SURGICAL HIGH-YIELD NOTES
Acute Appendicitis: Diagnosis, Scoring & Management
1. Clinical Presentation
The diagnosis is primarily clinical. Look for the classic sequence:
• Anorexia: Often the first sign (The Hamburger Sign).
• Periumbilical Pain: Early visceral pain.
• Vomiting: Usually follows the onset of pain.
• Migration: Pain shifts to the Right Iliac Fossa (RIF).
2. Essential Physical Signs
Rovsing’s Sign: RIF pain on palpation of the left iliac fossa.
Psoas Sign: Pain on passive extension of the right hip (Retrocecal).
Obturator Sign: Pain on internal rotation of flexed right hip (Pelvic).
3. Alvarado Scoring System (MANTRELS)
Feature Description Score
Migration Pain shifting to the RIF 1
Anorexia Loss of appetite 1
Nausea Nausea or Vomiting 1
Tenderness Tenderness in the RIF 2
Acute Appendicitis: Diagnosis, Scoring & Management
1. Clinical Presentation
The diagnosis is primarily clinical. Look for the classic sequence:
• Anorexia: Often the first sign (The Hamburger Sign).
• Periumbilical Pain: Early visceral pain.
• Vomiting: Usually follows the onset of pain.
• Migration: Pain shifts to the Right Iliac Fossa (RIF).
2. Essential Physical Signs
Rovsing’s Sign: RIF pain on palpation of the left iliac fossa.
Psoas Sign: Pain on passive extension of the right hip (Retrocecal).
Obturator Sign: Pain on internal rotation of flexed right hip (Pelvic).
3. Alvarado Scoring System (MANTRELS)
Feature Description Score
Migration Pain shifting to the RIF 1
Anorexia Loss of appetite 1
Nausea Nausea or Vomiting 1
Tenderness Tenderness in the RIF 2
