A study of deranged liver function as an early predictor of perforated appendix
DOI:
https://doi.org/10.18203/2349-2902.isj20185082Keywords:
Appendicectomy (liver parenchyma), Tumour necrosis factorAbstract
Introduction: Appendicectomy accounts for 1% of all surgical operations. Portal blood carries nutrients and substances absorbed from gut including bacteria. It is commonly cleared by detoxification and immunological action of reticuloendothelial system. When bacterial load overwhelms the Kupffer cell function, causes dysfunction or damage to the hepatocytes. It reflects, rise in serum bilirubin alone or in combination with liver enzymes depending upon the type, severity and site of lesion. Recently, another substance known as cytokines have also been labelled to be responsible for depressed excretory function of liver. To study deranged liver function test as a predictor of perforated appendix.
Methodology: This is a prospective study conducted at Dr. BR Ambedkar Medical college and Hospital between 2015-2017. Clinically suspected cases are investigated to confirm the diagnosis. Subsequently these cases are operated and clinical diagnosis was confirmed pre-operatively and post-operatively by histopathological examination of the specimen. Their clinical and investigative data are compiled and analysed and following observations are obtained. Routine liver function test results are compared with laboratory reference values.
Results: In present study non-perforated cases mean total bilirubin was 1.25 and in perforated group 1.83. SGOT in non-perforated cases was 44.58IU/L and perforated cases 107.33IU/L. SGPT in non-perforated cases was 52.19IU/L and perforated cases was 113.33IU/L. Hyperbilirubinemia in perforated appendicitis vs simple appendicitis had a specificity of 75% for perforated appendicitis, a sensitivity of 100%.
Conclusions: Elevated serum bilirubin has a high potential in predicting perforation of appendix in clinically suspected cases.
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References
Telfor G, Wallace J. Appendix. In: Morris PJ, Wood WC, eds. Oxford text book of surgery. Vol. 2. 2nd ed. Oxford Medical Publications; 2000:180-18.
Sauerland S, Lefering R, Holthausen U, Neugebauer EA. Laparoscopic vs conventional appendectomy-a meta-analysis of randomised controlled trials. Langenbeck's Arch Surg. 1998 Aug 1;383(3-4):289-95.
Christian F, Christian GP. A simple scoring system to reduce the negative appendicectomy rate. Annals Royal Coll Surg Eng. 1992 Jul;74(4):281.
Zielke A, Sitter H, Rampp T, Schäfer E, Möbius E, Lorenz W, Rothmund M. Can diagnostic scoring systems help decision making in primary care of patients with suspected acute appendicitis?. Deutsche medizinische Wochenschrift. 1999 May;124(18):545-50.
Estrada JJ, Petrosyan M, Barnhart J, Tao M, Sohn H, Towfigh S, Mason RJ. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastrointes Surg. 2007 Jun 1;11(6):714-8.
Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009 Aug 1;198(2):193-8.
Käser SA, Fankhauser G, Willi N, Maurer CA. C-reactive protein is superior to bilirubin for anticipation of perforation in acute appendicitis. Scandinav J Gastroenterol. 2010 Aug 1;45(7-8):885-92.
Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. Annals Royal Coll Surg Eng. 2011 Apr;93(3):213-7.
Khan S. Elevated serum bilirubin in acute appendicitis: a new diagnostic tool. Kathmandu Univ Med J. 2008 Apr;6(2):161-5.
Beltrán MA, Almonacid J, Vicencio A, Gutiérrez J, Cruces KS, Cumsille MA. Predictive value of white blood cell count and C-reactive protein in children with appendicitis. J Pedia Surg. 2007 Jul 1;42(7):1208-14.
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