Radioloģiskās izmeklēšanas metožu precizitāte pediatriskajiem pacientiem ar akūtu apendicītu.
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Darba mērķis ir izpētīt US precizitāti pacientiem, kuriem veikta ķirurģiska operācija un konstatēts akūts komplicēts apendicīts.
Darba uzdevumi:
1. Izpētīt literatūras avotus par akūta apendicīta diagnostikas kritērijiem, US nozīmību un kritērijiem apendicīta diagnosticēšanā.
2. Ievākt datus no Bērnu klīniskās universitātes slimnīcas pacientu slimības vēsturēm, tos apkopot un analizēt.
3. Salīdzināt US izmeklējumu atradi ar operācijas aprakstu.
4. Salīdzināt iekaisuma marķierus, Alvarado skalu ar US un operācijas aprakstu.
Darbā analizēts: dzimums, vecums, iekaisuma marķieri (neitrofīlie leikocīti, C-reaktīvais olbaltums (CRO), interleikīns-6, diagnoze pēc SSK-10 klasifikācijas, pilna klīniskā diagnoze, US apraksts (aklās zarnas piedēkļa lokalizācija, sieniņas biezums, brīvā šķidruma daudzums vēdera dobumā, ileusa, apendikolīta, limfadenopātijas, mezentērija infiltrācijas, periapendikulāra infiltrāta, abscesa, strutu, koprostāzes, perforācijas, tūskainības, veidojumu, rekatīvu izmaiņu vizualizācija) un operācijas apraksts (apendicīta tips - gangrenozs vai flegmonozs), perforācija, lokalizācija, brīvā šķidruma klātbūtne, infiltrācija, abscess, strutains saturs, apendikolīts, un šķidruma novērtējums (staipīgs, duļķains, serozs).
Pētījumā secināts, ka pacientiem ar īsu simptomu parādīšanās laiku ir noderīgi noteikt interleikīnu-6, jo tā izmaiņas, iekaisuma gadījumā, laboratoriskajos izmeklējumos ir visagrīnākās. Alvarado skalai sasniedzot 8 balles US izmeklējumam ir augstāka precizitāte vizualizējot periapendikulāru infiltrātu un neitrofīlo leikocītu skaits virs 17,58x109/l ir prognostisks rādītājs periapendikulāram infiltrātam, pat ja US, tas netiek vizualizēts. CRO virs 54,94 mg/l ir prognostisks rādītājs periapendikulāram abscesam. US vizualizēts periapendikulārs infiltrāts, abscess un taukplēves, mezentērija tūska norāda uz akūtu komplicētu apendicītu. Klīniski- laboratoriskie rādītāji, kuri liecina par nekomplicētu apendicītu ir Alvarado skala zem 7 ballēm, CRO līdz 14 mg/l un neitrofīlo leikocītu skaits zem 14,45x109/l.
Darbs saturs 30 lapas, 1 tabulu, 2 attēlus, 25 literatūras avotus, 2 pielikumus. Darbā analizēti pacientu dati, kas tika iegūti no elektroniskajām slimnīcas vēsturēm sistēmā “Andromeda”, kopā analizētas 474 slimības vēstures.
The aim of the study was to investigate the accuracy of the ultrasonography in patients who have undergone surgery and are diagnosed with acute complicated appendicitis. Tasks: 1. To study the literature on the diagnostic criteria of acute appendicitis, the role of the ultrasonography and the criteria in the diagnosis of appendicitis. 2. To collect the data from patients medical records of the Children's Clinical University Hospital, to collect and analyze them. 3. Compare the findings of the ultrasonography examination with the operations records. 4. Compare inflammatory markers, Alvarado scale with ultrasonography findings and surgery description. The study analyzed: gender, age, markers of inflammation (neutrophils, C-reactive protein, interleukin-6), diagnosis, ultrasonography description: localization of appendix, wall thickness, abdominal fluid , ileus, appendicolitis, lymphadenopathy, mesenteric infiltration, periapendicular infiltrate, abscess, pus, coprostasis, perforation, edema, visualization of lesions, and description of the operation: type of appendicitis (gangrenous or phlegmonous) , abscess, purulent contents, appendicolitis, and fluid assessment (stretchy, cloudy, serous). The study concluded that interleukin-6 is useful in patients with a short onset of symptoms, as changes in inflammation are the earliest in laboratory tests. When the Alvarado scale reaches 8 points, the ultrasonography has higher accuracy in visualizing periapendicular infiltrate and the neutrophil count above 17.58x109/l is a prognostic indicator for periapendicular infiltrate, even if it is not visualized in the ultrasonography. C-reactive protein above 54.94 mg/l is a prognostic indicator for periapendicular abscess. US visualized periapendicular infiltrate, abscess, and sebaceous membranes, mesenteric edema indicate acute complicated appendicitis. Clinical-laboratory parameters that indicate uncomplicated appendicitis have an Alvarado scale below 7, a C-reactive protein less than 14 mg / l and a neutrophil count below 14.45x109/l. The work contains 29 pages, 1 table, 2 figures, 25 references, 2 appendices. In the study were used patient data obtained from the electronic hospital records registred in the system "Andromeda", a total of 474 medical histories were analyzed.
The aim of the study was to investigate the accuracy of the ultrasonography in patients who have undergone surgery and are diagnosed with acute complicated appendicitis. Tasks: 1. To study the literature on the diagnostic criteria of acute appendicitis, the role of the ultrasonography and the criteria in the diagnosis of appendicitis. 2. To collect the data from patients medical records of the Children's Clinical University Hospital, to collect and analyze them. 3. Compare the findings of the ultrasonography examination with the operations records. 4. Compare inflammatory markers, Alvarado scale with ultrasonography findings and surgery description. The study analyzed: gender, age, markers of inflammation (neutrophils, C-reactive protein, interleukin-6), diagnosis, ultrasonography description: localization of appendix, wall thickness, abdominal fluid , ileus, appendicolitis, lymphadenopathy, mesenteric infiltration, periapendicular infiltrate, abscess, pus, coprostasis, perforation, edema, visualization of lesions, and description of the operation: type of appendicitis (gangrenous or phlegmonous) , abscess, purulent contents, appendicolitis, and fluid assessment (stretchy, cloudy, serous). The study concluded that interleukin-6 is useful in patients with a short onset of symptoms, as changes in inflammation are the earliest in laboratory tests. When the Alvarado scale reaches 8 points, the ultrasonography has higher accuracy in visualizing periapendicular infiltrate and the neutrophil count above 17.58x109/l is a prognostic indicator for periapendicular infiltrate, even if it is not visualized in the ultrasonography. C-reactive protein above 54.94 mg/l is a prognostic indicator for periapendicular abscess. US visualized periapendicular infiltrate, abscess, and sebaceous membranes, mesenteric edema indicate acute complicated appendicitis. Clinical-laboratory parameters that indicate uncomplicated appendicitis have an Alvarado scale below 7, a C-reactive protein less than 14 mg / l and a neutrophil count below 14.45x109/l. The work contains 29 pages, 1 table, 2 figures, 25 references, 2 appendices. In the study were used patient data obtained from the electronic hospital records registred in the system "Andromeda", a total of 474 medical histories were analyzed.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Akūts komplicēts apendicīts, ultrasonogrāfija, iekaisuma marķieri, Alvarado skala, Acute complicated appendicitis, ultrasonography, inflammatory markers, Alvarado score