What is the pathophysiology of left lower quadrant pain presenting in appendicitis?

Radiating pain: the nerves of the appendix also innervates the entire colon. When you push on the left side you and then release the nerves are stimulated. Since the appendix is inflamed the distention of the left transmits to the right and you sense the pain. The visceral peritoneum is directly attached. If the appendix is ruptured then the parietal peritoneum is inflamed and the test no longer holds.

Two causes: The appendix is usually located in the right lower quadrant(RLQ). That is where the most pain and tenderness usually occur. However occasionally the pain and tenderness localize in the left lower quadrant(LLQ) when the appendix is unusually long and extends from the RLQ over to the LLQ. Another cause of "left sided appendicitis" is Situs Inversus (see Wiki: http://bit.ly/1uo4Fg5) reversed organs