scholarly journals The effectiveness of the Raja Isteri Pengiran Anak Saleha Appendicitis Score in the diagnosis of acute appendicitis in elderly patients

2021 ◽  
Keyword(s):  
Acute Appendicitis ◽  
Elderly Patients ◽  
Perforated Appendicitis ◽  
Clinical History ◽  
Lymphoid Hyperplasia ◽  
Reactive Lymphoid Hyperplasia ◽  
Complication Rates ◽  
Common Cause ◽  
Mortality And Morbidity ◽  
Ripasa Score

Acute appendicitis (AA) is the most common cause of acute abdominal surgeries, accounting for 15% of all emergency visits due to acute abdominal pain in patients aged over 60 years. Appendicitis is reported as the third most common cause of abdominal surgery in geriatric patients. In this current retrospective study, the records of 68 patients aged over 65 years, who were treated by surgical resection in our clinic diagnosed for AA between February 2015 and February 2020, were analyzed. The age, gender, duration of hospital stay of the patients and, histopathological results of appendectomy specimens were recorded. The Raja Isteri Pengrian Anak Saleha Appendicitis (RIPASA) Score of the patients was calculated according to the clinical history, physical examination, and laboratory parameters of the patients. According to the RIPASA scores, the patients were divided into three groups as the low-score group (4 to 7), the intermediate-score group (7.5 to 11.5), and the high-score group (≥ 12). The groups were compared on the basis of the microscopic diagnosis. According to the calculated RIPASA score, there were 12 patients in the low-score group, 44 patients in the intermediate-score group, and 12 patients in the high-score group. When the results were classified based on the pathology, we detected non-complicated conditions such as a normal appendix or reactive lymphoid hyperplasia in ten patients and catarrhal stage appendicitis in 38 patients along with complicated (gangrenous or perforated) appendicitis in 20 patients. In conclusion, the RIPASA score can be used in elderly patients considering its high accuracy rate. In elderly patients with a high RIPASA score, the pathological stage of the appendectomy specimen may also be complicated (perforated or gangrenous) appendicitis. Therefore, the mortality and morbidity rates may increase with increased complication rates.

scholarly journals Appendicular perforation and its contributing factors

2017 ◽  
Vol 4 (6) ◽  
pp. 2007
Author(s):  
Anandaravi B. N. ◽  
Ramaswami B.
Keyword(s):  
Risk Factors ◽  
Acute Appendicitis ◽  
Elderly Patients ◽  
Perforated Appendicitis ◽  
Clinical History ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Delayed Presentation ◽  
Contributing Factors ◽  
Steroid Dependent

Background: The objective was to study of different risk factors contributing in appendicular perforation and effective management of patients by knowing risk factors.Methods: This study was conducted in the department of general surgery K. R. Hospital Mysore medical college and research institute, Mysore, Karnataka, India from January 2015 to June 2016. Patients of age above 18 years and both sexes operated for acute appendicitis were included in present study. The clinical history, clinical features, investigations, intraoperative findings, were noted and surgical procedure done and all perforated appendicitis cases were operated lower midline incision, through wash given with normal saline drain in situ. Post operatively antibiotics were given and all patients follow up done for one month.Results: Present study duration is one and half year we operated total 100 patients for acute appendicitis. In this study 55 patients were male (55%) and 45 patients were females (45%). According to our study acute appendicitis is more common in males. Appendicular perforation has noticed in 23 female patients. The incidence of perforated appendicitis is low in males 12 out of 35 as compared to females 23 out of 35. The incidence of appendicular perforation is higher in the extreme of ages. In the elderly patients it is 58.33%. Thus, according to present study findings age above (>40 years) is strongly associated with the perforated appendicitis (p<0.001 chi squared test). Delayed presentation shows 77.41% appendicular perforation and faecolith associated with 64.51%.Conclusions: The morbidity and mortality rates are higher in elderly patients, diabetics, steroid dependent and immunocompromised patients. We should be aggressive in the treatment of acute appendicitis associated with high risk factors. So once acute appendicitis is diagnosed, the expedient surgery and appropriate use of perioperative antibiotics can help in reducing the morbidity and mortality.

scholarly journals Acute appendicitis in the first three years of life

2006 ◽  
Vol 134 (5-6) ◽  
pp. 203-207
Author(s):  
Zoran Marjanovic ◽  
Zivojin Spasic ◽  
Dragoljub Zivanovic ◽  
Ana Kostic ◽  
Ivona Djordjevic ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Pediatric Surgery ◽  
Surgical Intervention ◽  
Clinical Course ◽  
Perforated Appendicitis ◽  
Mortality And Morbidity ◽  
Pediatric Health Care ◽  
Abdominal Wall Abscess ◽  
Previously Treated ◽  
High Level

Acute appendicitis is the most frequent disease in children population that requires an urgent surgical intervention. Only 2% of operated children belong to the group younger than 3 years. Yet, 77% are school children. Appendicitis in young children is characterized by: atypical clinical course, late diagnosis, high percentage of perforations, and high level of mortality and morbidity rates. The commonest symptoms are: vomiting, undefined abdominal pain, and high temperature. Abdominal distention and diffuse abdominal tenderness are the most frequent signs during examination. Our analysis (1991-2000) included all patients younger than 3 years who were hospitalized in Clinic for Pediatric Surgery Nis with diagnosis of the acute appendicitis. Out of 2533 patients with disease, 58 (2.3%) were younger than 3 years, 23 were girls (39.7%) and 35 were boys (60.3%). Perforated appendicitis was found in 55 (94.8%) of 58 children. Thirty five (60.5%) patients were previously treated. Complications developed in 36 (62.1%) cases: purulence (58.3%), dehiscence (22.3%), abdominal wall abscess (13.8%), and ileus (5.6%). Acute appendicitis is very specific condition that needs high attention by all doctors engaged in pediatric health care. Our recommendation is "to admit and observe" by using the physical examination in all suspected cases. Sometimes, even sedation may be used for better palpation results.

scholarly journals Factors Associated with Perforated Appendicitis in Elderly Patients in a Tertiary Care Hospital

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Siripong Sirikurnpiboon ◽  
Suparat Amornpornchareon
Keyword(s):  
Acute Appendicitis ◽  
Elderly Patients ◽  
Medical Records ◽  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Tertiary Care ◽  
Perforated Appendicitis ◽  
Care Hospital ◽  
Clinical Presentations ◽  
Perforation Group

Background. The incidence of perforated appendicitis in elderly patients is high and carries increased morbidity and mortality rates. The aim of this study was to identify risk factors of perforation in elderly patients who presented with clinical of acute appendicitis.Methods. This was a retrospective study, reviewing medical records of patients over the age of 60 years who had a confirmed diagnosis of acute appendicitis. Patients were classified into two groups: those with perforated appendicitis and those with nonperforated appendicitis. Demographic data, clinical presentations, and laboratory analysis were compared.Results. Of the 206 acute appendicitis patients over the age of 60 years, perforated appendicitis was found in 106 (50%) patients. The four factors which predicted appendiceal rupture were as follows: male; duration of pain in preadmission period; fever (>38°C); and anorexia. The overall complication rate was 34% in the perforation group and 12.6% in the nonperforation group.Conclusions. The incidence of perforated appendicitis in elderly patients was higher in males and those who had certain clinical features such as fever and anorexia. Duration of pain in the preadmission period was also an important factor in appendiceal rupture. Early diagnosis may decrease the incidence of perforated appendicitis in elderly patients.

scholarly journals Comparison of RIPASA and Alvarado score in diagnosing acute appendicitis

2019 ◽  
Vol 6 (3) ◽  
pp. 740
Author(s):  
Suraj S. Kagwad ◽  
P. Karuppasamy
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Cost Effective ◽  
Clinical History ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: Acute appendicitis is a common cause of abdominal pain and can be difficult to diagnose, especially during its early stages.  The diagnosis of acute appendicitis is based on clinical history, examination combined with investigations. The purpose of this study is to compare between the RIPASA score and Alvarado score in the diagnosis of acute appendicitis. The aim of the present study was to compare the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Alvarado and RIPASA score.Methods: The cases for the study will be sourced from cases admitted in SVMCH and RC, Puducherry during the period of November 2016 to June 2018.Results: Out of the 144 patients in our study 133 patients were diagnosed with acute appendicitis as per HPE report.As per our study, sensitivity, specificity, PPV, NPV of RIPASA and Alvarado scoring system is 96.2%, 57.1%, 97.7% and 44.4%; 81.9%,85.7%, 95.1% and 20%  respectively. The diagnostic accuracy of RIPASA score is 94.3 as compared to 82.1 of Alvarado score.Conclusions: The RIPASA scoring system is a promising and has good sensitivity, specificity and diagnostic accuracy when compared to Alvarado scoring for Asian Population.RIPASA scoring system is an easy and reliable, cost effective diagnostic tool which reduce negative appendicectomy rates and the expensive radiological investigations for the diagnosis of acute appendicitis.

scholarly journals A CLINICAL STUDY OF BLUNT CHEST TRAUMA

2020 ◽  
pp. 66-68
Author(s):  
Mohit B Chauhan ◽  
Hitesh Maheshwari ◽  
Dolli Aasani
Keyword(s):  
Road Traffic Accident ◽  
Blunt Chest Trauma ◽  
Traffic Accident ◽  
Chest Trauma ◽  
Road Traffic ◽  
Clinical History ◽  
Common Cause ◽  
Mortality And Morbidity ◽  
Physical Trauma ◽  
Cord Injury

Trauma to the chest is considered as one of the most serious injuries of the chest and it is also a common cause of mortality and morbidity. It is also the leading cause of death from physical trauma after head and spinal cord injury. Chest trauma is the primary or a contributing factor in approximately 1/4th of all trauma related deaths. Chest trauma accounts for 20-25% of deaths due to trauma. Approximately, 16,000 deaths per year in India alone are a result of chest trauma. The study was conducted on 25 patients of blunt chest trauma admitted in a G.G. Hospital affiliated to M.P. Shah Govt. Medical College during the years 2016- 2018. Detailed clinical history was recorded including age, sex, symptoms, mode of injury, associated injuries, external bleeding and mental status. Out of 25 patients having blunt chest trauma most common age group was 31-40 years, road traffic accident being the most common mode of injury in 60%, 64% having less than 4 ribs fractured, 60% having hemothorax and 54% having pneumothorax and 60% patients were treated with intercostal tube drainage. The study revealed that road traffic accident was the most common cause of blunt chest trauma. Majority of the patients with blunt chest trauma can be managed conservatively with pain management. Few required intercostal tube drain without the need of other invasive therapy.

scholarly journals Vyresnio amžiaus žmonių apendicito ypatumai

2003 ◽  
Vol 1 (1) ◽  
pp. 0-0
Author(s):  
Donatas Venskutonis ◽  
Virmantas Daubaras ◽  
Juozas Kutkevičius ◽  
Jelena Kornej
Keyword(s):  
Postoperative Complications ◽  
Acute Appendicitis ◽  
Elderly Patients ◽  
Age Groups ◽  
Perforated Appendicitis ◽  
The Mean ◽  
Group 2 ◽  
Medical Histories ◽  
Complications And Mortality ◽  
Group 1

Donatas Venskutonis1, Virmantas Daubaras1, Juozas Kutkevičius1, Jelena Kornej21 Kauno medicinos universiteto Bendrosios chirurgijos klinika, 2-oji Kauno klinikinė ligoninė2 Kauno medicinos universitetas Įvadas / tikslas Apendicitas yra viena iš dažniausių ūminių chirurginių pilvo ligų. Per gyvenimą ūminiu apendicitu suserga apie 7 % visos populiacijos. Literatūros duomenimis, ūminis apendicitas sudaro apie 5 % visų ūminių pilvo ligų vyresnio amžiaus grupėje. Šio darbo tikslas – išanalizuoti KMU Bendrosios chirurgijos klinikoje (II KKL) 1991–2000 metais gydytų vyresnio amžiaus žmonių apendicito formas, diagnostinio laikotarpio trukmę, bendrą gulėjimo stacionare laiką, komplikacijų ir baigčių aspektus, šiuos duomenis palyginti su jaunesnių kaip 65 metų ūminiu apendicitu sergančių ligonių grupe. Metodai Tyrimo metu retrospektyviai buvo išanalizuotos 1991–2000 m. gydytų nuo įvairių ūminio apendicito formų asmenų ligos istorijos, siekiant įvertinti ligos trukmę, diagnostinio laikotarpio trukmę, ligos formą, gulėjimo stacionare trukmę, komplikacijas, mirštamumą ir palyginti šiuos duomenis dviejų amžiaus grupių: iki 65 metų ir daugiau kaip 65 metų. Tiriant istorijas buvo kreipiamas dėmesys į diagnostinio laikotarpio trukmę iki operacijos, operacijos metu nustatytą apendicito formą, stacionarinio gydymo trukmę, buvusias komplikacijas ir baigtį. Rezultatai 1991–2000 m. nuo įvairių ūminio apendicito formų iš viso buvo gydyti 2378 ligoniai: pirmoje grupėje (iki 65 m.) buvo 2220 ligonių (92,51 %), antroje – 158 ligoniai (7,49 %). Pirmos grupės operuota 2130 ligonių (95,94 %), antros – 145 ligoniai (91,7 %). Vertinant apendicito formas, antroje amžiaus grupėje buvo gerokai daugiau gangreninių perforacinių nei pirmoje grupėje (p = 0,0014), o šioje – daugiau flegmoninių (p < 0,0010). Pirmos grupės ligoniai iki operacijos ligoninėje gulėjo 2,3 val., antros – 4,11 val. (p < 0,05). Bendras gulėjimo laikas pirmos grupės ligonių buvo 6,77 paros, antros – 11,14 paros (p < 0,05).Pooperacinių komplikacijų pirmoje grupėje buvo 151 (7,1 %), antroje – 31 (21,3 %), (p = 0,0151). Mirštamumas antroje grupėje sudarė 3,4 %, pirmoje grupėje mirusių nebuvo. Išvados Vyresnio amžiaus žmonės serga sunkesnėmis apendicito formomis, jų ikioperacinis ir bendras gulėjimo laikas yra ilgesnis (skirtumas statistiškai patikimas), pooperacinės komplikacijos sunkesnės ir dažnesnės (skirtumas statistiškai patikimas), visi mirusieji buvo vyresnio amžiaus žmonės, sirgę sunkiomis perforacinio apendicito formomis. Prasminiai žodžiai: apendicitas, vyresnio amžiaus ligoniai. Appendicitis - peculiarities in elderly patients Donatas Venskutonis1, Virmantas Daubaras1, Juozas Kutkevičius1, Jelena Kornej2 Background / objective Appendicitis is one of the most prevailing acute surgical abdominal diseases. According to literature data, acute appendicitis makes 5% of all acute diseases among elderly patients. The aim is to analyse the forms of appendicitis among elderly patients treated in KMU General Surgery Clinic (II KKL) in 1991–2000, as well as the duration of the diagnostic period, general duration of patients’ stay in hospital, the aspects of complications and mortality as compared to those in patients under 65 years of age. Methods Medical histories of the patients treated for acute appendicitis in 1991–2000 were analysed retrospectively. The patients were divided into two age groups: group 1 – under 65 years of age; group 2 – older than 65. The following criteria were evaluated: form of the disease, duration of diagnostic period; duration of stay in hospital; complications, mortality. These data were compared in both age groups. Results In 1991–2000, a total of 2378 patients were treated for various forms of acute appendicitis. There were 2220 patients (91.1%) in group 1 and 158 (7.49%) in group 2. In group 1, 2130 patients (95.94%) and in group 2, 145 (91.7%) were operated on. In group 2 there were more gangrenous perforated acute appendicitis forms than in group 1 (p = 0.0014) and in group 1 there were more phlegmonic forms of appendicitis (p < 0.001). As to the time of stay in hospital before operation, in group 1 it was 2.3 h and in group 2 4.11 h (p < 0.05). The mean stay in hospital in group 1 was 6.77 days and in group 2 11.14 days (p < 0.05). The number of postoperative complications was 151 (7.1%) in group 1 and 31 (21.3 %) in group 2 (p = 0.0151). Mortality in group 2 was 3.4%, while in group 1 nobody died. Conclusions Elderly people fall ill with more grave forms of appendicitis; their stay in hospital before the operation and total stay in hospital is longer, the postoperative complications are more severe and more fequent; the differences are statistically reliable; all lethal cases were elderly patients ill with severe forms of perforated appendicitis. Keywords: appendicitis, elderly patients.

scholarly journals Prevalence of parasitic infections in surgically removed appendices: parasitological and histopathological studies

2018 ◽  
Vol 55 (1) ◽  
pp. 33-44 ◽  
Author(s):  
A. S. Amer ◽  
A. E. Saad ◽  
S. N. Antonios ◽  
E. A. Hasby
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Intestinal Parasites ◽  
Demographic Data ◽  
Clinical History ◽  
Cross Sectional Study ◽  
Lymphoid Hyperplasia ◽  
Stool Examination ◽  
Parasitic Infections ◽  
Cross Sectional

Summary Intestinal parasites may cause symptoms similar to acute appendicitis. Moreover, the diagnosis of parasitic infections is only done by post-operative histopathological examination of the appendices. Therefore, our aims are to assess the prevalence of intestinal parasitic infections among patients who were be appendectomized at Tanta Hospitals, Egypt and to investigate the possible association between these parasitic infections and appendicitis. To achieve these objectives, we performed a cross-sectional study including 65 patients chosen randomly who had undergone appendectomy over a period of one year from Oct 2015 to Oct 2016. Demographic data were retrieved. Complete blood picture was done. Moreover, appendiceal faecolith were examined macroscopically then by direct smear examination, formol-ether concentration technique, modified Ziehl-Nelseen stain and rapid immunochromatographic test. Histopathological examination of resected appendices was done. We found that parasitic infections were detected in 24.6 % of examined cases. Most of parasitic infections were prevalent in patients belonging to the school age group. Different parasitic infections were detected in the faecolith specimens. Moreover, Enterobious vermicularis adult female and Schistosoma mansoni granuloma were detected in histopathological sections. Also, a spectrum of pathological changes in the appendices was found ranging from lymphoid hyperplasia to acute inflammation with peritonitis. In conclusion, intestinal parasites may cause clinical picture similar to that of acute appendicitis. Therefore, careful attention to clinical history, stool examination and high eosinophilia may aid diagnosis and avoid unnecessary appendectomy. Moreover, the presence of different parasitic stages in the narrow lumen of the appendix may have a role in the development of appendicitis and this needs further studies.

RISK FACTORS ASSOCIATED WITH PERFORATED APPENDICITIS IN ELDERLY PATIENTS PRESENTING WITH SIGNS AND SYMPTOMS OF ACUTE APPENDICITIS

2007 ◽  
Vol 77 (8) ◽  
pp. 662-666 ◽  
Author(s):  
Bor-Fuh Sheu ◽  
Te-Fa Chiu ◽  
Jih-Chang Chen ◽  
Meng-Sheng Tung ◽  
Meng-Wei Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Appendicitis ◽  
Elderly Patients ◽  
Perforated Appendicitis ◽  
Signs And Symptoms ◽  
Factors Associated

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

scholarly journals Clinical Profile of Acute Poisoning in Children at a Teaching Hospital in Lalitpur

2014 ◽  
Vol 34 (2) ◽  
pp. 100-103 ◽  
Author(s):  
Ajaya Kumar Dhakal ◽  
D Shrestha ◽  
A Shakya ◽  
SC Shah ◽  
H Shakya
Keyword(s):  
Teaching Hospital ◽  
Hospital Admissions ◽  
Acute Poisoning ◽  
Childhood Mortality ◽  
Age Group ◽  
Common Cause ◽  
Mortality And Morbidity ◽  
History Of ◽  
The Common ◽  
Poisoning In Children

Introduction: Acute poisonings are one of the common cause of emergency visits and hospital admissions and is potentially preventable cause of childhood mortality and morbidity. The objectives of this study were to identify the common type of poisoning in children, to determine types of poisoning according to age and to find out the common age group in which the incidence of poisoning was high.Materials and Methods: It was a descriptive observational study done in a teaching hospital in Lalitpur, Nepal in patients aged 1 month to 18 years who visited the emergency department and were admitted to hospital with history of alleged poisoning from 2009 July to 2014 January.Results: Fifty patients were included. Drugs, kerosene and organophosphorus were most common cause of poisoning. Drugs and kerosene below 10 years of age and organophosphorus and drugs above 10 years of age were common types of poisoning. Maximum numbers (50%) of children with poisoning cases were below five year of age. Mean duration of hospital stay was 2.1days and mean age of poisoning was 7.8 years with a male(54%) predominance. Majority of poisoning occurred at home (84%) and 68% of patients were symptomatic at presentation to hospital with 84% of patients presenting to hospital within six hours.Conclusion: This study showed that drugs, kerosene and organophosphorus were most common forms of poisoning. Young children were most vulnerable for acute poisoning.DOI: http://dx.doi.org/10.3126/jnps.v34i2.10139J Nepal Paediatr Soc 2014;34(2):100-103 

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