Typical appendicitis includes several hours of generalized abdominal pain that begins in the region of the umbilicus with associated anorexia, nausea, or vomiting. The pain then "localizes" into the right lower quadrant where the tenderness increases in intensity. It is possible the pain could localize to the left lower quadrant in people with situs inversus totalis. The combination of pain, anorexia, leukocytosis, and fever is classic. Atypical histories lack this typical progression and may include pain in the right lower quadrant as an initial symptom. Irritation of the peritoneum (inside lining of the abdominal wall) can lead to increased pain on movement, or jolting, for example going over speed bumps. Atypical histories often require imaging with ultrasound or CT scanning. Clinical
Aure-Rozanovas sign: Increased pain on palpation with finger in right Petit triangle (can be a positive Shchetkin-Bloombergs). Bartomier-Michelsons sign: Increased pain on palpation at the right iliac region as the person being examined lies on their left side compared to when they lie on their back. Dunphys sign: Increased pain in the right lower quadrant with coughing. Hamburger sign: The patient refuses to eat (anorexia is 80% sensitive for appendicitis)
Kochers (Koshers) sign: From the persons medical history, the start of pain in the umbilical region with a subsequent shift to the right iliac region. Massouh sign: Developed in and popular in southwest England, the examiner performs a firm swish with his or her index and middle finger across the abdomen from the xiphoid process to the left and the right iliac fossa.
It is also caused by trauma. In most cases, when white spots appear on a single or a couple of fingers or toes, the most common cause is injury to the base (matrix) of the nail. When this is the case, white spots disappear after around eight months, which is the amount of time necessary for nails to regrow completely. The pattern and number of spots may change as the nail grows. Longitudinal leukonychia
Longitudinal leukonychia is far less common and features smaller 1mm white longitudinal lines visible under the nail plate and parallel to the nail bed. It may be associated with Dariers disease. Cause
It is harmless and most commonly caused by minor injuries, such as nail biting, which occur while the nail is growing. Leukonychia occurs most commonly in healthy individuals, and is unrelated to any known nutritional or physiological deficiency. When caused by injury the marks will disappear as the nail grows outwards. While there are various sources that link dietary needs or vitamin deficiency with recurrent leukonychia, this notion has been challenged by some medical researchers.Other possible reasons for this problem with nail colour can be linked to:

Arsenic poisoning
Lead poisoning
Pneumonia
Heart disease
Kidney failure
Ill health
Hypoalbuminemia
Vitamin deficiency
Ulcerative colitis
Liver cirrhosis
Psychogenic stresses
Onychophagia
Trauma injury
Occupational trauma
Zinc deficiency
Protein deficiency
Psoriasis
Eczema
Iron deficiency

Diagnosis
A doctor will take a thorough medical history, and may take blood tests as well as examining liver and kidney function. Intracellular (red blood cell) assays are more sensitive than tests for plasma levels. Treatment
Improvements have been reported from treating malnutrition associated with zinc deficiency and other minerals. References


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