Appendicular abscess physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Physical Examination

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.

Vitals

• Fever
• Tachycardia
• Hypotension if the abscess is ruptured and associated with hemorrhage.
• Tachypnea.

Skin

• Diaphoresis
• Pallor
• Cold extremities.

Abdomen

• The abdominal wall is very sensitive to mild palpation.
• Rebound tenderness (it cannot be elicited in most of the patients due to abscess formation)
• 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.
• 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.