Popular mnemonic used to remember the Alvarado score factors is MANTRELS - Migration to the right iliac fossa, Anorexia, Nausea/Vomiting, Tenderness in the right iliac fossa,Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of leukocytes to the left (factors listed in the same order as presented above). Due to the popularity of this mnemonic, the Alvarado score is sometimes referred to as the MANTRELS score.
Signs and symptoms lead to the diagnosis of different health conditions. Similarly, the following signs lead to the diagnosis of appendicitis.
(3) White or furred tongue
(4) Fetor oris (an offensive odor)
(1) Pointing sign: Patient precisely localise the pain where it started and where to moved.
(2) Cough sign: Patient feels pain in right iliac fossa with cough impulse.
(3) Localized tenderness: When pain has been shifted to right iliac fossa it becomes localized at McBurney’s point.
(4) Muscle guarding and rigidity: Doctor can feel guarding and rigidity in right iliac fossa on palpation.
(5) Rebound tenderness: When hand is pressed and then released in right ilaic fossa the patient complains of pain.
(6) Rovsing’s sign: When left iliac fossa is pressed in patient with appendicitis, the patient feels pain in right iliac fossa.
(7) Psoas sign: In case of retrocaecal appendix, hyperextension of right hip causes pain in right iliac fossa. This is due to irritation of psoas muscle.
(8) Obturator sign: In case of pelvic appendix, the internal rotation of right hip causes pain in right iliac fossa. It is due to irritation of obturator muscle. (Last month, my friend suffered from appendicitis at night and passed the whole night in the emergency. However, he recovered his inflamed appendix and saved himself from undergoing operation of the inflamed appendix).