Appendicitis physical examination

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

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.

Skin

• Diaphoresis
• Pallor

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
  • 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
  • If the appendix lies entirely within the pelvis, there is usually complete absence of abdominal rigidity