Pointing Sign and Other Related Symptoms In Appendicitis

The most common signs and symptoms of appendicitis are periumbilical pain that localizes to the right iliac fossa, nausea, pyrexia, pointing sign and much more. Let's know in detail about this.

Pointing Sign and others Signs In Appendicitis

Signs of Appendicitis

Low-grade pyrexia
Pointing sign: If a doctor asks the patient of appendicitis, he points out where the pain started and where it moved.
Localized and rebound tenderness in the right iliac fossa or McBurney’s point- Asking the patient to cough or gentle percussion over the site of maximum tenderness (McBurney’s point) will elicit rebound tenderness.
Muscle guarding - Gentle superficial palpation of the abdomen, beginning in the left iliac fossa moving anticlockwise to the right iliac fossa will detect muscle guarding over the point of maximum tenderness, classically McBurney’s point (one-third of the distance between the umbilicus and the superior iliac spine).
Rovsing’s sign - Deep palpation of the left iliac fossa may cause pain in the right iliac fossa which is helpful in supporting a clinical diagnosis of appendicitis.
Psoas sign (hip extension) - Occasionally, an inflamed appendix being in contact with psoas muscle. The patient will lie with the right hip flexed for pain relief, called the psoas sign. It is usual in a young adult.
Obturator sign (internal rotation of the hip) - Sometimes when the hip is flexed and internally rotated, the spasm of the obturator internus is demonstrable. If an inflamed appendix is in contact with the obturator internus, this maneuver will cause pain in the hypogastrium.
Cutaneous hyperaesthesia - may be demonstrable in the right iliac fossa, but is rarely of diagnostic value.

Symptoms of Appendicitis

Common symptoms of appendicitis in young men are mild periumbilical pain and nausea. Symptoms of appendicitis start with poorly localized colicky abdominal pain resulting from mid-gut visceral discomfort in response to appendiceal inflammation and obstruction. Pain begins in the periumbilical region. There may be one or two episodes of vomiting occurring a few hours after the onset of pain. The pain then localizes to the right iliac fossa and progressively worsens. Usually, abdominal pain associated with malaise, anorexia and low-grade fever. Typically, coughing or sudden movement exacerbates the right iliac fossa pain.

Symptoms of appendicitis in infants may be vomiting, diarrhea, and irritability.

Symptoms of appendicitis in older children may be a recent bacterial viral illness, which causes enlargement of the appendiceal lymphoid follicles and obstruction. Anorexia is one of the most useful and constant symptoms of appendicitis in children.

Malaise, atypical pain, constipation, or even mental status changes are the symptoms of appendicitis in the elderly.

During the first 6 hours, usually, there is no alteration in temperature or pulse rate. After that time, there is slight pyrexia (37.2–37.7°C) with a corresponding increase in the pulse rate to 80 or 90 as usual. But, some patients have no pyrexia or tachycardia in the early stages. Children may have a temperature greater than 38.5°C suggests other causes like mesenteric adenitis.

Signs and Symptoms of Appendicitis, according to the position of the Appendix

Signs and Symptoms of Appendicitis, when it is Retrocaecal

It is called silent appendix because rigidity is often absent and even application of deep pressure may fail to elicit tenderness. However, deep tenderness is often present in the loin and rigidity of the quadratus lumborum may be in evidence.
Psoas spasm - as a result of the inflamed appendix being in contact with psoas muscle, may be sufficient to cause flexion of the hip joint. When the degree of psoas spasm is insufficient to cause flexion of the hip, hyperextension of the hip joint may induce abdominal pain.

Signs and Symptoms of Appendicitis, when it is Pelvic

Sometimes, early diarrhea may present due to an inflamed appendix being in contact with the rectum.
When the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity, and often there is a lack of tenderness over McBurney’s. In some instances, deep tenderness can be made out just above and to the right of the symphysis pubis.
In either event, a rectal examination reveals tenderness in the rectovesical pouch or the pouch of Douglas, especially on the right side.
Spasm of the psoas and obturator internus muscles may be present when the appendix is in this position.
An inflamed appendix in contact with the bladder may cause the frequency of micturition. This is more common in children.

Signs and Symptoms of Appendicitis, when it is Postileal (inflamed appendix lies behind the terminal ileum)

In this condition, the pain may not shift. The diagnosis is quite difficult. Tenderness, if any, is ill-defined, although it may be present immediately to the right of the umbilicus.
Diarrhea
Marked retching