scholarly journals Clinical Significance of Serum Bilirubin in the Diagnosis of Atypical Acute Appendicitis

2020 ◽  
Vol 8 (2) ◽  
Author(s):  
Shunxin Hao ◽  
Lisha Zhao
Keyword(s):  
Liver Function ◽  
Acute Appendicitis ◽  
Clinical Significance ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Elevated Serum ◽  
Liver Function Tests ◽  
Serum Bilirubin Level ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin

Objective: To investigate the significance of serum bilirubin in the diagnosis of atypical acute appendicitis. Methods: perform a retrospective analysis of 120 patients with atypical acute appendicitis diagnosed in our hospital from July 2012 to July 2016. All patients underwent routine liver function tests before surgery. Results: 83 patients were confirmed by surgery as acute appendicitis, of which 68 patients had elevated serum total bilirubin and direct bilirubin, and 15 patients were normal; 37 patients were confirmed by surgery as non-acute appendicitis, of which 7 patients had elevated serum total bilirubin and direct bilirubin, and 30 patients were normal. Conclusion: The increase of serum bilirubin level has certain clinical significance for the diagnosis of atypical acute appendicitis.

scholarly journals Elevated serum bilirubin in acute appendicular perforation as a newer serum marker: a diagnostic validation test

2020 ◽  
Vol 7 (2) ◽  
pp. 414
Author(s):  
Bhimanagouda V. Goudar ◽  
Varsha R. Kanchan
Keyword(s):  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Elevated Serum ◽  
Liver Function Tests ◽  
Serum Marker ◽  
Serum Total Bilirubin ◽  
Histopathological Diagnosis ◽  
Delay In Diagnosis ◽  
Major Procedure ◽  
A Prospective Study

Background: Acute appendicitis is the commonest cause of acute surgical abdomen. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. Delay in diagnosis and treatment results in increased rate of perforation, morbidity, mortality and hospital stay.Methods: A prospective study where a total of 100 patients with clinical, radiological and histopathological diagnosis of acute appendicitis or appendicular perforation were studied. The liver function tests were carried out in all the patients.Results: In a study group of 100 patients (74 males and 26 females); 59 cases were acute appendicitis and 41 cases were appendiceal perforation proven histopathological. Out of which 48 cases had elevated serum bilirubin levels i.e., 17 in acute appendicitis group and 31 in appendicular perforation group. The mean serum total bilirubin is 1±0.4 in acute appendicitis cases and 1.9±1.13 in the appendicular perforation cases. Similarly, the sensitivity and specificity of elevated serum bilirubin as a diagnostic marker in appendicular perforation was found to be 75.6% and 71.2% respectively.Conclusions: Elevated serum bilirubin levels appears to be a promising new supplemental diagnostic serum marker in Appendicular Perforation and perhaps be a decision-making investigation. 

scholarly journals Role of Hyperbilirubinemia as a Diagnostic Tool to Predict Gangrenous/Perforated Appendicitis: An Observational Study

2020 ◽  
Vol 3 (1) ◽  
pp. 52-55
Author(s):  
Mohak Mankad ◽  
Pranjal Sangole ◽  
Gyaneshwar Rao
Keyword(s):  
Observational Study ◽  
Acute Appendicitis ◽  
Diagnostic Tool ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Medical Science ◽  
Elevated Serum ◽  
Perforated Appendicitis ◽  
Serum Total Bilirubin

Background: Elevation in serum bilirubin was reported recently, but the importance of the raised total bilirubin has not been stressed in acute appendicitis and appendicular perforation. The aim of the study was to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis. Subjects and Methods: This was a prospective observational study, which was conducted at the Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. A total of 100 patients clinically diagnosed as appendicitis from August 2018 to August 2019 at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. Patients were clinically evaluated by detailed history, routine examination on initial contact with patients and the routine investigations as per surgery and anesthesia requirements with inclusion of serum total bilirubin. Based on histopathological examination patients will be categorized as positive (acute appendicitis with perforation and/or gangrene) and negative (acute appendicitis without perforation or gangrene). Results: Out of 100 patients, 20 were managed conservatively (mass formation) and was called for interval appendectomy after 6 weeks. In acute catarrhal appendicitis group 47 patients showed normal total bilirubin levels, whereas 8 patients showed increase in levels of total bilirubin.  In gangrenous appendicitis group all 10 patients showed elevated serum total bilirubin levels  In perforated appendicitis group consisted of 15, 11 patients showed elevated serum bilirubin levels and 4 patients showed normal total bilirubin levels. Conclusion: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations.

scholarly journals Baseline Serum Bilirubin and Risk of First Stroke in Hypertensive Patients

2020 ◽  
Vol 9 (12) ◽  
Author(s):  
Jiancheng Wang ◽  
Xianglin Zhang ◽  
Zhuxian Zhang ◽  
Yuanyuan Zhang ◽  
Jingping Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Proportional Hazards ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Cox Proportional Hazards ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin ◽  
Inverse Association ◽  
Baseline Serum ◽  
Hypertensive Patients

Background Data on the association between serum bilirubin and the risk of stroke are limited and inconclusive. We aimed to evaluate the association between serum bilirubin and the risk of first stroke and to examine any possible effect modifiers in hypertensive patients. Methods and Results Our study was a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). A total of 19 906 hypertensive patients were included in the final analysis. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for the risk of first stroke associated with serum bilirubin levels. The median follow‐up period was 4.5 years. When serum total bilirubin was assessed as tertiles, the adjusted HR of first ischemic stroke for participants in tertile 3 (12.9–34.1 μmol/L) was 0.75 (95% CI, 0.59–0.96), compared with participants in tertile 1 (<9.3 μmol/L). When direct bilirubin was assessed as tertiles, a significantly lower risk of first ischemic stroke was also found in participants in tertile 3 (2.5–24.8 μmol/L) (adjusted HR, 0.77; 95% CI, 0.60–0.98), compared with those in tertile 1 (<1.6 μmol/L). However, there was no significant association between serum total bilirubin (tertile 3 versus 1: adjusted HR, 1.45; 95% CI, 0.89–2.35) or direct bilirubin (tertile 3 versus 1: adjusted HR, 1.27; 95% CI, 0.76–2.11) and first hemorrhagic stroke. Conclusions In this sample of Chinese hypertensive patients, there was a significant inverse association between serum total bilirubin or direct bilirubin and the risk of first ischemic stroke.

scholarly journals Serum Bilirubin Level Predicts Frontal QRS-T Angle Change in Patients with Acute Coronary Syndrome

2020 ◽  
Vol 6 (4) ◽  
pp. 75-83
Author(s):  
Güney Erdoğan ◽  
Mustafa Yenercağ ◽  
Gündüz Durmus ◽  
Diyar Koprulu ◽  
Uğur Arslan
Keyword(s):  
Acute Coronary Syndrome ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Multivariate Logistic Regression Analysis ◽  
Serum Bilirubin Level ◽  
Serum Total Bilirubin ◽  
Operating Characteristics ◽  
Coronary Syndrome ◽  
Angle Change ◽  
Total Ischemic Burden

AbstractIntroduction: The predictive role of serum bilirubin levels on the alteration of total ischemic burden expressed via frontal QRS-T angle change has never been studied in patients with acute coronary syndrome (ACS). In this study, we aimed to investigate the relationship between serum bilirubin levels and frontal QRS-T angle change after percutaneous coronary intervention (PCI) in ACS patients.Methods: Frontal QRS-T angle change was accepted as positive or negative according to whether the value of the baseline frontal QRS-T angle minus the post PCI frontal QRS-T angle is positive or negative. A total of 314 consecutive patients with ACS who underwent PCI were divided into two groups based on their negative frontal QRS-T angle change (n = 152 patients) and positive frontal QRS-T angle change (n = 162 patients).Results: Multivariate logistic regression analysis showed that the C-reactive protein (CRP) to albumin ratio (CAR) (Odds ratio [OR]: 0.519, 95% CI: 0.373–0.724, p <0.001), total bilirubin (OR: 3.687, 95% CI: 1.151–8.095, p = 0.03), and low-density lipoprotein (LDL) (OR: 0.985, 95% CI: 0.970–1.000, p = 0.04) were independent predictors of positive QRS-T angle change. In receiver operating characteristics curve analysis, a cut-off value of 0.59 total bilirubin had a 69% sensitivity and a 65% specificity (area under curve: 0.739, p <0.001) for the prediction of positive QRS-T angle change.Conclusion: In ACS patients, serum total bilirubin has been found to be a useful decision-making tool to predict positive frontal QRS-T angle change as a sign of reduced total ischemic burden, to assess early invasive strategy independently from other study parameters.

scholarly journals DIFFERENCES OF LIVER FUNCTION TESTS IN TYPE 2 DIABETES MELLITUS PATIENTS WITH AND WITHOUT CORONARY ARTERY DISEASE

2018 ◽  
Vol 24 (3) ◽  
pp. 266
Author(s):  
Hendra Saputra ◽  
Burhanuddin Nasution ◽  
Santi Syafril
Keyword(s):  
Diabetes Mellitus ◽  
Liver Function ◽  
Total Bilirubin ◽  
Liver Function Tests ◽  
Arterial Disease ◽  
Direct Bilirubin ◽  
Coronary Arterial Disease ◽  
Type 2 Dm ◽  
Significant Difference

One of the macroangiopathic complications of Diabetes Mellitus (DM) is Coronary Arterial Disease (CAD). Several studies showed that the liver was one of the organs involved in the pathological development of diabetes.The aim of this study was to find the differences of liver function in type 2 DM patients with CAD and without CAD. This was an analytical observational study with cross-sectional design. Forty-four type 2 DM patients with and without CAD at the Adam Malik Hospital Medan who came during June - August 2016 were studied for liver function (total bilirubin, direct bilirubin, AST and ALT). In this study, the average values of total bilirubin and direct bilirubin level in patients with CAD were found to be lower than without CAD. Statistically a significant difference revealed a total bilirubin (p < 0.001) and direct bilirubin (p = 0.001) in type 2 DM patients with and without CAD. There was a significant difference in liver function tests in DM type 2 patients with, and without coronary arterial disease, these data suggested that total billirubin and direct billirubin levels in type 2 DM patients with CAD were found lower than those without CAD. 

scholarly journals A study on the role of raised serum bilirubin levels in acute appendicitis and its outcomes

2019 ◽  
Vol 6 (5) ◽  
pp. 1561
Author(s):  
Abhilash Madhavan ◽  
Lakshmana Raman
Keyword(s):  
Acute Appendicitis ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Elevated Serum ◽  
Perforated Appendicitis ◽  
Serum Bilirubin Level ◽  
Inclusion Criteria ◽  
Predictive Capacity ◽  
College Hospital ◽  
Medical College

Background: Acute appenidictis is the most common general surgical emergency and early surgical intervention improves outcomes. Despite the increased use of ultrasonography, computed tomography and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%) as has the rate of appendicular perforation. Thus, elevated serum bilirubin level will help in the early and accurate diagnosis of acute appendicitis and if so does it have the predictive capacity to warn us about appendicular perforation.Methods: In this study 100 patients were selected as per satisfaction of the inclusion criteria. This study was carried out at SRM medical college hospital between July 2017 to October 2018. All the data findings were recorded and were analysed.Results: In this study 100 patients were selected on satisfying the inclusion criteria. The serum bilirubin levels were recorded for all these patients. Based on the study it was found out that the serum bilirubin levels was elevated in majority of the cases of acute appendicitis and markedly elevated in case of perforated appendicitis. Though the results were not statistically significant the study seems to be clinically significant.Conclusions: Serum bilirubin level seems to be a reliable diagnostic marker for predicting acute appendicitis and perforated or gangrenous appendicitis.

scholarly journals Evaluation of hyperbilirubinemia as an innovative diagnostic marker for acute appendicitis and its role in the prediction of appendicular perforation

2017 ◽  
Vol 4 (5) ◽  
pp. 1662
Author(s):  
Veerabhadra Radhakrishna ◽  
S. M. Patil ◽  
Rajshekhar S. Patil
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Serum Bilirubin ◽  
Urine Analysis ◽  
Complete Blood Count ◽  
Demographic Data ◽  
Liver Function Tests ◽  
Clinical Findings ◽  
Serum Bilirubin Level ◽  
Negative Appendicectomy

Background: Acute appendicitis is one of the most common causes of acute abdomen in surgical practice. Despite advances in the radiological and laboratory investigations, the diagnosis of appendicitis remains dilemma. The negative appendicectomy rate varies 15-50%, with up to 50% postoperative complications in these patients. Hence we conducted a study to assess the role of hyperbilirubinemia in diagnosing acute appendicitis and to foresee appendicular perforation.Methods: It was a prospective study conducted in the Department of General Surgery, M.R. Medical College, Gulbarga, Karnataka, India for 18 months duration from December 2010 to May 2012. Only histopathologically confirmed cases of acute appendicitis and/or appendicular perforation were included in the study. Demographic data, history and clinical findings were recorded on a predesigned proforma. Investigations included complete blood count, reticulocyte count, platelet count, peripheral smear, serum haptoglobulin, liver function tests, HbsAg, urine analysis (routine and microscopy).Results: The sensitivity and specificity of serum bilirubin as a marker in predicting acute appendicitis and appendicular perforation was 78.6% and 8.6% respectively. Similarly, the positive predictive value and negative predictive value for the same was 77.5% and 9.1% respectively. The Odds ratio was 0.344.Conclusions: Serum bilirubin level appears to be a promising new laboratory marker for diagnosing acute appendicitis and would be a decision-making investigation. Patients with clinical appendicitis and with hyperbilirubinemia are to be suspected of having a higher risk for appendicular perforation.

scholarly journals Role of serum bilirubin in predicting the severity of acute appendicitis

2019 ◽  
Vol 6 (12) ◽  
pp. 4415
Author(s):  
Sandeep Y. Chinnapur ◽  
Naveen Kumar S. ◽  
Hanumanthaiah K. S.
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Histopathological Examination ◽  
Serum Total Bilirubin ◽  
Medical College ◽  
Gangrenous Appendicitis ◽  
Routine Investigations

Background: The aim of the study was to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis.Methods: A prospective study carried for 9 months (March 2018 to November 2018) at Rajarajeswari Medical College and Hospital. All patients admitted with clinical diagnosis of acute appendicitis and posted for surgery were included in the study. Serum total bilirubin results will be compared with Rajarajeswari Medical College and Hospitals laboratory reference values. These cases will be operated and clinical diagnosis will be confirmed per-operatively and post-operatively by histopathological examination. Final histopathological examination will be considered as a gold standard for diagnosing and categorizing patients as having normal appendix, acute appendicitis and acute appendicitis with perforation and/or gangrene. Based on histopathological examination patients will be categorized as positive (acute appendicitis with perforation and/or gangrene) and negative (acute appendicitis without perforation or gangrene).Results: Sensitivity of serum bilirubin in case of perforated/gangrenous appendicitis was found to be 90%. Specificity of serum bilirubin was found in case of perforated/gangrenous appendicitis was found to be 90.47%. Positive predictive value and negative predicting value of serum bilirubin in perforated/gangrenous appendicitis was found to be 81.8% and 95% respectively with p value of 0.003.Conclusions:Serum total bilirubin is an easily available and cheap and can be estimated from the same blood sample withdrawn for routine investigations, if added to routine investigations, then diagnosis of complicated appendicitis can be made with fair degree of accuracy.  

scholarly journals Comparison of Sensitivity of TLC and Liver Assay in Diagnosing Appendicitis and Complicated Appendicitis at a Rural Medical Institution

2020 ◽  
Vol 7 (46) ◽  
pp. 2710-2713
Author(s):  
Sandeep Kumar Goyal ◽  
Vilkram Saini ◽  
Minaxi Saini ◽  
Gopal Singhal ◽  
Kanishak Mehta ◽  
...  
Keyword(s):  
Liver Function ◽  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Clinical Signs ◽  
Liver Function Tests ◽  
Complicated Appendicitis ◽  
Total Serum Bilirubin ◽  
Total Leukocyte Count ◽  
Total Serum ◽  
Function Tests

BACKGROUND Diagnosis of acute appendicitis is always a challenging task in emergency ward which can most of the time be diagnosed with thorough history and physical examination by surgeon, various clinical signs and laboratory investigations like total leukocyte count (TLC), neutrophils shift to left. Unnecessary surgical interventions of appendix can be reduced by precise diagnosis of levels of TLC and total serum bilirubin values. We wanted to evaluate the sensitivity of laboratory marker like TLC and liver function tests in diagnosing a case of appendicitis and complicated appendicitis. METHODS 100 patients who were admitted in the Department of General Surgery, Maharaja Agrasen Medical Collage, Agroha (Hisar), with clinical diagnosis of acute appendicitis were included in the study. Data was statistically analysed and sensitivity of TLC and liver function test in diagnosing acute appendicitis was compared. RESULTS Sensitivity of TLC was found to be 47 %; that of total serum bilirubin was 72 % which is significant; that of SGOT was 26 %; that of SGPT was 21 % and that of ALP was 8 % in diagnosing acute appendicitis. While comparing sensitivity of this marker to diagnose complicated appendicitis (gangrenous and perforated appendix) it was 56.3 % for TLC, 100 % for total serum bilirubin, 31.3 % for SGOT, 37.5 % for SGPT and 12.5 % for ALP. CONCLUSIONS Raised total serum bilirubin has potential to detect complications of appendicitis and the need for early intervention by surgeon. KEYWORDS Appendicitis; Liver Function Tests; Serum Bilirubin

scholarly journals Role of liver function tests to assess severity of acute appendicitis and predict complications

2021 ◽  
Vol 8 (3) ◽  
pp. 885
Author(s):  
Puli Vineela ◽  
Nikhil Deshmukh ◽  
Krishnamurthy Penugondla
Keyword(s):  
Acute Appendicitis ◽  
Total Bilirubin ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
Complicated Appendicitis ◽  
Direct Bilirubin ◽  
P Value ◽  
Institutional Ethics ◽  
Surgical Emergencies

Background: Acute appendicitis is commonest surgical emergencies of abdomen. Literature shows LFT can be used as a marker of acute appendicitis and may predict severity of appendicitis.Methods: An observational prospective study of 100 cases of acute appendicitis. Study period was from October 2018 to September 2020. Ethical clearance certificate was taken from Institutional ethics Committee. All patients underwent abdominal ultrasound, blood tests including LFT and appendectomy. Histopathology reports were analysed. Patients were divided into 2 groups- inflammatory and complicated appendicitis. Data was collected and statistically analysed using SPSS software version 19.Results: Out of 100 patients 64% are males and 36% females. 4% are negative appendectomies. Total bilirubin elevated in 60% of inflammatory and 89% of complicated appendicitis, p value=0.0053 (significant), sensitivity- 62%. Direct bilirubin elevated in 88% of inflammatory and 96% of complicated appendicitis, p value=0.05 (significant), sensitivity-69%. ALT, AST not raised in both groups. ALP elevated in 81% of inflammatory and 82% of complicated appendicitis with sensitivity-70.5%.Conclusions: LFT can be used to diagnose, assess severity and predict complications of acute appendicitis with elevations of total bilirubin, direct bilirubin and ALP being most useful. 

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