Hyperbilirubinemia, a Predictor of the Severity of Acute Appendicitis

Introduction: Appendicitis is a challenging diagnosis to make especially in children/elderly and the diagnosis is mostly made on clinical grounds. To operate upon a case of suspected acute appendicitis is a double challenge for a budding surgeon and can be a nightmare if it turns out to be a complicated appendicitis (e.g., Gangrenous or Perforated) especially when the surgeon is on their own as the findings are relatively unexpected. The surgeon can perform better with planning if they are knowledgeable or have a high index of suspicion about the complexity of the situation. Raised serum bilirubin in acute complicated appendicitis can help in better understanding the severity of the situation, especially the complicated cases like perforated and/or gangrenous appendix. Aim: This retrospective study抯 aim was to assess high bilirubin levels in acutely inflamed appendicitis and to look for its value in severity of acute inflammation of appendix. b: In this study, serum bilirubin was raised in 60% of cases of perforated/gangrenous appendicitis. Conclusion: Therefore, a simple, cheap, and readily available blood test like Serum Bilirubin can be of great value and importance in the management of complicated appendicitis.

Intestine associated lymphoid system

The components, structure, and immune significance of intestine-associated lymphoid system [IALS] are discussed in the light of recent experimental and some clinical data. The role intraepithelial granulated lymphocytes occupying strategic positions against luminal antigens is particularly emphasized. The discussion includes the structure and functions of Payer's patches and lymphoid system of the appendix. The alleged relationship between IALS lymphocytes and mucosal mast cells is also considered. The review also includes a discussion of the immunological role of IALS