Diagnosis of Acute Appendicitis

Answer

Diagnosis of Acute Appendicitis

Diagnostic reasoning will be employed for development of differential diagnosis of acute appendicitis. If left untreated, acute appendicitis may resolve steadily through the help of host defense system, or deteriorate to life-threatening suppurative necrosis with perforations (Weledji, 2015). Thus, early diagnosis and treatment may help in prevention of disease progression and saving of lives. A clinician should have knowledge of acute appendicitis differential diagnosis of acute appendicitis to reach reliable and valid conclusions. The essay lists differential diagnoses of acute appendicitis, final diagnosis and distinguishes between normal and abnormal specific auscultation palpation.

                Differential diagnosis of a suspected case of acute appendicitis include weight loss probably due to Caecal carcinoma and/or Crohn’s disease; previous episode of similar symptoms that may as well be attributed to Crohn’s disease, and vaginal discharge which may be attributed to salpingitis. Other differential diagnoses include dysplasia perhaps due to perforated ulcers or cholecystitis; sore throat perhaps due to mesenteric edenitis; arthralgia that may be attributed to Crohn’s disease or Yersinia enterocolitica infection, and frequent urge to urination perhaps due to urinary tract infection. People of Asian origin are likely to manifest with ileo-caecal tuberculosis. Other important differential symptoms include preserved appetite due to gynecological or non-specific factors (Weledji, 2015).

                In this condition, the point of maximum tenderness is almost always localized to one-third lengthwise right from the umbilicus; which designates the surface anatomy of the appendix, to the anterior superior iliac spine. This section guards the appendix from being inflamed further. Palpitation or application of pressure on the left iliac fossa seem to generate pain in the right iliac fossa in a pathological state; but not specific. For instance, peritonitis may obscure the maximum area of tenderness.

Fact-finding history is an important element of diagnosis. History components will include chief complaint, history of present illness, past medical history, habits, sociocultural factors, family, and review of systems. Physical examination follows the patient history fact-finding process.  Physical examination is conducted through the use of keen observational skills so as to generate reliable and valid findings. Failure rate, associated with clinical diagnosis, is as a high as 15%. However, the failure rate may be reduced by right selection of diagnostic tools and procures informed by patient history and physical examination. Besides, diagnostic statistical tools should be employed to help in rational decision-making process and development of conclusions that will dictate the direction of therapy or treatment. Statistical tools will help inform the sensitivity, specificity, pretest probability, and likelihood ratio of a given condition (Goolsby & Grubbs, 2014).

                Classical symptoms include dull, referred, colicky periumbilical and poorly localized pain and luminal obstruction. Other symptoms include peritoneal irritation attributed to an inflamed appendix, nausea, vomiting, constipation and low-grade pyrexia.  Point tenderness and swinging pyrexia may be detected on rectal examination. Rectal examination is required in patients in which rebound tenderness may not be detected. Subacute obstruction may be experienced by the elderly population and that the appendix mass may mimic Crohn’s disease, caecal carcinoma, ovarian cancer or tuberculosis (Weledji, 2015).

                If history and outcome of clinical evaluation is consistent with acute appendicitis then a small bowel study or computed-tomography scan may be necessary.  Reliable and valid diagnostic results are essential since they may influence decisions on whether to operate or not.  Various examination options and regular re-evaluation of a patient complaining of acute abdominal pain is recommended in standard care. Historical background and examination are considered as important diagnostic modalities that aid early diagnosis of acute appendicitis (Weledji, 2015).

                The ability of clinical examinations and diagnosis to detect and identify peritoneal inflammation is important for reaching the final decision to perform a surgical operation. Acute appendicitis may be tackled by application of an antibiotic therapy though the approach is associated with recurrent rate os 25%. Thus, early surgical operation is a sure way for avoiding impeding peritoneal sepsis. Differentiation of an abscess from a phlegmonous mass is not a practical issue since surgical operations are right intervention approaches for both (Weledji, 2015).

What is the final diagnosis and what assessment findings serve to support this?

What are the specific auscultation palpation findings of the abdomen that are normal versus abnormal?

It has to be APA format, 3-4 pages, if possible I want you to use these three books as references, because the professor does not want references more than five years.