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Acute appendicitis: Difference between revisions
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Other possible symptoms include fever and abnormal bowel habits. | Other possible symptoms include fever and abnormal bowel habits. | ||
Various physical signs may be positive in acute appendicitis, including McBurney point tenderness, | Various physical signs may be positive in acute appendicitis, including McBurney point tenderness, Rovsing sign, psoas sign, and obturator sign. Because of the localised peritonitis over the appendix, peritonitis signs like guarding, rebound tenderness, and heel-drop test may be positive and elicit pain in the right lower quadrant. | ||
Diffuse peritonitic signs may be a sign of perforated appendicitis. The longer the duration of the symptoms, the higher the risk that the appendix has ruptured. After 48h, 65% of appendixes haved perforated. Following perforation, the symptoms usually alleviate temporarily, as the pressure is relieved, until the condition worsens again. | Diffuse peritonitic signs may be a sign of perforated appendicitis. The longer the duration of the symptoms, the higher the risk that the appendix has ruptured. After 48h, 65% of appendixes haved perforated. Following perforation, the symptoms usually alleviate temporarily, as the pressure is relieved, until the condition worsens again. | ||
There is considerable anatomical variation in the location of the free end of the appendix, which will influence the site of pain and findings on physical examination. A retrocaecal appendix may not cause localised tenderness in the right lower quadrant (because localised peritonitis does not occur). A pelvic appendix may cause localised tenderness well below McBurney’s point. | There is considerable anatomical variation in the location of the free end of the appendix, which will influence the site of pain and findings on physical examination. A retrocaecal appendix may not cause localised tenderness in the right lower quadrant (because localised peritonitis does not occur). A pelvic appendix may cause localised tenderness well below McBurney’s point. | ||
=== Physical signs of acute appendicits === | |||
Rovsing sign refers to pain in the right iliac fossa upon deep palpation of the left iliac fossa. | |||
Psoas sign is elicited by asking the patient to lie on the left side with the hip flexed, and the examiner passively extending the right hip. This causes pain in the right lower quadrant in the case of appendicitis because the right psoas muscle lies beneath the appendix, and so stretching or contracting it elicits pain. | |||
Obturator sign is elicited by the examiner flexing the patient’s right hip and knee, followed by internal rotation of the right hip. This causes pain in the right lower quadrant in the case of appendicitis because the right obturator internus muscle lies beneath the appendix, and so stretching or contracting it elicits pain. | |||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||