ZyraDoc #56 - September 26, 2026

A 22-year-old male presents with a 24-hour history of vague periumbilical abdominal pain that migrated to the right lower quadrant, accompanied by anorexia, nausea, and low-grade fever.

On physical examination, he exhibits severe tenderness at McBurney's point, localized abdominal guarding, rebound tenderness, and a positive Rovsing sign.

Laboratory evaluation reveals leukocytosis (15,200/µL with a left shift), and an abdominal ultrasound demonstrates a non-compressible, blind-ending tubular structure in the right lower quadrant measuring 8.5 mm in outer diameter, confirming Acute Appendicitis.

Case Summary

Clinical Focus:

The diagnosis is Uncomplicated Acute Appendicitis.

Aetiology/Cause:

Luminal obstruction of the vermiform appendix, most commonly secondary to lymphoid hyperplasia (in adolescents/young adults) or a fecalith/appendicolith.
Obstruction causes increased intraluminal pressure, venous congestion, mucosal ischemia, and rapid bacterial overgrowth (e.g., Escherichia coli and Bacteroides fragilis).

Clinical Features:

Classic visceral periumbilical pain migrating to the right lower quadrant (McBurney point).
Anorexia (hamburger sign), low-grade fever, nausea, and vomiting occurring after pain onset.
Peritoneal signs: localized guarding, rebound tenderness, Rovsing sign, Psoas sign, and Obturator sign.

Diagnosis and Investigations:

You've already played this ZyraDoc! Try out others from the Archives, or come back tomorrow for a new one!

Incorrect!

Correct!

Please pick from the selection list or skip

1/3.

✗

2/3.

✗

3/3.

✗

What's the Best Next Step?

Case Summary

Reset Password

Verify Your Account

Verify Your Account