Symptoms

Normally, appendicitis is accompanied by severe pain. Typically, this pain occurs very suddenly. In the beginning, the pain is usually located in the middle upper abdomen or around the navel.

It is often described as dull, and an exact location cannot usually be defined more precisely. If the bacteria have migrated through the intestinal wall, after about 8 to 12 hours a permanent pain occurs, the position of which can be described exactly. This change in the localization of the pain, the migration from the upper or middle abdomen to the right lower abdomen is not always present, but is nevertheless characteristic of the pain in the context of appendicitis.

Since the appendix is very mobile due to its shape, it can hang from the appendix in different directions. Therefore, the location of the pain depends on the position of the appendix. In almost two thirds of people, the appendix is located behind the appendix (retrocecal).

This location can mean that there is no pain in the abdomen. Instead, an inflammation of the appendix can manifest itself, for example, by pain in the area of the right flank. If the appendix is located behind the appendix, lifting the stretched right leg causes the appendix to lie on the iliopsoas muscle.

This can be used in the diagnosis of appendicitis by testing whether lifting the stretched right leg causes or can increase pain (psoas signs). A positive psoas sign indicates that the appendix lies behind the appendix and is inflamed. In almost one third of people, the appendix hangs down.

In this case, the pain is often caused or intensified by pressure on the landmark (right third of an imaginary line between the two anterior superior iliac spines) or McBurney’s point (middle of an imaginary line between the navel and the anterior superior iliac spine). There are also rare variations in the position of the appendix. For example, if the appendix hangs into the pelvis, the pelvic organs can be irritated, so that appendicitis is accompanied by urge to urinate and defecate.

In this case, the pain also exists mainly during rectal or vaginal examination. In general, in the case of appendicitis, the pain often increases when coughing, sneezing and walking. Even hopping on the right leg is often no longer possible due to severe pain.

Besides pain, appendicitis is often accompanied by nausea, vomiting and fever. Loss of appetite is often present. In small children, old people and pregnant women, the symptoms of appendicitis are often not very typical.

Elderly people and especially diabetics with an existing polyneuropathy often have little pain and hardly any temperature increase. In pregnant women, the appendix shifts upwards through the uterus, which means that the pain is more likely to occur in the middle and right upper abdomen. Also, in some patients, the pain does not start suddenly, but increases slowly.

This variability can make the diagnosis of appendicitis much more difficult. In most cases, appendicitis pain does not begin directly in the right lower abdomen, where the appendix actually lies. Initially, there is usually a rather difficult to localize abdominal pain, sometimes in the region around the navel.

In the course of time, the pain then shifts to the region of the appendix in the right lower abdomen. If an appendicitis leads to a rupture of the appendix, the pain decreases abruptly and the peritoneum relaxes. However, the secretion that has escaped into the abdominal cavity then causes increased diffuse abdominal pain.

In case of an irritation of the appendix, the appendix is usually the first to be affected. If this part of the intestine is bent or narrowed, stool can accumulate inside and bacteria multiply. Inflammatory reactions are set in motion, which causes the mucous membrane to swell.

The appendix is covered by peritoneum, which contains many nerve endings. Pressure on these causes pain. At the beginning of an irritation of the appendix, the pain begins in the middle upper abdomen or around the navel.Depending on the position of the appendix, the pain migrates to the right lower abdomen.

Pressure on the region can increase the pain. If the inflammation recedes and the mucous membrane swells, the pain disappears. However, if the irritation persists, the inflammation spreads and the pain increases.

Pressure and sudden release on the opposite side sets the peritoneum in motion, which also causes pain in the appendix area (contralateral release pain). Similarly, lifting the right leg against resistance provokes pain (psoas pain). The physical examination by the doctor includes the examination of the so-called appendicitis signs.

This refers to pain in regions of the body that are caused or intensified by certain movements or the pressing of certain points. It is important to note that the appendicitis signs can only serve as indications and must be considered in conjunction with other findings. None of the appendicitis signs proves the presence of appendicitis, and the presence of none of the signs cannot rule out appendicitis.

If painkillers have already been taken, the doctor must be informed in any case, as this may unmask the pain. The appendicitis signs include, for example, a producible pressure pain on the McBurney point. This is located in the middle of an imaginary line between the navel and the anterior upper iliac spine.

The Lanz point is located in the right third of an imaginary line between the two anterior superior iliac spines. A pressure pain at this point can also indicate the presence of appendicitis. When testing for the Blumberg sign or release pain, the lower abdomen is pressed in the area of the left lower abdomen (“contralateral”) and released quickly.

If (increased) pain occurs in the area of the right lower abdomen, this is referred to as a positive Blumberg sign. Pain that can be triggered by stroking the colon in the direction of the appendix with the appendix is called positive rovsing-sign. If pain can be triggered by bending the right leg in the hip joint against resistance, a positive psoas sign is present.

If the right leg is lifted in an extended position and the subsequent dropping causes pain, the Baldwin sign is positive. The Cope-stretch-sign occurs when in left-side position an overstretching of the right leg leads to pain. The Sitkowski sign is pain in the area of the right lower abdomen, which occurs when the abdominal muscles are stretched and relieved in the left-side position.

The obturator sign is positive if an internal rotation of the right leg causes or increases pain in the right lower abdomen. A positive Chapman’s sign is spoken of when straightening the upper body causes or increases pain. If the digital-rectal examination, the palpation of the anus by the doctor’s fingers, leads to increased pain, this is called Douglas pain. The Ten-Horn sign in men is a pain in the right lower abdomen, which is caused by the pull on the spermatic cord.