Page 126 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
9 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
Right Iliac Fossa Pain
In suspected acute appendicitis, imaging can significantly reduce the negative appendicectomy rate but must not delay treatment.
Both ultrasound and CT are accurate for the diagnosis of appendicitis.
Ultrasound is generally preferable as the first investigation in young patients because:
• there is no ionizing radiation
• it can detect gynaecological causes of acute pain in young female patients
Pelvic USS
Acute Right Iliac Fossa Pain
History & examination βHCG in reproductive age group
Young women
High likelihood of Appendicitis
Atypical for Appendicitis
Yes
Young patients or pregnant patients
Other causes of right iliac fossa pain that merit further
No
Imaging may lower the negative appendectomy rate but can delay treatment and should be performed selectively in other patients.
Surgery
In general, USS and CT both have similar sensitivity and specificity for diagnosing appendicitis.
The following are some general considerations.
Other patients
USS does not involve exposure to radiation
Thin patient
Obese or older patient
Ultrasound
Ultrasound
CT
Appropriate management depending on imaging findings