Appendicitis: The Misdiagnosis and Diagnosis

Home of Kyle J. Norton for The Better of Living & Living Health Appendicitis is defined as a condition of inflammation of Appendix. It is classified  as an emergency, in many required the removal of the appendix. If burst, or perforate, spilling infectious materials into the abdominal cavity can be life threatening.

IV. Misdiagnosis and Diagnosis
A. Misdiagnosis
1. Diverticulitis 
According to the study by the Hôpital Saint-Joseph, appendicitis and diverticulitis of the colon are the two main causes of febrile acute abdomen in adults. Diagnosis from imaging (ultrasound and CT) is usually easy. However, an imaging procedure which is not suitable for the clinical situation and an examination performed with the wrong protocol are sources of error and must be avoided. Anatomical variants, inflammatory cancers, complicated forms (perforation, secondary occlusion of the small intestine, peripheral abscesses, fistulae, pylephlebitis, liver abscesses) and associated signs related to a peritoneal inflammatory reaction (reflex ileus, reactive ileitis or salpingitis) can also lead to a wrong diagnosis(24).

2. Visceral myopathy
Visceral myopathy is rare pathological condition of gastrointestinal tract with uncertain clinical presentation and unknown etiology. It is a very rare group of disease and poorly understood condition that may present with chronic or acute intestinal pseudo-obstruction and often mimic other more common gastrointestinal disease. VM should be considered as differential diagnosis whenever the patient presents with acute appendicitis, uncharacteristic abdominal symptoms, recurrent attacks of abdominal distention, and pain with no radiological evidence of intestinal obstruction, according to the First Hospital of Jilin University(25).

3. Malignant lymphoma
There is a report of a case of localized malignant lymphoma of the appendix associated with the histological features of acute inflammation that presented clinically as acute appendicitis(26).

4. Herniation pit
herniation pits of the right femoral neck should be considered a potential cause of right lower abdominal pain mimicking acute appendicitis, particularly if the psoas sign and obturator sign are positive and the patient is physically active(27).

5. Acute scrotum
Acute appendicitis presents typically with periumbilical pain that in a few hours settles at the right lower quadrant of the abdomen. Atypical presentations are common but association with acute scrotum is an extreme rarity(28).

6. Testicular mass
There is a report of a case where ultrasound demonstrated an inflamed appendix and a scrotal abscess, allowing the correct surgical management in a difficult clinical situation. In a child presenting with scrotal signs and vague lower abdominal symptoms, an ultrasound assessment of the right iliac fossa should always be performed(29).

7. Cystic lymphangiomas 
There is a report of a case of a 4-year-old boy who was admitted to our hospital because of the right lower quadrant acute abdominal pain suspect of acute appendicitis. At laparotomy, a giant, cystic, encapsulated and lipomatous mesenterial mass was found, 15 x 15 x 10 cm in size, infiltrating the jejunum. The tumor was located 70 cm from Treitz’s ligament(30).

B, Diagnosis
After recording the past and present history and completing a physical exam, including certain symptoms of above for signs of inflamed appendix. The tests which your doctor orders may include
1. Blood test
The aim of the blood test is to sign of infection by checking the level of white blood cells.

2. Urine test 
the aim of the test is to rule other causes of infection, including urinary infection or kidney stone causes of infection.

3. Abdominal X-ray, Ultrasound and Computerized tomography ((CT) scan
The aim of the tests is to confirm appendicitis or other causes for your pain
a. Plain abdominal X-ray and Ultrasound
According to the study by the, in a prospective study of 109 patients with non-classical symptoms of appendicitis using the standard ultrasound (US) machine and plain abdominal x-rays demonstrated that US was superior to plain x-ray with a sensitivitiy, specificity and overall accuracy of 89%, 96% and 91%, respectively as compared with plain x-ray with 48%, 93% and 67% respectively(31).

b. Computerized tomography ((CT) scan
In the study to determine the influence of computed tomography (CT) scans on diagnosis and management of patients with suspected appendicitis, found that CT scan utilization increased the appendectomy rate only in patients with a low clinical suspicion for appendicitis. Preoperative CT scans did not decrease the negative appendectomy rate.

Made From Fresh Fruits And Vegetable Recipes
 Secret To A Vibrant And Healthy Lifestyle
That You Can Find Easily At The Comfort Of Your Kitchen.

Chinese Secrets to Fatty Liver and Obesity Reversal
Research based & Scientifically proven Efficacy To Treat Fatty Liver Diseases & Achieve Optimal Health & Loose Weight Recommended by Kyle J. Norton

 For the series of Hemorrhaging visit http://diseases-researches.blogspot.ca/p/cystitis.html

For more health articles, please visit http://medicaladvisorjournals.blogspot.ca  
 
Sources 
(24) http://www.ncbi.nlm.nih.gov/pubmed/23759294 
(25) http://www.ncbi.nlm.nih.gov/pubmed/23738185
(26) http://www.ncbi.nlm.nih.gov/pubmed/16442000 
(27)  http://www.ncbi.nlm.nih.gov/pubmed/23837953
(28) http://www.ncbi.nlm.nih.gov/pubmed/21816859
(29) http://www.ncbi.nlm.nih.gov/pubmed/11089472
(30) http://www.ncbi.nlm.nih.gov/pubmed/23837284
(31) http://www.ncbi.nlm.nih.gov/pubmed/17587990
(32) http://www.ncbi.nlm.nih.gov/pubmed/17998781
  http://medicaladvisorjournals.blogspot.com