At the General Practice it is extremely challenging to refer or not to refer to the General Surgical team at the hospital. Differential diagnosis includes mesenteric adenitis, ovarian rupture, gastroenteritis, other Gastrointestinal and Gynaecological diseases.
Most common Symptoms of acute appendicitis are migratory RIF Pain, nausea and vomiting and anorexia. Most common SIGNS of appendicitis include right iliac fossa tenderness- McBurney’s tenderness, fever and rebound tenderness on the left iliac fossae. Lab investigations include leucocytosis and neutrophilic shift to the left.
Most common investigation at the GP setting is a urine dipstick test. This will rule out Urinary tract infections if there is a positive leucocyte. Other investigations included a blood test for a Full Blood count and a CRP.
Alvarado scoring system is a 10 point system used to diagnose acute appendicitis. It is often used by surgical and emergency medicine residents to diagnose acute appendicitis. This scoring system is safe and can be used in the General Practice setting.
13 patients scored more or equivalent Alvarado score of six and were subsequently referred to hospital directly to the General Surgery/Paediatric General Surgery Department. 9 were males and 4 were females. All had their appendix removed and only 2 females had normal appendix.
45 patients scored an Alvarado score less than six. Only 9 patients were subsequently referred to hospital after two or three days.