Appendicitis is not always easily dx. That's why the physician/APN have these examination guidelines. But, the psoas, obturator signs, if absent, should never
One must consider differential dx as well. Such as (not all inclusive):
- even acute cholecystitis
Classic s/s do not always readily avail themselves in those with appendicitis. One classic sign that I observe is vomiting after the onset of pain. If vomiting occurs before
pain starts, one should reevaluate the situation for it probably is not appendicitis.
As for the rectal exam, in those cases where the provider failed to accurately dx appendicitis and the patient went on to perforate, this has been one issue cited in malpractice claims: failure to perform digital rectal exam
Abdominal X-rays are inconclusive in many cases. Abd. CT is specific.