Clinical Skills 1 (Appendicitis)

Diagrammatic drawing of the normal site of cecum and appendix in the lower abdomen and of their relation to two visible and palpable auxiliary lines in the lower abdomen. The first line lies between the navel and the anterior upper iliac spine; the second line between the right and left spine. Mc Burney's point lies in the middle of the first line and corresponds to the base of appendix. The Lanz' point lies between the right and middle third of the second line and corresponds to the tip of the appendix. Here, localized tenderness can be palpated and pain can be elicited by pressure or sudden release of the palpating finger from the same or the contralateral side (Blumberg's sign). Because the appendix may lie retrocecally, deeply in the pelvis, or somewhere else, the corresponding points for localized tenderness (défense musculaire) must be looked for elsewhere; for instance, in the direction of the flank in retrocecal and in the direction of the bladder in pelvic appendicitis. In case of an unusual site of such a point the differential diagnosis of a Meckel's diverticulum has to be considered. $$abdo_16??££Picture for comparison.§§