Pemeriksaan Penunjang

1. Pemeriksaan laboratoriuim
a. Leukosit darah
Jumlah leukosit darah biasanya meningkat pada kasus apendisitis, terlebih
dengan komplikasi berupa perforasi. Namun, peningkatan jumlah leukosit
darah berbeda pada setiap pasien dan jumlah leukosit yang normal jarang
ditemukan pada pasien dengan apendisitis. Pada apendisitis akut biasanya
terdapat leukositosis ringan mulai dari 10.000 - 18.000 sel/mm3, apabila
jumlah leukosit meningkat >18.000 sel/mm3 terdapat kemungkinan
terjadinya komplikasi berupa perforasi. Beberapa penulis menekankan
bahwa persentase jumlah neutrofil (shift to the left) menunjang diagnosis
klinis apendisitis.
b. Urinalisis
Pasien dengan nyeri perut dilakukan urinalisis untuk menyingkirkan
penyebab urologi. Urinalisis adalah pemeriksaan mikroskopik untuk
mendeteksi sel darah merah, sel darah putih dan bakteri pada urin.
Kebanyakan pasien apendisitis memiliki hasil urinalisis yang normal
sehingga hasil yang normal lebih didiagnosis dengan apendisitis
dibandingkan masalah traktus urinarius. Apabila apendiks terletak didekat
ureter dan kandung kemih disertai inflamasi yang cukup besar dapat
menyebabkan piuria, hematuria, bakteriuria. Urinalisis seringkali
menunjukkan hasil yang abnormal apabila terdapat inflamasi atau batu
pada saluran urinarius. Pada apendisitis akut dapat ditemukan ketonuria
yang disebabkan dehidrasi dan kelaparan terutama pada pasien dengan
perforasi apendisitis.
c. Radiografi konvensional
Pada foto polos abdomen, meskipun sering digunakan sebagai bagian dari
pemeriksaan umum pada pasien dengan abdomen akut, jarang membantu
dalam mendiagnosis apendisitis akut. Gambaran radiologi foto polos
abdomen dapat berupa bayangan apendikolit (radioopak), distensi atau
obstruksi usus halus, deformitas sekum, adanya udara bebas, dan efek
massa jaringan lunak. Pemeriksaan tambahan radiografi lainnya yaitu
pemeriksaan barium enema, ditemukan adanya non-filling apendiks
(barium enema tidak mengisi apendiks vermiformis), efek massa di
kuadran kanan bawah abdomen, apendiks tampak tidak bergerak,
pengisian apendiks tidak rata atau tertekuk dan adanya retensi barium
setelah 24-48 jam.
d. Ultrasonografi
Pemeriksaan USG menunjukkan adanya edema apendiks yang disebabkan
oleh reaksi peradangan. Ultrasonografi berguna dalam memberikan
 diferensiasi penyebab nyeri abdomen akut ginekologi, misalnya dalam
mendeteksi massa ovarium. Ultrasonografi juga dapat membantu dalam
mendiagnosis apendisitis perforasi dengan adanya abses. Apendisitis akut
ditandai dengan (1) adanya perbedaan densitas pada lapisan apendiks
vermiformis / hilangnya lapisan normal (target sign); (2) penebalan
dinding apendiks vermiformis; (3) hilangnya kompresibilitas dari apendiks
vermiformis ; (4) peningkatan ekogenitas lemak sekitar (5) adanya
penimbunan cairan . Keadaan apendisitis dengan perforasi ditandai dengan
(1) tebal dinding apendiks vermiformis yang asimetris ; (2) cairan bebas
intraperitonial, dan (3) abses tunggal atau multipel.
Aperistaltic and non-compressible structure with diameter >6 mmw8
Sensitivity of 86%; specificity of 81%1
An ultrasound is a painless procedure that uses sound waves to provide
images to identify organs within the body. Ultrasound can identify an
enlarged appendix or an abscess. Nevertheless, during appendicitis, an
enlarged inflamed appendix or abscess can be seen in only 50% of patients.
Therefore, not seeing the appendix during an ultrasound does not exclude
appendicitis. Ultrasound also is helpful in women because it can exclude
the presence of conditions involving the ovaries, Fallopian tubes and
uterus (pelvic inflammatory disease, PID) that can mimic appendicitis.
e. Computed Tomography Scanning
Untuk mendeteksi abses periapendiks
Abnormal appendix identified or calcified appendicolith seen in
association with periappendiceal inflammation or diameter >6 mm
Sensitivity of 94% and specificity of 95% in diagnosis of acute
appendicitis2
f. Barium enema
A barium enema is an X-ray test in which liquid barium is inserted into the
colon from the anus to fill the colon. This test can, at times, show an
impression on the colon in the area of the appendix where the
inflammation from the adjacent inflammation impinges on the colon.
Barium enema also can exclude other intestinal problems that mimic
appendicitis, for example Crohn's disease.
g. Laparoscopy
Laparoscopy is a surgical procedure in which a small fiberoptic tube with
a camera is inserted into the abdomen through a small puncture made on

1
Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed
tomography and ultrasonography to detect acute appendicitis in adults and
adolescents. Ann Intern Med 2004;141: 537-46.
2
ibid
 the abdominal wall. Laparoscopy allows a direct view of the appendix as
well as other abdominal and pelvic organs. If appendicitis is found, the
inflamed appendix can be removed with the laparoscope. The
disadvantage of laparoscopy compared to ultrasound and CT is that it
requires a general anesthetic.

One meta-analysis and one systematic review on the role of

ultrasonography and computed tomography scanning in the diagnosis of
acute appendicitis have concluded that these investigations should be done
only in patients in whom a clinical and laboratory diagnosis of
appendicitis cannot be made. As ultrasonography studies are operator
dependent and need careful examination, these authors also recommend
the use of computed tomography in preference to ultrasonography in this
group of patients as it has a greater diagnostic accuracy.3,4

3
Ibid

4
Diagnosis of appendicitis in adults by ultrasonography or computed tomography: a
systematic review and meta-analysis.

Weston AR, Jackson TJ, Blamey S

Int J Technol Assess Health Care. 2005 Summer; 21(3):368-79.
Why is it difficult to diagnose appendicitis?
It can be difficult to diagnose appendicitis. The position of the appendix in
the abdomen may vary. Most of the time the appendix is in the right lower
abdomen, but the appendix, like other parts of the intestine, has a
mesentery. This mesentery is a sheet-like membrane that attaches the
appendix to other structures within the abdomen. If the mesentery is large,
the appendix to move around. In addition, the appendix may be longer
than normal. The combination of a large mesentery and a long appendix
allows the appendix to dip down into the pelvis (among the pelvic organs
in women). It also may allow the appendix to move behind the colon
(called a retro-colic appendix). In either case, inflammation of the
appendix may appear to be more like the inflammation of other organs, for
example, of a woman's pelvic organs.

The diagnosis of appendicitis also can be difficult because other

inflammatory problems may mimic appendicitis, for example, right side
diverticulitis. Therefore, it is common to observe patients with suspected
appendicitis for a period to see if the problem will resolve on its own or
develop characteristics that more strongly suggest appendicitis or, perhaps,
another condition.