Appendicular abscess physical examination

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

Physical examinations mostly focus on abdominal findings. The patient may appear toxic with diffuse abdominal pain and high grade fever and tachycardia. Even minimal pressure on the abdomen can elicit a marked response from the patient due to pain.

• High grade fever
• Tachycardia
• Hypotension(If its associated with rupture)
• Tachypnea ^[1]

• Diaphoresis
• Pallor
• Cold extremities

• No masses

• Regular rate and rhythm
• Normal S1, S2
• No murmurs, rubs, or gallops

Bilateral normal vesicular breath sounds.

• The abdominal wall is very sensitive to mild palpation.
• Characteristic signs of appendicitis may not be present in abscess.
• Rebound tenderness and abdominal guarding can or cannot be elicited.
• 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.^[2]
• 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.^[3]

Alert, oriented X 3