Guide to Clinical Examination/Quick Guide/Gastrointestinal examination

Diagnosis of Acute Appendicitis

On History: Anorexia with vomiting 75% of cases

15% report diarrhea (esp in children)

Describes pain as sharp or colicky of less than three days duration

Pain tends to decrease upon rupture

On Exam:

Increased pulse and temperature

Patient avoids movement due to pain

Localized Abdominal Signs:

---Abdomen is rigid with guarding

---Rovsing’s sign = RLQ pain on palpation of LLQ

---Obturator sign pain on external rotation of right leg

---Flex pain = pain on flexion of hip (internal obturator muscle)

---Psoas sign = pain on rear extension of hip (iliopsoas muscle)

sometimes a tender mass on rectal exam

LABORATORY

WBC moderate increase (<20K) with increased Segs

ESR increased

U/A w/o signs of infection

Often an air-fluid level seen on abdominal x-ray

DIFFERENTIAL DIAGNOSIS:

Acute gastro-enteritis

U TI

Ureteral colic

Meckel’s diverticulosis

Mesenteric Lymphadenitis

Intussusception in young children

Primary peritonitis

Peptic ulcer

Females:

--Pelvic Inflammatory Disease

--Twisted Ovarian Cyst

--Ruptured Follicle

Males:

--Epididymitis

--Testicular torsion