Thirumanikandan, P L (2014) Study on evaluation of serum bilirubin in acute appendicitis and its credibility in predicting its severity. Masters thesis, Chengalpattu Medical College, Chengalpattu.
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Abstract
BACKGROUND AND OBJECTIVES: Acute appendicitis is the most common surgical emergency in the second and third decades of life. Despite the availability of modern imaging modalities, diagnosis of appendicitis is still more clinical and the dilemma still continues because of the non-availability of imaging techniques at most of our set up during emergency. The present study was done to assess the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis and also its predictive potential in diagnosis of appendicular perforation. METHODOLOGY: This one year cross sectional study was conducted in the department of general surgery, Chengalpattu medical college and hospital during the period of December 2012 to November 2013. A total of 100 patients with clinical diagnosis acute appendicitis or appendicular perforation were studied. The serum bilirubin and liver function tests were carried out in all the patients. RESULTS: In this study, male (62%) outnumbered females (38%) and overall the mean age was 28.96± 9.9. The mean total serum bilirubin of all 100 patients was 1.77±0.94 mg/dl which was above the normal range (>1.0 mg.dl) considered for the study, hence indicating the presence of hyperbilirubinemia. The mean of direct bilirubin was 1.25±0.88 mg/dl while that of indirect bilirubin was 0.49±0.2 mg/dl. Among the patients with inflamed appendix, 53 patients (82%) were found to have elevated bilirubin (>1.0mg/dl). In patients diagnosed with appendicular perforation (n=23), 19 patients (84%) had bilirubin elevated (>1.0mg/dl), while only 4 patient (16%) had normal level (<1.0 mg/dl). Thus hyperbilirubinemia was seen in 82% of patients with acute appendicitis and 84% of patients with complicated appendicitis. Sensitivity and specificity of bilirubin in diagnosing acute appendicitis and appendiceal perforation was 81.82% and 83.33% respectively. Similarly positive predictive value and negative predictive value of bilirubin was 97.33% and 38.46%. The Odd’s ratio was calculated to be 22.5. CONCLUSION AND INTERPRETATION: Serum bilirubin routinely added to the blood investigation can be useful laboratory investigation for aiding in the diagnosis of acute appendicitis. Can be easily done and cheaply available. Patients with three times the normal bilirubin value and clinical signs of appendicitis and appendicular perforation have higher probability of having complicated appendicitis.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Acute appendicitis ; appendicular perforation ; hyperbilirubinemia ; serum bilirubin. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 06 Jul 2018 16:25 |
| Last Modified: | 07 Jul 2018 16:52 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8667 |
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