) complaining of abdominal pain, and who could potentially have appendicitis. Upon entering the ER, the current standard of care for these patients is to draw blood and urine samples, take vital signs and complete an initial physical health examination. Depending upon the results and clinical impression of the ER physician, a computed tomography (CT) scan may ... be scheduled to assist in the diagnosis or rule out of appendicitis. CT scans generally take several hours to schedule and complete the procedure, and interpret the results.
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Recent clinical experience suggests that patients with perforated appendicitis with mild symptoms and localized abscess or phlegmon on abdominopelvic CT scans can be initially treated with intravenous antibiotics and percutaneous or transrectal drainage of any localized abscess. If the patient's symptoms, WBC count, and fever satisfactorily resolve, therapy can be changed to oral antibiotics and the patient can be discharged home. Delayed (interval) appendectomy can then be performed 4-8 weeks later. This approach is successful in the vast majority of patients with perforated appendicitis and localized symptoms. Some have suggested that interval appendectomy is not necessary unless the patient presents with recurrent symptoms. Further studies are needed to clarify whether routine interval appendectomy is indicated.
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There is no definitive test for diagnosing appendicitis. Typically, a great emphasis is placed on the WBC. The WBC is elevated in up to 90% of patients with acute appendicitis but is normal in the other 10% (4,6). Too much emphasis on the WBC can cause serious delays in operative intervention and result in perforation (6). Serial WBC may aid in diagnosis if the second test is performed 4-8 hours after the first (7). Finally, a combination of elevated WBC and neutrophilia greater than 75% appears to be more sensitive than the WBC alone (8).
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Acute appendicitis usually begins with pain, frequently localized to the area around the belly button. This is commonly followed by loss of appetite: most children with appendicitis show no interest in their favorite foods. Nausea and vomiting usually are seen next. In time the pain eventually shifts to the right lower area of the abdomen. In some patients, the appendix lies behind the first part of the large intestine and in those patients the shift of pain to the right lower area of the abdomen may be absent. The pain in appendicitis is continuous and generally does not get better.
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Of the 125 patients clinically suspected of having appendicitis, 57 had acute appendicitis and 68 did not (prevalence, 46%). In all 57 patients with acute appendicitis, the diagnosis was confirmed with surgery and histologic evaluation. In the appendicitis group, the surgical and histologic findings showed perforation of the appendix in 15 patients. Among the 68 patients without acute appendicitis, the diagnosis was confirmed at surgery in four patients, at endoscopy with biopsy in two patients, and at clinical follow-up in 62 patients. Table 1 lists the final diagnoses established in the nonappendicitis group. According to the final diagnosis, all patients who did not undergo surgery had resolution of symptoms in a period ranging from 2 hours to 1 month after inclusion in the study.
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For correct diagnosis of appendicitis, the entire process begins with the complete history and physical examination of the patient. Based on the physical tests and the medical history of the patient appendicitis can be identified. Patients often have a high body temperature and they will experience moderate to severe tenderness when the doctors presses their abdomen. If the inflammation has already spread to the peritoneum, often there will be rebound tenderness associated with the non- localized pain. Rebound tenderness becomes a severe pain especially when the doctor presses around the tenderness gently, and quickly removes his hand from the portion of the tenderness.
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