Rovsing's sign
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2008-06-30T11:43:54Z
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'''Rovsing's sign''', named after the Danish surgeon [[Niels Thorkild Rovsing Kimpel]]<ref>http://www.whonamedit.com/synd.cfm/3126.html Rovsing's sign (www.whonamedit.com)</ref>, is a sign of [[appendicitis]]. If palpation of the [[lower left quadrant]] of a person's [[abdomen]] results in more pain in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis.
==Referral of pain==
This anomaly occurs because the [[pain]] [[nerve]]s deep in the [[intestine]]s do not localize well to an exact spot on the [[abdominal wall]], unlike pain nerves in [[muscle]]s. Pain from a stomach [[ulcer]] or [[gallstone]] can be interpreted by the brain as pain from the [[stomach]], [[liver]], [[gall bladder]], [[duodenum]], or first part of the [[small intestine]]. It will "refer" pain often to the mid upper abdomen.
Because the [[appendix]] is a piece of intestine, it follows a similar referral pattern. An appendix with some early inflammation may give a non-specific irritation somewhere near the [[umbilicus]] (belly button). Should the inflammation become severe, it may actually irritate the inner lining of the abdominal cavity called the [[peritoneum]]. This thin layer lies under or behind the abdominal wall muscles. Now the pain is "localized". If pressure is applied to the muscles of the right lower abdomen (or [[iliac fossa]]) near a very irritated appendix, then the muscle fibers in that area will be stretched and will hurt.
==Process==
A Rovsing's sign is elicited by pushing on the abdomen far away from the appendix in the left lower quadrant as in most people the appendix is in the right lower quadrant. While this maneuver stretches the entire peritoneal lining, it only causes pain in any location where the peritoneum is irritating the muscle. In the case of appendicitis, the pain is felt in the right lower quadrant despite pressure being placed elsewhere.
Most practitioners push on the left lower quadrant to see where the patient complains of pain. If pain is felt in the right lower quadrant, then there may be an inflamed organ or piece of tissue in the right lower quadrant. The appendix is generally the prime suspect, although other pathology can also give a "positive" Rovsing's sign. If left lower quadrant pressure by the examiner leads only to left-sided pain or pain on both the left and right sides, then there may be some other [[pathology|pathologic]] [[etiology]]. This may include causes relating to the [[urinary bladder|bladder]], [[uterus]], [[colon (anatomy)|descending (left) colon]], [[fallopian tubes]], [[ovaries]], or other structures.
==See also==
* [[Abdominal exam]]
* [[McBurney's sign]]
==References==
{{reflist}}
{{Unreferenced|date=October 2007}}
[[Category:Medical signs]]
{{med-sign-stub}}
{{Eponymous medical signs for digestive system and general abdominal signs}}
[[es:Signo de Rovsing]]
[[pl:Objaw Rovsinga]]
[[pt:Sinal de Rovsing]]
[[ru:Симптом Ровзинга]]