2. Rovsing's sign : indirect tenderness. in which the pain is elicited in Right Iliac Fossa while applying pressure at LIF. lower sensitivity than McBurney's point. As if as you push the organs in LIF towards the inflamed appendix in RIF (-_-)
3. Obturator's test : Ask patient to flex hip and rotate internally while liying supine. Can you imagine that???!!!! it indicates inflammation of obturator internus. if the test is positive in right leg, it would be spesific for retrocecal appendicitis (more likely)
But if positive bilaterally, suggestive of O&G conditions.
Should be positive when there is suprapubic pain. This is spesific for retrocecal appendicitis
http://www.aafp.org/afp/1999/1101/afp19991101p2027-f2b.jpg
http://www.jamaevidence.com/loadBinary.aspx?filename=sime_c005f002t.jpg
4. reverse psoas maneuver : Ask the patient to roll towards left side and hyperextend the right hip
5. rectal tenderness : in Per rectal examination, not sure how. will be updated later.
Modified Alvarado scale assigns score, designed to look if appendicitis should be prioritized and favored managements.
<5 : rule out
=/> 7 : rule in diagnosis
o-3 : low risk of appendicitis. discharged and adviced to return if no improvement in symptoms
4-6 : admitted for observation and re-examine if score remains after 12 hours----> if remains? operatelah beb!!!
male 7-9 : appendectomy
non-preggy female 7-9 ; diagnostic laparascopy and appendectomy
But, please refer to the local procedure and setting. Tq.
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