Permans sign: In acute appendicitis palpation in the left iliac fossa may produce pain in the right iliac fossa. Blood and urine test
While there is no laboratory test specific for appendicitis, a complete blood count (CBC) is done to check for signs of infection. Although 70–90 percent of people with appendicitis may have an elevated white blood cell (WBC) count, there are many other abdominal and pelvic conditions that can cause the WBC count to be elevated. Due to its low sensitivity and specificity, on its own, WBC is not seen as a good indicator of appendicitis. The diagnostic performance of novel molecules such as Interleukin-6, calprotectin and NGAL has recently been studied  in pediatric appendicitis and has shown moderate utility. Also, Interleukin-6 has shown has shown a moderate ability to discriminate between complicated and uncomplicated appendicitis in children. A urinalysis generally does not show infection, but it is important for determining pregnancy status, especially the possibility of an ectopic pregnancy in women of childbearing age. The urinalysis is also important for ruling out a urinary tract infection as the cause of abdominal pain. The presence of more than 20 WBC per high-power field in the urine is more suggestive of a urinary tract disorder. Imaging
In children the clinical examination is important to determine which children with abdominal pain should receive immediate surgical consultation and which should receive diagnostic imaging.
Blounts disease (or Blount disease) is a growth disorder of the tibia (shin bone) which causes the lower leg to angle inward, resembling a bowleg. It is also known as "tibia vara". Description and risk factors
Blount disease is a growth disorder of the shin bone which causes the lower leg to angle inward, resembling a bowleg. It can present in boys under 4-years in both legs, or in adolescents usually on one side. Causes are thought to be genetic and environmental, like obesity, African-American lineage, and early walkers. Etymology
Blount disease is named after Walter Putnam Blount (1900–1992), an American pediatric orthopedic surgeon, who described it in 1937. It has also been known as Mau-Nilsonne Syndrome, after C. Mau and H. Nilsonne, who published early case reports of the condition. it is today considered an acquired disease of the proximal tibial metaphysis rather than an epiphyseal dysplasia or osteochondrosis. Diagnosis
Differential Diagnosis
Lower extremity deformities in Rickets can closely mimic those produced by Blounts disease. To differentiate between Rickets and Blounts disease it is important to correlate the clinical picture with laboratory findings such as calcium, phosphorus and alkaline phosphatase. Besides the X-ray appearance. Bone deformities in Rickets have a reasonable likelihood to correct over time, while this is not the case with Blounts disease. Nevertheless, both disorders may need surgical intervention in the form of bone osteotomy or more commonly guided growth surgery. Osteochondrodysplasias or genetic bone diseases can cause lower extremity deformities similar to Blounts disease.