The article was consulted professionally by Dr. Tran Nhu Tu and Master, Dr. Le Thi Hong Vu – Department of Diagnostic Imaging – Share99 Danang International Health Hub.
Due to its fast, safe, low cost, relatively high accuracy, abdominal ultrasound is the first imaging technique used when patients suspect acute appendicitis.
1. What is acute appendicitis?
The appendix has a finger-shaped structure of the digestive tract attached to the first segment of the large intestine (clues). The appendix has immune function, helping B lymphocytes mature and produce antibodies. However, the role of the appendix is not so important, the body does not increase the risk of infection as well as immuno-deterioration if the appendix is cut off.
Acute appendicitis is a very common abdominal surgery emergency. The disease can occur at any age, from the elderly to children. There are many causes of appendicitis such as: stool stones, lymphoid tissue hypertroocemia due to bacterial infections, parasites, gallstones, appendix tumors,… These causes clogging, increased pressure on the appendix, reduced perfusion of appendicitis, facilitation of bacterial growth that causes inflammation, damaged appendix tissues and death. If not detected and treated in time, the appendix may rupture, the bacteria release into the abdomen, causing dangerous complications, which can be life-threatening such as resident or total peritonitis, appendix absculsion,…
2. Why is it necessary to perform an ultrasound of the abdomen in the diagnosis of acute appendicitis?
With acute appendicitis, patients will have symptoms such as smoldering abdominal pain on the navel then move down to the lower right corner, mild fever (high fever from 39oC when the appendix has complications), digestive disorders such as loss of appetite, diarrhea, nausea,… If based solely on clinical symptoms and blood tests, bio-bioenergical diseases, the disease will be easily confused with many other digestive, urinary and genital diseases with symptoms similar to right renal cramping pain, inflammation of the right appenenty, manh-ileum inflammation, twisted right ovarian tumor, right ovarian cyst hemorrhage , right extrapenal pregnancy, acute gallbladder inflammation,…
According to studies, if only based on clinical manifestations and biomedical, hematological tests, the rate of abdominal pecking but without an appendix is 16-47%. If imaging means are used, this rate drops to 6-7%. Thus, the use of imaging means is extremely important in the definitive diagnosis of acute appendicitis. Imaging means that can be used in the diagnosis of acute appendicitis are abdominal ultrasound, comoclassography (CT), mri, and ,… in which abdominal ultrasound is the first method, safe, highly sensitive, easy to perform, widely used in medical facilities.
The normal appendix has a tubular structure, without persis, the structure from the outside into the inside consists of the mucosa, muscle layer, lower mucous layer, mucous layer and appendix. The wall of the appendix is about 2mm thick, less than 6-7mm in diameter. If ultrasound shows a normal appendix image will eliminate the appendix diagnosis.
When the appendix is inflamed, the image on the ultrasound is a tubular structure filled with water, structured like the intestine, not pressed, the wall is thicker than usual, the diameter is larger than 6-7mm. Using color doppler ultrasound and energy doppler detect the formation of tubular structures that present with increased perfusentation. Using an override probe can distinguish the moving intestinal peridicitis and a fixed inflammatory appendix. Diseases of gastrointestinal and genital origin, urinary manifestations resembling appendicitis can be detected on ultrasound of 1⁄4 of the lower right abdomen.
3. What are the advantages of acute appendicitis ultrasound?
Although not as accurate as CT or MRI, in the diagnosis of acute appendicitis, ultrasound has many advantages, namely:
- Compared to com computerized ct scans, ultrasound of acute appendicitis has the advantage of the absence of radiation ions, which is very important for women, children and adolescents, who are common subjects with acute appendicitis and also the subject group that is susceptible to radiation. Patients who perform an ultrasound also do not need to take sedatives, perform a full-body anesthesia, take or inject photothrical drugs, therefore will not experience side effects, risks, allergies when taking or injecting these drugs. Ultrasound has the advantage of being able to survey the appendix in different poses, dynamic survey and easy to repeat many times without radiation, not harmful to the body and the cost is also lower than CT or MRI scans. Although the sensitivity is not as high as CT, given the prevalence of the disease and if the abdominal ultrasound technique performed by a skilled doctor, the sensitivity and specificity in the diagnosis of acute appendicitis in children is 98.5% and 98.2%, respectively.
- The method of reflex imaging (MRI) avoids the patient's exposure to radiation, however high costs, long duration, delays in diagnosis and treatment will increase the risk of appendicitis appearing complications. Ultrasound has the advantage of fast, low-cost implementation, helping patients to be diagnosed and treated in a timely manner.
Therefore, according to the current assessment ultrasound is the first method of implementation in patients with suspected appendicitis. Clinical manifestations consistent with ultrasound images that detect appendicitis are sufficient to conduct surgery. Only if the patient has clinical symptoms the images on the ultrasound are not clearly defined, if the physician is still in doubt to perform additional techniques. In normal, non-pregnant adult patients, the technique in which the ultrasound is insularly followed by a comoclass scan (CT), in pregnant women, the technique used is a rem resonance imaging (MRI).
Dr. Tran Nhu Tu has more than 20 years of experience, including 3 years as Deputy Dean of Subclinical Department – Hoa Vang Health Hub, 16 years as Deputy Head of Imaging Department at Da Nang Health Hub of Obstetrics and Pediatrics; Dr. Tu diagnoses accurately, minimizes errors based on the images obtained, ready to serve patients 24/24 in emergencies and emergencies.
Dr. Tu has been involved in domestic and foreign training courses such as: Master of Diagnostic Imaging, PhD student in Diagnostic Imaging at Hanoi Medical University, Diagnostic Imaging at CHU Reims – France, Electro-optic Intervention at Winterthur Health Hub – Switzerland, Electro-Optic Intervention at Singapore General Health Hub … before being the head of Imaging Department at Share99 Danang Health Hub as it is today.
Dr. Le Thi Hong Vu has good English, has participated in many short-term and continuous training courses on imaging annually. The doctor has more than 7 years of experience as a doctor in the field of imaging, especially ultrasound.
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- Complications of acute appendicitis
- CT, MRI scan in diagnosis of appendicitis