Authors eponymously associated with abdominal signs, symptoms, investigation and management of appendicitis.
appendicitis: appendix (small outgrowth of an internal organ) + -itis (inflammation)
American physician Reginald Heber Fitz (1843–1913) coined the term appendicitis in 1886 when he recognised that the abscesses frequently seen in the right iliac fossa were caused by perforating inflammation of the vermiform (worm-like) appendix. He analysed 466 cases of abdominal disorders that had previously been variously diagnosed and showed that they all involved a diseased appendix.
As a circumscribed peritonitis is simply one event, although usually the most important, in the history of inflammation of the appendix, it seems preferable to use the term appendicitis to express the primary condition.Fitz 1886
Alvarado score (1986)
Alvarado score for predicting acute appendicitis. In 1986, the American general surgeon Alfredo Alvarado published a retrospective single center study in Philadelphia. His method relies on a combination of factors derived from physical signs, symptoms, and laboratory tests and produces a numerical score used to rule in or rule out acute appendicitis. It is a well-established and widely-used clinical decision tool that may help reduce CT usage.
- Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986 May;15(5):557-64
- MDcalc Alvarado Score for Acute Appendicitis is a useful automated tool to record the score
Aaron sign (1913)
- Charles Dettie Aaron (1866 – 1951) American gastroenterologist.
- Aaron CD. A sign indicative of chronic appendicitis. JAMA. 1913; 60(5): 350-351
Arapov contracture is a reflex contraction of the right hip joint in acute appendicitis. Pain induced reflex contraction of the right hip joint in acute appendicitis
- Dmitry Alekseyevich Arapov (Дмитрий Алексеевич Арапов) (1897 – 1984) Russian military surgeon.
- Arapov DA et al. Paradoxes of acute appendicitis. Vestn. Khir. Im. II Grek. 1968; 101(11): 22-26.
Bassler sign (1913)
Bassler sign: Pain induced by compressing (pinching) the appendix between the abdominal wall and iliacus, indicative of chronic appendicitis
- Anthony Bassler (1874-1959) American gastroenterologist.
- Bassler A. Pinching the appendix in diagnosis of chronic appendicitis. American Journal of the Medical Sciences. 1913; 146(4): 204-208.
Blumberg sign (1907)
Blumberg sign [*aka rebound tenderness ]. Pain felt upon sudden release of steadily applied pressure on the abdomen indicative of peritonitis
- Blumberg sign sensitivity 0.81; specificity 0.49 in diagnosing acute appendicitis.
- Jacob Moritz Blumberg (1873 – 1955) German surgeon
- Blumberg JM. Ein neues diagnostisches Symptom bei Appendicitis. Münchener medizinische Wochenschrift, 1907; 54(1): 1177-1178
Cope obturator test (1919)
Cope obturator test [*aka thigh-rotation test; obturator test ]. The examiner stands to the right of the patient with the right thigh slightly flexed. The limb is then fully rotated at the hip, first internally and then externally. Positive with conditions causing irritation to the obturator internus muscle e.g. inflammatory fluid in the pelvis, abscess, or perforated appendix.
- Cope obturator sign: sensitivity (8%); specificity (94%) in diagnosing acute appendicitis.
- Sir Vincent Zachary Cope (1881 – 1974) English surgeon.
- Cope VZ. The thigh-rotation or obturator test: A new sign in some inflammatory conditions. Br J Surg. 1919; 7: 537.
Cope psoas test (1921)
Cope psoas test [*aka Ilio-psoas rigidity; psoas extension test; Obraztsova sign ]. The patient is lying in the lateral decubitus position opposite the side where the pain is located. Extension of the thigh causes pain.May be positive in retrocaecal appendicitis as well as primary/secondary psoas abscess.
- Cope psoas test: sensitivity (13 – 42%); specificity (79 – 97%); positive likelihood ratio of 2.0 for detecting appendicitis.
- Sir Vincent Zachary Cope (1881 – 1974) English surgeon.
- Cope Z. Method of diagnosis: (II) The examination of the patient. Determination of illiopsoas rigidity. 1921
Dunphy sign (1953)
Dunphy sign [* cough test; coughing test ] increased abdominal pain, localised to the right lower quadrant, with coughing
- Most commonly referenced as Osborne Joby Dunphy (1898–1989)…however I can find no records, or publications pertaining to this individual. More probably an eponymous tribute to the eminent American surgeon John Englebert Dunphy (1908-1981)
- Dunphy JE. Examination of the Abdomen: Acute appendicitis. In: Physical Examination Of The Surgical Patient. 1953
Markle Sign (1973)
Markle Sign, Markle Test or Heel Drop Jarring Test is elicited in patients with intraperitoneal inflammation by having a patient stand on his or her toes and suddenly dropping down onto the heels with an audible thump.If abdominal pain is localised as the heels strike the ground, the Markle Sign is positive. If the pain is localised to the right lower quadrant, this is suggestive of acute appendicitis.
- George Bushar Markle IV (1921-1999) American surgeon
- Markle, GB. A simple test for intraperitoneal inflammation. The American Journal of Surgery. 1973; 125(6): 721-722
Massouh sign: A firm swish of the examiner’s index and middle finger across the patient’s abdomen from xiphoid sternum to first the left and then the right iliac fossa. A positive Massouh sign is a grimace of the patient upon a right sided (and not left) sweep.
- Farouk Massouh is a British General Surgeon
- Publication of evidence is limited to a tweet; a Linkedin post; and a wikipedia article:
McBurney’s point (1889)
McBurney’s point lies one-third of the distance laterally on a line drawn from the umbilicus to the right anterior superior iliac spine. […or as McBurney described it: ‘between an inch and a half and two inches from the anterior spinous process of the ilium on a straight line drawn from that process to the umbilicus‘ ]. Classically used as a guide to the location of the base of the appendix, determined by pain elicited by the pressure of a single digit at the point (McBurney’s sign).
- Charles Heber McBurney (1845-1913) American general surgeon
- McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix. New York Medical Journal, 1889; 50: 676-684.
Note: Mathematics confuses semantics. McBurney originally described his point at a set distance from a fixed point (ASIS) along a line between two fixed points (ASIS and umbilicus). In recent times this point has been re-defined as fraction (one third) of the distance between the two fixed points (ASIS and umbilicus).
Note: McBurney’s point (1889) and McBurney’s Incision (1894) are not the same. ‘It has seemed to me that in all cases where it is desirable first to locate the base of the appendix, and usually too where
one wishes to make an entrance into an abscess originating in disease of this organ, it is much better to incise the abdominal wall a little to the outer side (lateral) of the normal situation of the appendix‘ [McBurney C. The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Annals of Surgery 1894: 20: 38–43]
Rovsing sign (1907)
Rovsing sign: In acute appendicitis, palpation of the left lower quadrant may elicit pain in the right lower quadrant. If this occurs, it is said to be a positive Rovsing sign.
- Niels Thorkild Rovsing (1862-1927) was a Danish surgeon
- Rovsing T. Indirektes Hervorrufen des typischen Schmerzes an McBurney’s Punkt. Ein Beitrag zur Diagnostik der Appendicitis und Typhlitis [Indirect elicitation of the typical pain at McBurney’s point. A contribution to the diagnosis of appendicitis and typhlitis]. Zentralblatt für Chirurgie 1907;34:1257-59
Sherren triangle (1905)
Sherren triangle is formed by the lines joining the summit of the iliac crest, the pubic tubercle and umbilicus. Sherren proposed the skin of this triangle is hyperaesthetic found in acute appendicitis
- James Sherren (1872 – 1945) British General surgeon
- Sherren J. The causation and treatment of Appendicitis. Practitioner, 1905; 74: 833-844
Sitkovskiy sign (1922)
Sitkovskiy sign [*aka Rosenstein Sign ]. Tenderness in the right lower quadrant increases when the patient moves from the supine position to a recumbent posture on the left side
- Piotr Porfiryevich Sitkovskiy (Петр Порфирьевич Ситковский) (1882 – 1933) Russian surgeon.
- Paul Rosenstein (1875 – 1964) German urologist
- Ситковский П. П. Об одном из клинических признаков при воспалении червеобразного отростка, Туркестанск. мед. журн., т. 1, № 1, с. 37, 1922
Volkovich-Kocher sign (1926)
The appearance of pain in the epigastric region or around the stomach at the beginning of disease with a subsequent shift to the right iliac region.
- Nikolay Markianovich Volkovich (Николай Маркианович Волкович) (1858 – 1928) Ukrainian surgeon.
- Волкович Н. М. Аппендицит, желчно-каменная болезнь, туберкулезный перитонит – Киев, 1926.
Of all the ills within the abdomenZachary Cope 1921
Which cause affliction to the sons of men
There’s none more often puts them in a fix
Than trouble in the worm-like appendix
- Fitz RH. Perforating inflammation of the vermiform appendix: with special reference to its early diagnosis and treatment. 1886
- Moore SW. The Physiological Basis for Diagnostic Signs of an Acute Abdomen. Surgical Clinics of North America, 1958; 38(2): 371–383.
- Berry J Jr, Malt RA. Appendicitis near its centenary. Ann Surg. 1984 Nov;200(5):567-75. [PMC1250537]
- Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA. 1996 Nov 20;276(19):1589-94. [PMID 8918857]
- McGee S. Evidence-Based Physical Diagnosis. Elsevier
- Rastogi V et al. Abdominal Physical Signs and Medical Eponyms: Movements and Compression. Clin Med Res. 2018 Dec;16(3-4):76-82 [PMC6306146]
- Alvarado A. How to improve the clinical diagnosis of acute appendicitis in resource limited settings. World J Emerg Surg. 2016 Apr 26;11:16. [PMC4845369]
myths behind the history