In addition to the abdomen, what should be included in the physical exam of a patient with suspected appendicitis?

Updated: Jul 23, 2018
  • Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

A careful physical examination, not limited to the abdomen, must be performed in any patient with suspected appendicitis. Gastrointestinal (GI), genitourinary, and pulmonary systems must be studied. Male infants and children occasionally present with an inflamed hemiscrotum due to migration of an inflamed appendix or pus through a patent processus vaginalis. This is often initially misdiagnosed as acute testicular torsion. In addition, perform a rectal examination in any patient with an unclear clinical picture, and perform a pelvic examination in all women with abdominal pain.

According to the American College of Emergency Physicians (ACEP) 2010 clinical policy update, clinical signs and symptoms should be used to stratify patient risk and to choose next steps for testing and management. [8, 9]


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