A positive Massouh sign is a grimace of the person being examined upon a right sided (and not left) sweep. Obturator sign: The person being evaluated lies on her or his back with the hip and knee both flexed at ninety degrees. The examiner holds the persons ankle with one hand and knee with the other hand. The examiner rotates the hip by moving the persons ankle away from his or her body while allowing the knee to move only inward. A positive test is pain with internal rotation of the hip. Psoas sign, also known as "Obraztsovas sign", is right lower-quadrant pain that is produced with either the passive extension of the right hip or by the active flexion of the persons right hip while supine. The pain that is elicited is due to inflammation of the peritoneum overlying the iliopsoas muscles and inflammation of the psoas muscles themselves. Straightening out the leg causes pain because it stretches these muscles, while flexing the hip activates the iliopsoas and causes pain. Rovsings sign: Pain in the lower right abdominal quadrant with continuous deep palpation starting from the left iliac fossa upwards (counterclockwise along the colon). The thought is there will be increased pressure around the appendix by pushing bowel contents and air toward the ileocaecal valve provoking right-sided abdominal pain. Sitkovskiy (Rosenstein)s sign: Increased pain in the right iliac region as the person is being examined lies on their left side.
The performance of scores such as the Alvarado score and the Pediatric Appendicitis Score, however, are variable.The Alvarado score is the most known scoring system. A score below 5 suggests against a diagnosis of appendicitis, whereas a score of 7 or more is predictive of acute appendicitis. In a person with an equivocal score of 5 or 6, a CT scan or ultrasound exam may be used to reduce the rate of negative appendectomy. Pathology
Even for clinically certain appendicitis, routine histopathology examination of appendectomy specimens is of value for identifying unsuspected pathologies requiring further postoperative management. Notably, appendix cancer is found incidentally in about 1% of appendectomy specimens.Pathology diagnosis of appendicitis can be made by detecting a neutrophilic infiltrate of the muscularis propria. Periappendicitis, inflammation of tissues around the appendix, is often found in conjunction with other abdominal pathology. Differential diagnosis
Children: Gastroenteritis, mesenteric adenitis, Meckels diverticulitis, intussusception, Henoch–Schönlein purpura, lobar pneumonia, urinary tract infection (abdominal pain in the absence of other symptoms can occur in children with UTI), new-onset Crohns disease or ulcerative colitis, pancreatitis, and abdominal trauma from child abuse; distal intestinal obstruction syndrome in children with cystic fibrosis; typhlitis in children with leukemia. Women: A pregnancy test is important for all women of childbearing age since an ectopic pregnancy can have signs and symptoms similar to those of appendicitis.