← All Conditions ← Digestive Overview

Appendicitis

★ CMTO Exam Focus

Acute inflammation of the vermiform appendix, most commonly caused by luminal obstruction. Appendicitis is the most common surgical emergency of the abdomen, with peak incidence in adolescents and young adults (ages 10-30). It presents with abdominal pain that can initially mimic musculoskeletal or digestive complaints. Delayed recognition leads to perforation and peritonitis within 24-72 hours — a life-threatening complication.

Recognition

  • Classic pain progression: Periumbilical pain migrating to the right lower quadrant (RLQ) within 12-24 hours
  • McBurney point tenderness: Sharp tenderness at one-third the distance from the ASIS to the umbilicus — the hallmark finding
  • Rebound tenderness: Pain worsens when pressure is released — indicates peritoneal irritation
  • Anorexia (often the earliest symptom), nausea, vomiting (usually after pain onset)
  • Low-grade fever (higher fever suggests perforation)
  • Rovsing sign: RLQ pain with palpation of the LLQ
  • Psoas sign: RLQ pain with right hip extension (retrocecal appendix)
  • Atypical presentations: Pregnant women (appendix displaced superiorly), elderly (blunted symptoms), children (rapid progression to perforation)

MT Relevance

  • Acute appendicitis is a medical emergency — massage is contraindicated. Any client with acute abdominal pain, fever, and RLQ tenderness must be referred for emergency medical evaluation immediately. Do not perform abdominal massage when appendicitis is suspected.
  • Post-appendectomy: Gentle massage supports recovery and is fully safe once surgical healing is complete. Scar tissue mobilization after full healing (typically 2-4 weeks for laparoscopic, 4-6 weeks for open). Post-surgical adhesions can cause chronic abdominal discomfort that benefits from careful manual work.

Required Actions

  • RLQ tenderness with rebound at McBurney point: Cease all treatment and refer to emergency services immediately
  • High fever (> 38.5C) with severe RLQ pain and abdominal rigidity: Suggests perforation — call 911
  • Do not delay referral by attempting further assessment — perforation can occur within 24-72 hours of symptom onset

Key Takeaways

  • Appendicitis is the most common surgical emergency of the abdomen, peaking in ages 10-30
  • Classic presentation: periumbilical pain migrating to RLQ, anorexia, low-grade fever
  • McBurney point tenderness with rebound is the hallmark — refer immediately
  • Massage is contraindicated during acute appendicitis. Safe and beneficial post-appendectomy after healing
  • Perforation can occur within 24-72 hours — delayed recognition is dangerous

Related Conditions

Sources

  • Werner, R. (2019). A massage therapist's guide to pathology (7th ed.). Books of Discovery.
  • Norris, T. L. (2019). Porth's essentials of pathophysiology (5th ed.). Wolters Kluwer.
  • Tortora, G. J., & Derrickson, B. H. (2021). Principles of anatomy and physiology (16th ed.). Wiley.
← All Conditions Digestive Overview →