Signs

• patient looks unwell

• flushed at first, then pale

• furred tongue and halitosis

• tenderness in RIF, usually at McBurney's point

• local rigidity and rebound tenderness

• ± superficial hyperaesthesia

• ± psoas sign: pain on resisted flexion of right leg, on hip extension or on elevating right leg (due to irritation of psoas especially with retrocaecal appendix)

• ± obturator sign: pain on flexing patient's right thigh at the hip with the knee bent and then internally rotating the hip (due to irritation of internal obturator muscle)

• Rovsing's sign: tenderness in RIF while palpating in LIF

PR: tenderness to right, especially if pelvic appendix or pelvic peritonitis.

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