Appendicitis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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