In which disease is a positive Rovsing's sign present?

Haryana CHO - 2022

Medical & Surgical Nursing

Easy

Appeared in: Haryana CHO - 2022

Explanation

Rovsing's sign is elicited when pressure on the left lower quadrant (LLQ) of the abdomen causes pain in the right lower quadrant (RLQ).
This referred pain occurs because palpation of the LLQ stretches the peritoneum, irritating the inflamed appendix in the RLQ.
It is a specific sign used in the physical examination to help diagnose acute appendicitis.
The mechanism involves the displacement of bowel gas by the palpating hand, which distends the cecum and appendix, causing pain.

Option A: Colitis, which is inflammation of the colon, typically presents with generalized or localized abdominal pain, cramping, and diarrhea, but it is not associated with Rovsing's sign.
Option B: Cholecystitis is inflammation of the gallbladder. The classic sign for this condition is Murphy's sign, where deep palpation of the right upper quadrant (RUQ) during inspiration causes sharp pain and an abrupt stop in inspiration.
Option D: Pancreatitis is inflammation of the pancreas. It typically causes severe epigastric pain that radiates to the back. In severe, hemorrhagic cases, it can be associated with Cullen's sign (periumbilical bruising) or Grey Turner's sign (flank bruising), not Rovsing's sign.

Clinical Relevance

Nursing practice connection: Knowing Clinical assessment signs for acute abdominal conditions helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Early and accurate identification of appendicitis using signs like Rovsing's is crucial for prompt surgical intervention, which prevents complications such as perforation, abscess formation, and peritonitis.
A nurse's thorough abdominal assessment, including checking for specific signs, provides vital information to the healthcare team, aiding in differential diagnosis and timely treatment.
What if? If a patient with suspected appendicitis suddenly reports that their severe pain has completely disappeared, the nurse must immediately suspect appendiceal rupture. This is a medical emergency, and the provider must be notified instantly, as the patient is at high risk for sepsis.

How to Approach the Question

First, identify the key term in the question, which is 'Rovsing's sign'.
Recall the definition of Rovsing's sign: pain in the right lower quadrant (RLQ) upon palpation of the left lower quadrant (LLQ).
Access your knowledge base of medical-surgical nursing to remember which condition is associated with this specific clinical sign.
Evaluate the given options: Colitis, Cholecystitis, Appendicitis, and Pancreatitis.
Match the sign to the correct pathology. Rovsing's sign is a classic indicator of peritoneal irritation in the RLQ, pointing directly to appendicitis.
Confirm your choice by mentally ruling out the other options and their associated signs (e.g., Cholecystitis with Murphy's sign).

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 pp. 499-501, 636-638