Examination of the Abdomen: Signs of Appendicitis (Paramedic)

00:01 Welcome to a new lecture on the signs of inflammation of the appendix.

00:05 You are probably more familiar with it under the term appendicitis.

00:10 Now, let us briefly review the anatomical basics of the appendix.

00:15 The cecum forms the beginning of the large intestine, the colon, and is usually located in the right lower quadrant.

00:26 Keep in mind, however, different anatomical locations are possible when dealing with cases of embryonic intestinal malrotation.

00:33 This is an important consideration, and we must remember that the pain of appendicitis may also occur in other regions, as is depicted in this illustration.

00:42 In most patients, however, the appendix is located in the right lower quadrant.

00:47 How can you recognize this clinical presentation? Inflammation of the appendix usually manifests as several specific symptoms that we can differentiate diagnostically.

00:58 Physicians, particularly those in emergency medicine, must remember that this disease is usually treated surgically, so patients with a clinical picture suggestive of appendicitis must be transferred to a hospital for treatment.

01:15 It can be difficult to differentiate inflammation of the abdomen, as the primary symptom is usually an acute abdomen.

01:22 This is the sudden onset of severe abdominal pain.

01:27 Without laboratory tests and imaging techniques, it is impossible to conclude the causative agent.

01:35 In this table you can see a listing of the most important appendicitis signs. Please note, however, that all of these signs are non-specific, meaning they may indicate appendicitis, but are by no means confirmatory. For the following demonstration video, I recommend that you print out the list of appendicitis signs and have it handy so that you can take notes if necessary.

02:01 During the video, I will focus less on the cause of the signs and more on how to perform the maneuver and what findings are important to the examiner.

02:13 This patient recently presented with mild abdominal pain.

02:18 The treating physician steps in and informs the patient about the abdominal examination. He asks them to completely undress their torso.

02:32 The patient is then placed in a relaxed supine position.

02:37 In order to relieve tension in the abdominal wall, the patient should place the arms relaxed at their sides.

02:43 Complete exposure of the abdomen also includes pushing the pants down a bit.

02:48 At the beginning, the practitioner orients himself to existing landmarks of the abdomen, the costal arch, and the pelvis, which border the abdomen.

02:58 Horizontal and vertical lines, drawn through the navel, divide the abdomen into four quadrants.

03:05 To find the appendicitis points, the iliac spines are palpated.

03:11 On an imaginary line between the iliac spine, also called ASIS, and the navel. McBurney's point is located one-third of the way from the iliac spine.

03:24 If pain occurs on palpation.

03:26 At this point, it is referred to as Aaron's sign.

03:30 If the provider spontaneously releases during palpation of the abdomen on the left side and pain subsequently occurs in the right lower quadrant, the Blumberg sign is positive and may indicate appendicitis.

03:44 On an imaginary line between the two iliac spines.

03:47 Lanz Point is located on the right lateral third of the line.

03:54 A painful Lanz point may also be a sign of appendicitis.

04:00 The psoas sign is then assessed.

04:03 As the leg is lifted against resistance, the psoas major muscle is tensed.

04:08 This can cause abdominal pain in appendicitis, as the appendix rests directly against this muscle.

04:14 The obturator sign can be seen when the provider inverts the hip and tenses the obturator internists muscle.

04:20 If this causes pain, the operator's sign is considered positive, indicating appendicitis. The provider then informs the patient about further diagnostic steps and possible therapeutic consequences.

04:34 I will now summarize the most important points once more.

04:37 The appendix is a small process off the cecum.

04:41 The position and orientation of the appendix are highly variable, but it is usually found in the right lower quadrant.

04:48 Appendicitis signs always represent nonspecific findings, so a diagnosis cannot be reached based on these signs alone.