- 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
- 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