**Question:** Which of the following is not a sign of appendicitis?

A. Abdominal pain
B. Nausea and vomiting
C. Diarrhoea
D. Anorexia

**Core Concept:** Appendicitis is a condition characterized by inflammation of the appendix, often resulting from obstruction of the appendiceal lumen. Common symptoms include abdominal pain, nausea, vomiting, and anorexia. Diarrhoea is less common and not typically considered a primary sign of appendicitis.

**Why the Correct Answer is Right:** Diarrhoea is generally not considered a primary sign of appendicitis due to the following reasons:

1. Appendicitis typically presents with abdominal pain, which is a more specific and clear symptom indicative of localized inflammation.
2. Appendicitis often leads to nausea and vomiting as the body attempts to expel the irritant causing the obstruction.
3. Anorexia is a common accompanying symptom due to the patient's body response to pain and inflammation.

**Why Each Wrong Option is Incorrect:**

A. Abdominal pain: Presents as periumbilical or right lower quadrant pain that may radiate to the right iliac fossa.
B. Nausea and vomiting: Indicate the body's response to pain and potential irritant, such as an appendiceal obstruction.
D. Anorexia: Reflects the patient's body response to pain, inflammation, and potential irritant causing obstruction.

**Clinical Pearl:** Appendicitis symptoms should be considered in the context of the patient's clinical presentation, history, and examination findings. While abdominal pain, nausea, and vomiting are typical, diarrhoea may not be as reliable a sign. Early recognition and prompt treatment of appendicitis can prevent complications such as rupture and peritonitis, which increase morbidity and mortality rates.