Varadharajan, V (2015) C Reactive protein and serum bilirubin as predictor of severity of acute appendicitis. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Acute appendicitis is one of the most common surgical emergencies. Its diagnosis is usually made depending on presenting history, clinical evaluation and laboratory tests. It has been estimated that the accuracy of the clinical diagnosis of acute appendicitis is between 76% and 92% The negative appendectomy rate is about 15 percent The perforation rate in acute appendicitis can be as high as 35 percent. No specific marker exists to assess severity of inflammation preoperatively. This study was done to assess the utility of C reactive protein and Serum Bilirubin in assessing severity of Acute appendicitis. AIM OF THE STUDY: The aim of the study was to assess the correlation between pre operative CRP and Serum Bilirubin levels and the intra operative finding and thereby predicting the severity of appendicitis. MATERIALS AND METHODS Period of Study: Data was collected prospectively from September 2013 to September 2014 Place of Study: Department of Surgery, Govt Kilpauk Medical College Inclusion Criteria: 1. Patients admitted with acute abdominal pain with signs and symptoms of appendicitis who are clinically diagnosed to have acute appendicitis were included in this study. 2. Patient of both sexes. 3. Age from 18 years to 60 years. 4. Patients who were willing to give consent for study were included. Exclusion Criteria: 1. Pregnant women, 2. Patients on Long term steroids/immunosuppressant, 3. Patients on treatment for Chronic Inflammatory diseases, 4. Known CAHD patient, 5. Patients with Chronic liver disease. STUDY METHODOLOGY: 100 eligible patients were chosen. History and signs were recorded. Basic routine investigations was done for all patients. Consent was obtained for inclusion under study. CRP and Serum Bilirubin was done preoperatively for all patients Subsequently patients were taken up for open appendicectomy. Macroscopic analysis by the surgeon intra operatively was used by surgeon to classify the appendix as acute appendicitis, gangrenous or perforated, mass, abscess or normal appendix. The data was analyzed. CONCLUSION: It was seen that C Reactive protein and Elevated serum bilirubin values may be used in pre-operative assessment of patients with suspected appendicitis. C reactive protein maybe used as a rule out test and maybe helpful in reducing the negative appendectomy rates. But, Serum bilirubin, based on this study, is found to be a precise indicator of severity of disease than just diagnosing if a patient has acute appendicitis or not. With CRP having high sensitivity and Serum bilirubin having good specificity, combining both can be useful in creating an ideal screening platform which is both sensitive and specific. So by combining both Serum Bilirubin values and CRP levels, negative appendectomy rate and perforation related complications in a case of acute appendicitis may be brought down.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | C reactive protein ; Serum bilirubin ; Hyperbilirubinemia ; perforated ; gangrenous ; Severity ; negative appendicectomy ; predictors. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 02 Oct 2018 13:39 |
| Last Modified: | 03 Oct 2018 02:38 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/9623 |
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