Appendicitis physical examination: Difference between revisions
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{{Appendicitis}} | {{Appendicitis}} | ||
{{CMG}} | {{CMG}} | ||
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==Overview== | ==Overview== | ||
Physical examination will mostly be focused on abdominal findings. The patient may be ill appearing, in pain, with a fever and mild tachycardia. Even minimal pressure on the abdomen may elicit a marked response from the patient due to pain. | Physical examination will mostly be focused on abdominal findings. The patient may be ill appearing, in pain, with a fever and mild tachycardia. Even minimal pressure on the abdomen may elicit a marked response from the patient due to pain. | ||
==Physical Examination== | |||
==Appearance of the Patient== | ===Appearance of the Patient=== | ||
Patient is usually ill appearing, may be of any age but more likely to be a child. They may be doubled over in pain, appearing distressed. | Patient is usually ill appearing, may be of any age but more likely to be a child. They may be doubled over in pain, appearing distressed. | ||
===Vitals=== | |||
==Vitals== | ====Temperature==== | ||
===Temperature=== | |||
*A [[fever]] is often present | *A [[fever]] is often present | ||
====Pulse==== | |||
===Pulse=== | =====Rate===== | ||
====Rate==== | |||
*[[Tachycardia]] may be present | *[[Tachycardia]] may be present | ||
====Rhythm==== | =====Rhythm===== | ||
*The pulse is regular | *The pulse is regular | ||
====Symmetry==== | =====Symmetry===== | ||
*The pulses may be asymmetric | *The pulses may be asymmetric | ||
===Blood Pressure=== | ====Blood Pressure==== | ||
*[[Hypotension]] may be present | *[[Hypotension]] may be present | ||
===Respiratory Rate=== | ====Respiratory Rate==== | ||
*[[Tachypnea]] may be present, or breathing patterns may be altered by patient to compensate for abdominal pain | *[[Tachypnea]] may be present, or breathing patterns may be altered by patient to compensate for abdominal pain | ||
==Skin== | ===Skin=== | ||
* [[Diaphoresis]] may be present | * [[Diaphoresis]] may be present | ||
* [[Pallor]] may be present | * [[Pallor]] may be present | ||
==Abdomen== | ===Abdomen=== | ||
* Abdominal wall very sensitive to mild palpation. | * Abdominal wall very sensitive to mild palpation. | ||
* [[Rebound tenderness]] | * [[Rebound tenderness]] | ||
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** This maneuver will cause pain in the [[hypogastrium]] | ** This maneuver will cause pain in the [[hypogastrium]] | ||
==Other== | ===Other=== | ||
* A digital rectal examination elicits tenderness in the [[rectovesical pouch]] in special cases of appendicitis | * A digital rectal examination elicits tenderness in the [[rectovesical pouch]] in special cases of appendicitis | ||
** In case of a retrocaecal appendix even deep pressure in the right lower quadrant may fail to elicit tenderness | ** In case of a retrocaecal appendix even deep pressure in the right lower quadrant may fail to elicit tenderness | ||
** If the appendix lies entirely within the pelvis, there is usually complete absence of the abdominal rigidity | ** If the appendix lies entirely within the pelvis, there is usually complete absence of the abdominal rigidity | ||
==References== | |||
{{reflist|2}} | |||
{{WH}} | |||
{{WS}} | |||
[[Category:Primary care]] | |||
[[Category:emergency medicine]] | |||
[[Category:Inflammations]] | |||
[[Category:Medical emergencies]] | |||
[[Category:General surgery]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Disease]] |
Revision as of 19:43, 6 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Physical examination will mostly be focused on abdominal findings. The patient may be ill appearing, in pain, with a fever and mild tachycardia. Even minimal pressure on the abdomen may elicit a marked response from the patient due to pain.
Physical Examination
Appearance of the Patient
Patient is usually ill appearing, may be of any age but more likely to be a child. They may be doubled over in pain, appearing distressed.
Vitals
Temperature
- A fever is often present
Pulse
Rate
- Tachycardia may be present
Rhythm
- The pulse is regular
Symmetry
- The pulses may be asymmetric
Blood Pressure
- Hypotension may be present
Respiratory Rate
- Tachypnea may be present, or breathing patterns may be altered by patient to compensate for abdominal pain
Skin
- Diaphoresis may be present
- Pallor may be present
Abdomen
- Abdominal wall very sensitive to mild palpation.
- Rebound tenderness
- Abdominal guarding
- Rovsing's sign
- Deep palpation of the left iliac fossa may cause pain in the right iliac fossa
- Psoas sign
- Occasionally, an inflamed appendix lies on the psoas muscle and the patient will lie with the right hip flexed for pain relief.
- Obturator sign
- If an inflamed appendix is in contact with the obturator internus, spasm of the muscle can be demonstrated by flexing and internally rotating the hip.
- This maneuver will cause pain in the hypogastrium
Other
- A digital rectal examination elicits tenderness in the rectovesical pouch in special cases of appendicitis
- In case of a retrocaecal appendix even deep pressure in the right lower quadrant may fail to elicit tenderness
- If the appendix lies entirely within the pelvis, there is usually complete absence of the abdominal rigidity