gastrointestinal disorders
Appendicitis
Diagnosis of Appendicitis
Clinical evaluation Abdominal CT if necessary Ultrasonography an option to CT When classic appendicitis symptoms and signs are present, the appendicitis diagnosis is clinical. In such patients, delaying appendicitis surgery to do imaging tests only increases the likelihood of perforation and subsequent complications. In patients with atypical or equivocal findings, imaging studies should be done without delay. Contrast-enhanced CT has reasonable accuracy in diagnosing appendicitis and can also reveal other causes of an acute abdomen. Graded compression ultrasonography can usually be done quickly and uses no radiation (of particular concern in children); however, it is occasionally limited by the presence of bowel gas and is less useful for recognizing nonappendiceal causes of pain. Appendicitis remains primarily a clinical diagnosis. Selective and judicious use of imaging studies may reduce the rate of negative laparotomy. Laparoscopy can be used for diagnosis as well as definitive treatment of appendicitis; it may be especially helpful in women with lower abdominal pain of unclear etiology. Laboratory studies typically show leukocytosis (12,000 to 15,000/mcL [12.00 to 15.00 × 109/L]), but this finding is highly variable; a normal white blood cell count should not be used to exclude appendicitis. 