Which of the following is a possible manifestation of appendicitis?

Which of the following is a possible manifestation of appendicitis?

• A. Increased abdominal pain with coughing
• B. Esophageal reflux
• C. High-grade fever
• D. A negative Rovsing's sign

Answer: (A)

Peritoneal irritation from appendicitis often makes pain worse with activities that increase intra-abdominal pressure, such as coughing. This is because coughing sends a surge of pressure into the abdomen, intensifying the inflamed tissues and any surrounding peritoneum. So increasing abdominal pain with coughing is a plausible presentation of appendicitis. Context helps: appendicitis typically starts with dull, periumbilical pain that shifts to the right lower quadrant, with tenderness and guarding as the inflammation progresses. A high fever can occur but is more suggestive of a systemic infection or perforation rather than an early sign. Esophageal reflux is unrelated to appendicitis, and a negative Rovsing’s sign does not rule out appendicitis since not all patients produce this sign.

Peritoneal irritation from appendicitis often makes pain worse with activities that increase intra-abdominal pressure, such as coughing. This is because coughing sends a surge of pressure into the abdomen, intensifying the inflamed tissues and any surrounding peritoneum. So increasing abdominal pain with coughing is a plausible presentation of appendicitis.

Context helps: appendicitis typically starts with dull, periumbilical pain that shifts to the right lower quadrant, with tenderness and guarding as the inflammation progresses. A high fever can occur but is more suggestive of a systemic infection or perforation rather than an early sign. Esophageal reflux is unrelated to appendicitis, and a negative Rovsing’s sign does not rule out appendicitis since not all patients produce this sign.