Tests for the detection of appendicitis

Introduction

The main symptom of appendicitis is abdominal pain. However, as there are many diseases that cause abdominal pain, some tests are necessary to find a diagnosis. The first tests are usually physical.

The doctor presses on certain areas of the abdomen, which are usually painful in appendicitis. A blood test can also provide information. Some imaging procedures, such as ultrasound, CT and MRT can also show an inflamed appendix. However, sometimes the appendix is inflamed without this being visible.

Physical examination

Bouncing causes a strong movement of the abdominal organs and can increase the pain in case of appendicitis. This increase is particularly strong if the appendix is located at a specific muscle, the psoas muscle, because this muscle is tensed during the hopping movement. However, an affected person with severe pain will not jump voluntarily through the emergency room, but will lie in a gentle position.

Moreover, the hopping is a very unspecific sign and is not only painful in appendicitis. If appendicitis is suspected, there are certain points on the body where pressure can trigger pain. The McBurney point is located in the middle between the navel and the right upper bony spine of the pelvic scoop.

The examiner pushes it in and the person affected feels increased pain if the appendicitis is present and the appendix is in a normal position. Like the McBurney point, the Lanz point is one of the typical pain points in appendicitis. Here a line is drawn between the two upper bone spines of the pelvic blades and this line is divided into three parts.

The Lanz point lies between the right and middle third of the line. When this point is pressed, the pain of the affected person increases when the appendix is in the typical position. With the Rovsing symptom, the pressure on the appendix is triggered from within.

The examiner sweeps the contents of the colon against the normal course from the bottom left, across the upper abdomen, down the right to the appendix. This also increases the pain in case of appendicitis. This test is normally no longer carried out, as in the case of an appendix rupture the intestinal contents are additionally pressed into the abdomen, thus increasing the risk of peritonitis.

The Blumberg’s sign is also one of the signs of appendicitis. The examiner presses in the lower abdomen on the non-painful side and releases without warning. In the case of appendicitis this causes pain in the right lower abdomen.

This is explained by the fact that when the patient lets go, movement occurs in the abdominal organs, further irritating the inflamed appendix. The Blumberg sign also depends on the typical location of the appendix and is not specific to appendicitis. The Sitkowski’s sign is not a pressure point but a general pain in the right lower abdomen which occurs in left lateral position.

This is due to the stretching and tension of the abdominal wall muscles. Just like all other appendicitis signs, the Sitkowski’s sign is not specific for appendicitis and can also be positive for other diseases or negative despite the presence of appendicitis. The psoas is a muscle that runs from the spine down to the thighbones.

In some people the appendix lies directly on the muscle surface of the psoas. Therefore, if the muscle is tensed or moved, the pain increases. The doctor can check this by lifting the stretched leg of the affected person in a supine position. Other diseases in the vicinity of the muscle, such as bleeding, can also lead to a positive psoas sign.