Appendicitis:
Definition : Inflammation of the vermiform appendix due to obstruction, leading to bacterial
overgrowth, swelling, and potential rupture.
Pathophysiology
• Acts like a diverticulum with a narrow lumen.
• Contains gut-associated lymphoid tissue (GALT).
• Appendectomy may reduce ulcerative colitis risk but increase C. difficile colitis
risk.
Signs and Symptoms
• Abdominal Pain: Initially periumbilical, then localizes to the right lower quadrant
(McBurney’s point).
• Nausea & Vomiting: After the onset of pain.
• Fever: Low-grade initially, may rise with complications.
• Pain Migration: From umbilicus to RLQ.
• Children <3 years: Atypical presentation with generalized pain.
Clinical Signs
1. Aure-Rozanova’s Sign: Pain in the right Petit triangle.
2. Bartomier-Michelson’s Sign: RLQ pain when lying on the left side.
3. Dunphy’s Sign: Pain with coughing.
4. Hamburger Sign: Refusal to eat.
5. Kocher’s Sign: Pain migrates from umbilicus to RLQ.
6. Massouh Sign: Grimace when swiping abdomen.
7. Obturator Sign: Pain with hip flexion and internal rotation.
8. Psoas Sign: Pain with hip extension/flexion.
9. Rovsing’s Sign: RLQ pain during left-side palpation.
10. Sitkovskiy Sign: Increased pain lying on the left side.
