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Why appendicitis pain moves to the right iliac fossa
Surgery · exam-style practice question with explanation
Pain in acute appendicitis typically starts around the umbilicus and later moves to the right iliac fossa. What explains the move?
- A. The appendix migrates as it swells
- B. Visceral pain gives way to parietal peritoneal irritation
- C. Referred pain from the right ureter
- D. Spread of infection to the caecum
Show the answer and explanation
Answer: B. Visceral pain gives way to parietal peritoneal irritation
Early on, the inflamed appendix causes poorly localised visceral pain felt in the midgut area, around the umbilicus. When inflammation reaches the overlying parietal peritoneum, which has somatic nerve supply, the pain localises to the right iliac fossa near McBurney's point.
Key point: Periumbilical (visceral) pain, then RIF (parietal peritoneum) pain.
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