In appendicitis the initial presenting symptom is generalized periumbilical abdominal pain, which localizes over a 24-hour time period to the right lower quadrant. The pain is initially mild, but increasing to become steady and more severe. It may be aggravated by movement or cough. The patient experiences anorexia, nausea, and possible vomiting. These symptoms are found in classic appendicitis. The more unusual presentations of appendicitis occur at the extremes of age, which this patient does not fall into. A patient with a ruptured appendix would have worse vital signs and a rigid abdomen.
In our patient's scenario, the location of the pain, which has not changed since the onset, is in the left lower quadrant, which is less likely to be caused by appendicitis.
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