Symptoms of appendicitis: what should I look for?

Appendicitis is formed at any age, against a background of complete health, suddenly. Appendicitis symptoms are typical, which are manifested by the appearance of pain in the right iliac region or in epigastrium (Kocher's symptom), or near-the-buccal region (Kymmel symptom). But after 2-4 hours the pain is necessarily moved to the right side from the bottom, although there may be deviations in the atypical location of the shoot. It is constant, noisy, without irradiation. The second main symptom of appendicitis is dryness of the lips and tongue, manifests itself 4-6 hours after the onset of the disease. The third symptom of appendicitis is tachycardia, although it is moderate, but is present in all cases. May be, but not necessarily: nausea, vomiting, mild subfebrile condition, diarrhea.

[1], [2], [3], [4], [5], [6], [7]

Symptoms to diagnose

The study gives a fairly clear picture in the form of specific symptoms. They are described more than two hundred, but not all of them have absolute diagnostic reliability, but the simultaneous combination of three or four of them already clearly indicates the development of appendicitis.

Leading of them and absolutely pathognomonic are the tension of the anterior abdominal wall (the defens symptom) and the positive symptom of Shchetkin-Blumberg in the right ileal region. Of the other symptoms of appendicitis, the most recognized were the following:

• Bartome-Michelson's symptom. The patient is placed on the left side. When palpation of the right iliac region appears pain, and compared with the original localization, it is displaced medial.
• Resurrection symptom. Ill lying on his back. Stretch the shirt with the left hand, and with the right brush spend from the epigastrium to the right side, there is pain in the zone of the appendage.
• Caravan's symptom. Press the right lower side with the palm of the hand, hold until the pain subsides, then ask the patient to cough. With appendicitis, pain reappears. Kushnirenko describes the same technique without pressing.
• The Lennander symptom. The temperature difference in the armpit and rectum is more than 1 °.
• An exemplary symptom. Increased pain on the right while raising the right lower limb. It is noted with a retrocetically located process.
• Razdolsky symptom. A cautious tapping with a hammer or a bent finger on the right causes the appearance of pain. This is the earliest symptom.
• The roving a symptom. The jerk in the region of the left iliac region causes pain in the right side to increase due to gas displacement and stretching of the cecum.
• Sitkovsky symptom. If the patient, lying on his back or right side, turns to the left, the pain on his right or below will appear or intensify.
• Yaure-Rozanova symptom. The appearance of pain when pressing a finger in the triangle Petit.

Gabay proposed to determine the symptom of Shchetkin-Blumberg in the triangle Petit.

In the mandatory examination complex includes a blood test with the calculation of LII, urine, blood biochemistry. And in doubtful cases, dynamic observation and repeated research are necessary. In very doubtful cases, and for differential diagnosis with the pathology of the female genital area, a puncture of the posterior vaginal fornix or laparoscopy can be performed, ultrasound and X-ray methods, including laterography, are of little informative value. In all doubtful cases, it is better to go for diagnostic laparotomy than to miss appendicitis, the symptoms of which can often go atypically and allow the development of peritonitis. A clinical picture similar to acute appendicitis is given by tiflitis, terminal ileitis (Crohn's disease), Meckel's diverticulitis, but differentiation is in most cases achieved only during surgery. Differential diagnosis in most cases has to be carried out with the pathology of the female sexual sphere, and gynecologists, even after consulting the patient, again return it to the surgeon with the requirement to exclude appendicitis. In this case, several rather informative symptoms are used.

• Zelheim is a symptom. In digital rectal examination, thickening, tension and soreness in the right sacro-uterine ligament indicates salpingitis.
• Carl is a symptom. The patient is offered to lie down on the left side pressing on the McBurney point (in the middle of the awning-umbilical line). With acute appendicitis, the patient experiences pain, with salpingo-oophoritis it will not.
• Circular symptom. With appendicitis, the growth of ESR is slow, with inflammation of the appendages very fast.
• Posner is a symptom. When vaginal examination, the cervix is grasped with two fingers and produces pendulum movements. In diseases of the female sexual sphere, a rather sharp soreness appears.
• Promtova symptom. When tested through the rectum, press down on the bottom of the Douglas space. With acute appendicitis, pain appears, and with inflammation of the appendages it will not, but it appears when the uterus is lifted.

Very carefully differential diagnosis is done in pain: in the abdomen of children, especially in the presence of angina or tonsillitis, in which abdominal pains are caused by mesadenites and solyarites.