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Related Concept Videos

Appendicitis-II: Diagnostic Studies and Management01:29

Appendicitis-II: Diagnostic Studies and Management

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Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
113
Appendicitis-I: Introduction01:22

Appendicitis-I: Introduction

359
The appendix, a small, narrow, blind tube extending from the inferior part of the cecum, is widely regarded as a vestigial organ, having lost much of its original function through evolution. Despite its diminished role, the appendix can become inflamed, a condition known as appendicitis.
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
359
Acute Pancreatitis II: Clinical Manifestations and Management01:30

Acute Pancreatitis II: Clinical Manifestations and Management

165
Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
165
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
26
Endoscopic Procedures V: ERCP01:26

Endoscopic Procedures V: ERCP

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Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
675
Chronic Pancreatitis II: Collaborative Care01:29

Chronic Pancreatitis II: Collaborative Care

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The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
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Clinical practice selectively follows acute appendicitis guidelines.

Gary Alan Bass1,2,3,4, Shahin Mohseni5, Éanna J Ryan6

  • 1Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA. gary.bass@pennmedicine.upenn.edu.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
|January 31, 2023
PubMed
Summary
This summary is machine-generated.

Adherence to acute appendicitis guidelines is crucial. Non-compliant care significantly increases postoperative complications, highlighting the need for improved evidence-to-practice implementation.

Keywords:
Acute appendicitisAppendectomyGuidelinesObservational cohort

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Area of Science:

  • Surgical Practice and Guideline Adherence
  • Evidence-Based Medicine
  • Health Services Research

Background:

  • Acute appendicitis is a frequent surgical emergency with established diagnostic and management guidelines.
  • Assessing adherence to these guidelines reveals practice patterns and resource limitations.
  • This study aims to identify evidence-to-practice gaps in contemporary appendicitis care.

Purpose of the Study:

  • To evaluate compliance with World Society of Emergency Surgery (WSES) Jerusalem guidelines for acute appendicitis diagnosis and management.
  • To correlate guideline compliance with the incidence of postoperative complications.
  • To identify specific areas for improvement in appendicitis care pathways.

Main Methods:

  • A preplanned analysis of the ESTES SnapAppy observational cohort study was conducted.
  • Patient-level data were assessed for adherence to WSES Jerusalem guidelines and Surviving Sepsis Campaign recommendations.
  • Compliance rates were correlated with postoperative complication rates.

Main Results:

  • Four thousand six hundred thirteen patients with acute appendicitis were analyzed.
  • Only 13% of patients received fully guideline-compliant care; 87% had partial compliance.
  • Non-compliant and partially compliant care was associated with significantly higher postoperative complication rates (36% and 16% vs. 7.3%).

Conclusions:

  • Significant variability exists in adherence to acute appendicitis guidelines across institutions.
  • Areas for improvement include diagnostic imaging, postoperative antibiotic stewardship, and ambulatory treatment pathways.
  • Enhancing guideline compliance is essential for reducing postoperative complications in acute appendicitis.