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