What are the symptoms of appendicitis?
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Symptoms of Appendicitis: A Comprehensive Overview
Common Symptoms of Appendicitis
Abdominal Pain in Appendicitis
Abdominal pain is the hallmark symptom of appendicitis. Typically, the pain begins in the central abdomen or periumbilical region and then migrates to the right lower quadrant (RLQ) within 1-12 hours . This pain is often described as dull and aching initially but becomes sharper and more localized as the condition progresses .
Gastrointestinal Symptoms: Nausea, Vomiting, and Anorexia
Nausea, vomiting, and loss of appetite (anorexia) are frequently associated with appendicitis. These symptoms can vary in intensity but are commonly present in most cases .
Fever and Rigidity
Low-grade fever often accompanies appendicitis, and as the condition worsens, patients may experience abdominal rigidity and localized tenderness in the RLQ .
Atypical Symptoms of Appendicitis
Variability in Pain Location
In some cases, the pain may not follow the classic pattern and can be felt anywhere in the abdomen, back, or rectum. This variability can lead to diagnostic confusion .
Urinary and Gastrointestinal Symptoms
Atypical presentations may include painful urination, bloating, flatulence, and generalized abdominal tenderness. Some patients may also experience constipation or diarrhea.
Absence of Typical Symptoms
In rare instances, patients may not exhibit the classic symptoms of appendicitis, such as pain, nausea, vomiting, or fever. This can make diagnosis particularly challenging.
Diagnostic Signs and Scoring Systems
Physical Examination Signs
Several physical examination signs are useful in diagnosing appendicitis. These include:
- Right Lower Quadrant Pain: A key indicator in adults.
- Positive Psoas Sign: Pain on extension of the right thigh, indicating irritation of the iliopsoas muscle.
- Positive Obturator Sign: Pain on internal rotation of the flexed right thigh, suggesting irritation of the obturator internus muscle.
- Positive Rovsing Sign: Pain in the RLQ upon palpation of the left lower quadrant.
Scoring Systems
Scoring systems like the Alvarado score, Pediatric Appendicitis Score, and Appendicitis Inflammatory Response score incorporate clinical and laboratory findings to stratify patients by risk and aid in diagnosis.
Conclusion
Appendicitis presents with a range of symptoms, from the classic abdominal pain migrating to the right lower quadrant, nausea, vomiting, and fever, to atypical presentations that can complicate diagnosis. Recognizing the variability in symptoms and utilizing physical examination signs and scoring systems can aid in timely and accurate diagnosis, reducing the risk of complications such as perforation and sepsis.
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