Appendicitis Symptoms and Signs

Study Notes

Appendicitis is a condition in which the appendix becomes inflamed.
The onset of symptoms generally occurs within 24 hours from the development of acute appendicitis.
In a typical presentation of appendicitis, palpation of McBurney point, located 1/3 of the distance from the anterior iliac spine to the umbilicus, may reveal focal peritoneal signs.
Patients with variant locations of their appendiceal tips may present with suprapubic or back/flank tenderness.
A palpable mass is uncommon but may indicate a periappendiceal phlegmon or abscess.
It is important to perform a complete abdominal examination in a patient who presents with acute abdominal pain to rule out other etiologies.
The following maneuvers may also be performed to elicit pain from acute appendicitis, usually localizing to the right side.
Obturator sign. The patient lies supine with hips and knees flexed. A positive Obturator sign occurs when pain develops as the examiner internally rotates the leg on the side of inflammation.
Psoas sign. The patient lies in the left lateral decubitus position with knees extended. The examiner extends the right leg at the hip. Pain is elicited if the inflamed appendix irritates the psoas muscle. This can occur with retroperitoneal appendicitis.
Rovsing sign. A positive Rovsing sign is the development of worsening RLQ abdominal pain with palpation of the left lower quadrant (LLQ). Palpation of the LLQ will stretch the whole peritoneum, causing the inflamed appendix to contact and irritate the