lying still, with shallow breaths and reluctant to cough
tachycardia
fever 37.5-38.5øC, worsening with perforation
foetor oris - halitosis
furred tongue
flushed
right iliac fossa signs:
tenderness:
dependent on position of viscus; localised tenderness per se is a more valuable sign than tenderness localised over McBurney's point
not evident before later inflammation of serosa and parietal peritoneum
often masked in obese due to inability to displace viscus
rigidity:
after the development of localised tenderness
localised initially progressing to generalised with perforation or increasing peritonitis
guarding
rebound tenderness
tender on the right per rectum
a mass in the right iliac fossa is suggestive of abscess formation
positive Rovsing's sign
with retrocaecal appendicitis, possible positive:
psoas sign
obturator sign
paraesthesia:
occasionally reported in the distribution of T10-T12 on the right side
test with light scratch with a sterile needle
Notes:
a systematic review revealed that the most useful single feature for diagnosing appendicitis in children with abdominal pain was fever in unselected children and rebound tenderness in selected children (1)
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