A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
- Inspection (viewing).
- Skin, mucous membranes, oral cavity and sclerae (white part of the eye) [secondary symptom: dry tongue].
- Abdomen
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Auscultation (listening) of the heart [due todifferential diagnoses:
- Auscultation of the lungs
- Examination of the abdomen (belly):
- Auscultation of the abdomen [vascular or stenotic sounds?, bowel sounds?]
- Palpation (palpation) of the abdomen, etc., with examination of pressure points (see below) (tenderness?, knocking pain?, coughing pain?, guarding tension?, bowel sounds?, hernial orifices?, surgical scars?, renal bearing knocking pain?) [Leading symptom: pain that usually occurs in the area of the right lower abdomen.
- Local (local) defensive tension in the right lower abdomen → irritation of the parietal peritoneum (abdominal cavity lining outer sheet of peritoneum).
- Diffuse defensive tension (spread, i.e., without definite boundaries) → indication of a severe complicated form of appendicitis]
- Pressure points in appendicitis:
- McBurney point – pressure pain in the middle of the line between the umbilicus and the spina iliaca anterior superior (anterior superior iliac spine – very prominent bony prominence that is easily palpable through the skin).
- Lanz point – pressure pain on the line connecting the two spinae iliacae anteriores superiores (anterior superior iliac spine – very prominent and easily palpable through the skin bony prominence) in the right third.
- Release pain (Blomberg’s sign) – pain in the area of the appendix (appendix) when releasing the pressure point on the contralateral side (opposite side).
- Rovsing’s sign – pain is triggered when swiping the large intestine in the direction of the appendix.
- Douglas pain – irritation of the peritoneum (peritoneum) with pain triggered by rectal palpation (examination through the rectum).
- Psoas sign – pain in the area of the appendix (appendix) when lifting the right leg against resistance.
- Baldwin’s sign – pain in the right flank caused by flexion of the right leg.
- Cope sign – pain is triggered when the right leg is hyperextended in the left lateral position.
- Obturator sign – when the right leg is internally rotated (internally rotated), a pain is triggered in the right lower abdomen
- Sitkowski’s sign – when the patient is positioned in the left lateral position, a pain is triggered.
- Chapman sign – when the upper body is raised, a pain occurs.
- Ten-horn sign – when pulling the spermatic cord can cause a pain in the right lower abdomen.
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation [leading symptoms: urge to defecate, fecal retention].
- Inspection (viewing).
- If necessary, gynecological examination[due todifferential diagnoses:
- Extrauterine pregnancy – implantation of the fertilized egg outside the uterus (womb) such as: Tubalgravidity (ectopic pregnancy), Ovariangravidity (pregnancy in the ovary), Peritonealgravidity/Abdominalgravidity (abdominal pregnancy) or Cervicalgravidity (a pregnancy in the cervix).
- Endometriosis – occurrence of endometrium (lining of the uterus) outside the uterus, for example, in or on the ovaries (ovaries), tubes (fallopian tubes), urinary bladder or intestines].
- If necessary, urological examination [due todifferential diagnoses: renal colic, mainly caused by kidney stones; pyelonephritis (inflammation of the renal pelvis)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
