INTRODUCTIONReginald Fitz from Boston first identified inflammation of the appendix as a cause of right lower quadrant pain. He coined the term appendicitis and recommended early surgery intervention. Robert Lawson performed first appendectomy in England.1 Now 130 years later, acute appendicitis still remains one of the most common abdominal emergency, demanding surgery. Mortality rate has improved since advent of antibiotics in 1940. No perfect diagnostic evaluation tool exists to detect appendicitis if symptoms are ambiguous. If symptoms are vague diagnostic process takes longer, thus delaying surgery increasing the possibility of complications. On the other hand, hasty operation without accurate diagnosis will lead to negative appendectomy, increasing the morbidity and cost of treatment. 2,3Even with the advent of modern diagnostic tools, misdiagnosis of appendicitis has remained more or less constant. The percentage of misdiagnosis is higher among women than men. Diagnostic approaches include symptomatology, physical examinations, laboratory findings and imaging modalities like ultrasonography and computerized tomography (CT) of abdomen. Although the advent of ultrasound has improved the diagnosis of ABSTRACT Background: Acute appendicitis is one of the most common surgical emergencies encountered by doctors on call with emergency appendicectomy being a very common outcome of emergency laparotomies. There's been a marked decline in mortality over the past 50 years, but the rates of perforation and negative laparotomy have not changed much as they're influenced by factors untouched by technological advances. Methods: A prospective comparative study to compare appendicitis inflammatory response score (AIR) and Alvarado scoring systems in evaluating suspected cases of acute appendicitis. 100 patients presenting with pain in the right lower quadrant of abdomen at the surgical clinics at Basaveshwar Teaching and General Hospital, Kalaburagi, Karnataka, India, who after clinical examination and relevant investigations were provisionally diagnosed to have acute appendicitis and warranted surgery for the same were evaluated using the scoring systems -Alvarado Score and Appendicitis Inflammatory Response Score. The scores were tallied and compared with final histopathology report. The study was conducted for a period of one and a half year. Results:The results revealed that AIR (at score >4) demonstrated a higher sensitivity and specificity compared to Alvarado score (89.9 versus 78.6%) and (63.6 versus 54.5) respectively. Alvarado showed a slightly better sensitivity at score>8 (21.3 versus 12.3%). Conclusions: The Appendicitis Inflammatory Response Score outperformed the Alvarado score. It holds promise to be incorporated into the clinician's daily inventory in efficiently diagnosing Appendicitis.

BACKGROUND AND OBJECTIVES: Duodenal ulcer perforation is one of the acute abdominal emergencies in the surgical field. Duodenal ulcers are often caused due to imbalance between mucosal defences and acid /peptic injury. the cases of duodenal ulcer perforation in surgically treated patients were thoroughly studied with respect to trends in age, distribution of occurance, risk factors, seasonal variation, outcome of operative and non-operative modalities of treatment and factors influencing the prognosis of the disease. The current study summarizes epidemiology, risk factors, Pathophysiology, pathogenesis, clinical features, investigations, modalities of treatment and prognostic determinents of duodenal ulcer perforation in BTGH, Gulbarga.

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Background: As many studies have been done upon IAP and its outcome on the patients that Intra-Abdominal Hypertension (IAH) leaves an impact on every organ. In recent times it is strangely under diagnosed. Although IAP is an independent predictor in measuring the morbidity and mortality. Aim and Objectives: To evaluate changes in various clinical parameters due to increasing Intra-abdominal Pressure and also to evaluate the Morbidity and Mortality in patients who develop abnormal Intra-Abdominal Pressure Methodology: The present study was a prospective analysis of IAP in patients presenting to surgical emergency of Mahavir Institute of Medical Sciences, Shivareddypet, Vikarabad, Ranga Reddy -Telangana, India.over a period of 1year from December 2019 to December 2020. A total number of 40 patients were assessed with regards to their clinical diagnosis, vital parameters al presentation, IAP and the morbidity and mortality. The SEDREK'S Technique of IAP measurement was used to determine the IAP. In this method, the Foleys catheter is marked as '0', few mm proximal to the Y-junction, which serves as the zero reference point when it is at the level of symphysis pubis.The drainage tubing is marked at an increment of 1 cm on the tape, starting from the mark on the foley's catheter as '0'. Next introduce 50 to 100 ml of sterile saline into the bladder. After reconnecting the Foley's catheter to the drainage tubing, the zero reference point is kept at the level of pubic symphysis and the drainage tubing is raised vertically. Result and Conclusion: IAP was found to be a significant predictor of mortality in patients undergoing laparotomy (P<0.001). Elevated IAP was found to affect all the organ systems adversely. The incidence of post-op ACS was 3.05% in the general population and 13.16% in trauma patients. The mortality rate for this subgroup was 100%. Out of a total number of 40 patients 18 patients belonged to this category which is 45%. 5 patients were diagnosed with two day history of intestinal obstruction, 5 patients with two day history of peritonitis, 7 patients with one day history of peritonitis and 1 patients with ruptured liver abscess. The clinical condition of this particular subset of patients was relatively stable when compared to the patients in the other Grades. The average pulse rate was 96/mt, the average systolic blood pressure 98 mmhg and the average respiratory rate 15/mt. Post operative recovery was uneventful without any complication in 14 cases, 4 patients had wound gaping which could be due to other factors. Hence this study demonstrates that increase in Intra-Abdominal Pressure causes a change in different clinical Parameters. Grade 4 Intr-Abdominal Pressure is associated with Abdominal compartment syndrome and hence with very high mortality. Measurement of Intra-Abdominal Pressure by the Sedrek's technique is easy, reliable and can underlying physiological status. Intra-Abdominal Pressure measurement can be used as an independent clinical parameter to assess the patients current clinical condi...

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