Acute Appendicitis: Diagnosis

Q: Describe at least 5 clinical signs at bedside for diagnosis of acute appendicitis?

Answer:  Various clinical maneuvers have been described to diagnose acute appendicitis. Some of the tests to perform are mentioned below.

1. Rovsing's sign: Continuous deep palpation starting from the left iliac fossa upwards (counterclockwise along the colon) may cause pain in the right iliac fossa

2. Psoas sign or Obraztsova's sign: is right lower-quadrant pain that is produced by either the passive extension of the patient's right hip (patient lying on left side, with knee in flexion) or the patient's active flexion of the right hip while supine. The pain elicited is due to inflammation of the peritoneum.

3. Dunphy's sign: Increased pain in the right lower quadrant with coughing.

4. Sitkovskiy or Rosenstein's sign: Increased pain in the right iliac region as patient lies on his/her left side.

5. Rebound tenderness: Deep palpation of the viscera over the suspected inflamed appendix followed by sudden release of the pressure causes severe pain on the site (Blumberg's sign).  

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References:

1. Moris D, Paulson EK, Pappas TN. Diagnosis and Management of Acute Appendicitis in Adults: A Review. JAMA. 2021 Dec 14;326(22):2299-2311. doi: 10.1001/jama.2021.20502. PMID: 34905026.

2. Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018 Jul 1;98(1):25-33. PMID: 30215950.