Important signs of appendicitis

Various symptoms (what patient complains) and signs (what doctor finds after examining the patient) can help in diagnosis of appendicitis. The symptoms of appendicitis are mainly related to disturbance in bowel function. Symptoms of classical appendicitis starts with pain first, than vomiting starts and after vomiting fever occur. In most cases the classical symptoms may be absent. Pain is usually in mid abdomen, but in children below 3 years of age pain may be localized to right iliac fossa. The abdominal wall becomes tender (pain on pressure) and even mild palpation is very painful. Rebound tenderness (there is severe pain on suddenly releasing a deep pressure in lower abdomen) is also present.

The following are some signs that may be elicited on examination of patient of appendicitis and may be helpful in diagnosis of appendicitis:

Rovsing’s sign:

This sign is elicited by upwards continuous deep palpation starting from the left iliac fossa anticlockwise along with colon, may cause pain in the right iliac fossa due to pushing of bowel contents towards the ileocecal valve, which increase pressure around the appendix.

Obturator’s sign:

This sign is elicited by flexion and internal rotation of the hip, which cause pain in hypogastrium, due to contact of obturator internus with inflamed appendix.

Psoas sign:

This sign is demonstrated by straightening out the leg, which cause pain in right lower-quadrant because it stretches the iliopsoas muscles over which inflamed peritoneum lies (may be also de to inflammation of the psoas muscles themselves), and flexing the hip into the “fetal position” which relieves pain.

Dunphy’s sign:

This is demonstrated by making the patient cough, which increases pain in the right lower quadrant of abdomen.

Blumberg sign:

This is also called rebound tenderness. Deep palpation over the suspected inflamed appendix followed by sudden release of the pressure causes the severe pain on the site indicates positive Blumberg’s sign and also peritonitis.

Sitkovskiy (Rosenstein)’s sign:

This elicited by asking the patient to lie down on left side, which increase pain in right iliac region.


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