What are the symptoms of appendicitis? There are actually ten of them

Appendicitis is one of the intestinal diseases with a relatively high incidence in daily life. It often presents as acute abdominal pain, so it is easily ignored by people, thus delaying treatment. Therefore, it is very important to understand the symptoms of appendicitis. Let’s take a look at the symptoms of appendicitis!

1. Abdominal pain: Typical acute appendicitis begins with pain in the upper abdomen or around the umbilicus. After a few hours, the abdominal pain shifts and becomes fixed in the right lower abdomen. In the early stage, it is a visceral nerve reflex pain, so the pain in the upper and middle abdomen and around the umbilicus is diffuse and often cannot be accurately located. When the inflammation spreads to the serosa and parietal peritoneum, the pain is fixed in the right lower abdomen because the latter are innervated by receptor nerves, are sensitive to pain and have precise localization. The original pain in the upper abdomen or around the umbilicus is alleviated or disappears. According to statistics, 70% to 80% of patients have a history of typical metastatic right lower abdominal pain. In a few patients, the disease progresses rapidly and the pain may be limited to the right lower abdomen from the beginning. Therefore, the absence of a typical history of migratory right lower quadrant pain does not exclude acute appendicitis.

2. Gastrointestinal symptoms: The gastrointestinal symptoms of simple appendicitis are not prominent. In the early stages, nausea and vomiting may occur due to reflex gastric spasm. Pelvic appendicitis or gangrenous appendix perforation may cause increased bowel movement frequency due to periproctitis. Complications of peritonitis and intestinal paralysis can cause abdominal distension and persistent vomiting.

3. Fever: Generally, there is only low fever without chills. The temperature of purulent appendicitis generally does not exceed 38℃. High fever is often seen in appendix gangrene, perforation or complicated by peritonitis. Accompanied by chills and jaundice, it suggests possible complications of suppurative portal vein thrombosis.

4. Tenderness and rebound pain: Abdominal tenderness is a manifestation of inflammatory irritation of the parietal peritoneum. The tenderness point of the appendix is ​​usually located at McBurney's point, which is the junction of the middle and outer 1/3 of the line connecting the right anterior superior iliac spine and the umbilicus. This surface anatomical landmark of the appendix is ​​not fixed; it can also be located at the Lanz point at the junction of the middle and right 1/3 of the line connecting the anterior superior iliac spines on both sides. The tenderness point may change accordingly with the variation of the anatomical position of the appendix, but the key is that there is a fixed tenderness point in the right lower abdomen. The degree and extent of tenderness often correlates with the severity of the inflammation.

5. Abdominal muscle tension: This sign will appear when the appendix is ​​suppurated, and the abdominal muscle tension is particularly obvious when gangrene perforation is complicated by peritonitis. However, the abdominal muscles of elderly or obese patients are weaker, so the contralateral abdominal muscles must be checked at the same time for comparison to determine whether there is abdominal tension.

6. Colon inflation test: also known as Rovsing sign. First press the descending colon area in the left lower abdomen with one hand, and then repeatedly press its upper end with the other hand. If the patient complains of right lower abdominal pain, it is positive. Only a positive result has diagnostic value.

7. Psoas major test: If the patient lies on his left side and hyperextends his right lower limb backward and causes right lower abdominal pain, the test is positive and helps in the diagnosis of retrocecal appendicitis.

8. Obturator muscle test: Lie on your back with your right leg flexed 90°. If it causes right lower abdominal pain, it is a positive test, which is helpful in the diagnosis of pelvic appendicitis.

9. Rectal examination: When the appendix in the pelvic cavity is inflamed, there may be no obvious tenderness in the abdomen, but there will be tenderness at the right anterior wall of the rectum. If there is gangrene perforation and pus accumulation around the rectum, there will not only be obvious tenderness, but also a feeling of fullness around the rectum. Rectal examination is also helpful in excluding inflammatory lesions of the pelvis and uterine adnexa.

10. Skin hyperesthesia: In the early stage, especially when there is obstruction in the appendix cavity, skin hyperesthesia may occur in the right lower abdomen. The range is equivalent to the innervation area of ​​the 10th to 12th thoracic cord segments, located in the triangle formed by the highest point of the right iliac crest, the right pubic crest and the umbilicus, also known as Sherren's triangle. It does not change due to the different positions of the appendix. If the appendix is ​​gangrenous and perforated, the skin hyperesthesia in this triangle will disappear.