A 23-year-old man comes to the physician because of a 2-day history of abdominal pain. Initially, the pain was diffuse and colicky, but over the past 24 hours, it has become sharp and has localized to the right lower quadrant; he has had nausea and has vomited three times. His last bowel movement was 2 days ago. His temperature is 38.1°C (100.6°F), pulse is 95/min, and blood pressure is 130/75 mm Hg. The lungs are clear to auscultation. Heart sounds are normal. Abdominal examination shows right lower quadrant tenderness with guarding. Which of the following is the underlying mechanism of the shift in location of this patient's pain?

A) Arterial occlusion
B) Inflammation to the parietal peritoneum
C) Progressive increase in intraluminal pressure
D) Transmigration of bacteria through the visceral wall
E) Visceral perforation

Thanks

i think the answer is B or D. because when appendicitis first starts out it's localized, but that diffuse visceral pain means that the infection has spread. this is why there is rebound pain..because the infection is getting worse and worse.
edited by pinomontalbano on 2/5/2013

Thanks , but it didnt help

it's B. i did it like that in NBME 4 n it didnt shopw up in my mistakes.

B