Abstract
Objectives:To determine the diagnostic role of hyperbilirubinemia in acute appendicitis like suppurative and gangrenous appendicitis.Methods:This observational study was conducted at Ward-3, Jinnah Postgraduate Medical Center (JPMC), Karachi from 1st June 2019 to 1st June 2020. Males and females above 12 years of age were included. Serum liver function tests and leukocyte counts were carried out. Appendectomies were done, the operative findings and histopathology reports were noted. Hyperbilirubinemia was related with the stages of appendicitis. Results were analyzed by SPSS version 25.Results:There were one hundred twenty patients. Thirty-eight (31.66%) were females and eighty-two (68.33%) were males. Age range was 13 to 60 years. Ten patients (8.33%) were between 13 – 20 years, sixty five (54.16%) were 21 to 30 years, thirty (25%) were 31 – 40 years, ten (8.33%) were 41 – 50 years and five patients (4.17%) were above 50 years of age. Sixty-two (51.66%) patients had simple appendicitis and fifty-four (45%) had complicated appendicitis like suppurative (26.66%) and (16.66%) gangrenous appendicitis. Negative appendectomy was found in four (3.33%). Hyperbilirubinemia was found (100%) in gangrenous, (94.12%) in suppurative and (12.3%) in catarrhal appendicitis. Enzymes like Alanine transaminase and Aspartate transaminase were raised (50%) in gangrenous, (50%) in suppurative and (9.67%) in catarrhal appendicitis. TLC was raised in 112 (96.55%) out of 116 patients and total leukocyte count was normal in negative appendectomies.Conclusions:It is concluded that hyperbilirubinemia is strong diagnostic predictor for complicated appendicitis.
Highlights
Diagnosis of acute appendicitis is essential for early appendectomy to prevent the complications of appendicitis
Sixty-two (51.66%) patients proved simple as acute catarrhal appendicitis and fifty four (45%)found out to be complicated appendicitis like suppurative (28.33%) and (16.66%) gangrenous appendicitis
Patients presented after 24 hours had complicated appendicitis like suppurative and gangrenous appendicitis
Summary
Diagnosis of acute appendicitis is essential for early appendectomy to prevent the complications of appendicitis. Complications of appendicitis are life threatening like appendicular abscess, gangrenous and perforation of appendix. Appendicitis is diagnosed on clinical examination but can be challenging in females and children.[1] Total leukocyte count is not always a good diagnostic criteria in acute appendicitis but when combined with clinical examination, it is helpful for appendectomy.[2] C-reactive protein and bilirubin are raised significantly in acute appendicitis (96.6%).[3] Sensitivity of TLC is more than (90%) in the
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