Appendicitis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farwa Haideri [2]
Overview
Physical examinations mostly focus on abdominal findings. The patient may appear in pain with a fever and mild tachycardia. Even minimal pressure on the abdomen can elicit a marked response from the patient due to pain.
Physical Examination
Vitals
- Fever
- Tachycardia
- Hypotension
- Tachypnea
- Breathing patterns may be altered by patient to compensate for abdominal pain.[1]
Skin
Abdomen
- The abdominal wall is 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[2]
- 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.
- A digital rectal examination elicits tenderness in the rectovesical pouch in special cases of appendicitis.[3]
- 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 abdominal rigidity.
References
- ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
- ↑ Stockman III, James A. (2012), Year Book of Pediatrics 2012 (2012 ed.), Maryland Heights, MO: Mosby
- ↑ Appendicitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Appendicitis Accessed on March 14th, 2016