Appendicitis

Symptoms

  • Pain starts around umbilicus → R lower quadrant, fever, nausea, anorexia
  • Progresses over hours to days
  • As w/peritonitis of any cause, patient lies still → movement increases pain

Physical Exam Findings

  • Fever
  • Vague pain in peri-umbilical region initially
  • Migrates to cause focal pain RLQ: McBurneys point→ 1/3 distance from iliac crest to umbilicus
  • With peritonitis: rebound tenderness, guarding, shake tenderness; + Rovsings→ pushing on LLQ and releasing causes RLQ pain
  • If retrocecal appendix→ psoas sign→ pain w/passive leg extension
  • If pelvic appendix→ obturator sign→ pain w/passive internal hip rotation