gastrointestinal disorders
Appendicitis
Symptoms and Signs of Appendicitis
The classic acute appendicitis symptoms are Epigastric or periumbilical pain followed by brief nausea, vomiting, and anorexia After a few hours, the pain shifts to the right lower quadrant. Pain increases with cough and motion. Classic signs of appendicitis are Right lower quadrant direct and rebound tenderness located at the McBurney point (junction of the middle and outer thirds of the line joining the umbilicus to the anterior superior iliac spine) Additional appendicitis signs are pain felt in the right lower quadrant with palpation of the left lower quadrant (Rovsing sign), an increase in pain caused by passive extension of the right hip joint that stretches the iliopsoas muscle (psoas sign), or pain caused by passive internal rotation of the flexed thigh (obturator sign). Low-grade fever (rectal temperature 37.7 to 38.3°C [100 to 101°F]) is common. Many variations of appendicitis symptoms and signs occur in > 50% of patients. Pain may not be localized, particularly in infants and children. Tenderness may be diffuse or, in rare instances, absent. Bowel movements are usually less frequent or absent; if diarrhea is a sign, a retrocecal appendix should be suspected. Red or white blood cells may be present in the urine. Atypical symptoms are common among older patients and pregnant women; in particular, pain is less severe and local tenderness is less marked. 