Gastrointestinal System Disorders Q 81

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Which of the following terms best describes the pain associated with appendicitis?

  

    A. Aching

    B. Fleeting

    C. Intermittent

    D. Steady

    

    

Correct Answer: D. Steady

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The pain begins in the epigastrium or periumbilical region, then shifts to the right lower quadrant and becomes steady. The pain may be moderate to severe. Classically, appendicitis presents as an initial generalized or periumbilical abdominal pain that then localizes to the right lower quadrant. Initially, as the visceral afferent nerve fibers at T8 through T10 are stimulated, and this leads to vague centralized pain.

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Option A: Pain upon passive extension of the right leg with the patient in the left lateral decubitus position is known as psoas sign. This maneuver stretches the psoas major muscle, which can be irritated by an inflamed retrocecal appendix. Patients often flex the hip to shorten the psoas major muscle and relieve pain.

Option B: As the appendix becomes more swollen and inflamed, it will irritate the lining of the abdominal wall, known as the peritoneum. This causes localized, sharp pain in the right lower part of the abdomen.

Option C: As the appendix becomes more inflamed, and the adjacent parietal peritoneum is irritated, the pain becomes more localized to the right lower quadrant. The pain tends to be more constant and severe than the dull, aching pain that occurs when symptoms start.

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