Acute Appendicitis (typical presentation) - Abdominal Examination

AP

Acute Appendicitis — Abdominal Examination

Focused findings highlighting localized peritonism and classical appendicitis signs.

RLQ tenderness

McBurney’s point

Rovsing’s sign

General Inspection

Patient appears uncomfortable and mildly distressed with guarded movements. Mild tachycardia may be present. Skin is warm, with no jaundice or pallor.

Inspection of the Abdomen

Abdomen may appear near-normal in contour but with localized guarding or antalgic posture. No visible surgical scars. Focal fullness or distension may be seen in the right lower quadrant (RLQ).

Palpation

Light palpation

Marked focal tenderness in the RLQ, maximal at McBurney’s point.

Deep palpation

Localized rigidity and rebound tenderness present. Guarding palpable.

Rovsing’s sign

Pain in RLQ upon palpation of left lower quadrant (positive).

Psoas / Obturator signs

May be positive, suggesting retrocecal appendix.

Other findings

No organomegaly or masses unless appendicular lump has formed.

Percussion

Mild localized tenderness on percussion over RLQ. Percussion note is generally tympanic unless paralytic ileus develops.

Auscultation

Bowel sounds are initially normal or slightly hyperactive, but may diminish with localized peritonitis.

Special Tests

Document guarding, rebound tenderness, Rovsing’s, psoas, and obturator signs. If a palpable mass is found in RLQ, describe its size, consistency, tenderness, and definition (suggestive of appendicular lump or abscess).

Conclusion

Findings are consistent with localized peritonism in the right lower quadrant — suggestive of acute appendicitis. Presence of an ill-defined tender mass would indicate an appendicular lump or abscess. Correlate with laboratory tests and imaging (ultrasound/CT) for confirmation.

Viva Summary (formal):

This patient demonstrates localized tenderness, rebound, and guarding in the right lower quadrant maximal at McBurney’s point, consistent with acute appendicitis. Rovsing’s and psoas signs may support the diagnosis. Further evaluation with ultrasound or CT abdomen is indicated.

Examination Tips (point form):

• Always inspect and palpate gently, starting away from the area of maximal tenderness.
• Ask the patient to cough lightly — localized pain supports peritonism.
• Rebound tenderness and involuntary guarding are key indicators of peritoneal irritation.
• Rovsing’s, psoas, and obturator tests help localize the inflamed appendix.
• If a mass is palpable, consider appendicular lump (phlegmon) vs abscess and avoid deep palpation to prevent rupture.
• Confirm clinical suspicion with imaging and monitor for progression to generalized peritonitis.

Prepared for surgical examination practice

Updated: Oct 2025