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Page: Signs, Symptoms and Findings
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Symptoms of acute appendicitis can be classified into two types, typical and atypical (Hobler, K., 1998). The typical history includes pain starting centrally (periumbilical) before localising to the right iliac fossa (the lower right side of the abdomen); this is due to the poor localizing (spatial) property of visceral nerves from the mid-gut, followed by the involvement of somatic nerves (parietal peritoneum) as the inflammation progresses. The pain is usually associated with loss of appetite and fever. Nausea or vomiting may or may not occur. With the typical type, diagnosis is easier to make, surgery occurs earlier and findings are often less severe.[citation needed] (Hobler, K., 1998).
Atypical symptoms may include pain beginning in the right lower quadrant, diarrhea and a more prolonged, smoldering course. Being more difficult to diagnose, CT scans and ultrasound tests are more useful. Surgical finding are more apt to be severe (suppuration, abscess, perforation, etc.)[citation needed] (Hobler,K., 1998).
In either type of history, physical findings of appendicitis usually include localized findings in the right lower quadrant suggesting peritonitis. The abdominal wall becomes very sensitive to gentle pressure (palpation) tapping (percussion). Coughing causes point tenderness in this area (McBurney's Point) and this is the least painful way to localize the inflamed appendix. If the abdomen on palpation is also involuntarily guarded (rigid), there should be a strong suspicion of peritonitis requiring urgent surgical intervention.
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