Which examination helps to evaluate for acute appendicitis in a patient?

The evaluation for acute appendicitis often includes specific physical examination maneuvers that assess for signs of irritation of the peritoneum surrounding the appendix. Testing the obturator and iliopsoas muscles is particularly relevant in this context because these tests can help elicit pain when the appendix is inflamed.

The iliopsoas test involves flexing the thigh against resistance, which can provoke pain if an inflamed appendix is in close proximity to the iliopsoas muscle. Similarly, the obturator test involves internal rotation of the hip, which can also cause pain if there is irritation in the lower right abdominal quadrant due to appendicitis.

While palpation of the abdomen, percussion, and checking for rebound tenderness are all important components of a physical examination, they do not specifically target the assessment of acute appendicitis in the same way the iliopsoas and obturator tests do. Rebound tenderness, for instance, suggests peritoneal irritation but does not localize the issue to the appendix. Therefore, the specific muscle tests help clarify the diagnosis of appendicitis more efficiently by focusing on signs of inflammation directly related to the anatomical structures involved.