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After all these centuries that have passed and appendicitis has been one of the most frequent issues of surgical practice, there has not been established a single objective test that confirms or rejects the diagnosis. There are indices of appendiceal inflammation, both imaging --i.e. ultrasonographic evidence of mural thickening of the appendix-- and laboratory --i.e. elevated WBC count-- ones, but none of them is diagnostic; they only come to support clinical suspicion. The definitive diagnosis has always been intra-operational, and this will be the case for the years to come, unless we find a method to directly visualize the appendix through the skin :p.

The general principle in surgery is that it is much more preferable to "tamper" the abdominal cavity under calm & controlled conditions, rather than "invading" it in the acute phase of any inflammatory process. This is applicable with appendicitis, too. Initial efforts should be directed at "calming down" the abdomen, which is achieved by means of NPO, parenteral fluids and close observation for the development of signs of peritonitis or deterioration of the clinical presentation of the patient in any way. Once the acute phase has eventually gone by, then it is much more preferable to operate under "cold" conditions.
 

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It's true, Dr. lee-usmle, that since the beginning of my Surgery internship, I am urged to see things in a much different way than I used to for the purposes of USMLE.

Thank you for landing me back to USMLE-Earth! I will soon need it for Step 3, although shifting back & forth between USMLE & actual Medicine has started becoming a little bit annoying...!:D

Thank you for the well-established, evidence-based, to-the-point explanation, anyway!
 
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