• The patient is conscious and oriented to time, place and person.
General Physical Examination
• Pulse: _______/min
• Blood Pressure: / mmHg
• Respiratory Rate: _______/min
• Temperature: ___ °F
• BMI:_____kg/m²
• Built and nourishment:
General examination :
• Pallor: Present / Absent
• Icterus: Present / Absent
• Cyanosis: Present / Absent
• Clubbing: Present / Absent
• Lymphadenopathy: Present / Absent
• Pedal edema: Present / Absent
• General condition: Comfortable / Toxic
Inspection of Abdomen
• Shape of abdomen: Symmetrical / Asymmetrical
• Movement with respiration: Normal / Restricted
• Fullness in right iliac fossa: Present / Absent
• Overlying skin: Normal / Erythema
• Scars: Present / Absent
• Sinuses: Present / Absent
• Dilated veins: Present / Absent
• Visible peristalsis: Present / Absent
• Umbilicus: Central and inverted / Everted / Deviated
• Generalized abdominal distension: Present / Absent
Palpation
Local Examination of Lump
• Lump palpable in: Right iliac fossa / Other ______________
• Number: Solitary / Multiple
• Size:___ × ___cm
• Shape: Oval / Rounded / Irregular
• Surface: Smooth / Nodular
• Margins: Well-defined / Ill-defined
• Overlying skin: Normal / Abnormal
• Skin pinchable: Yes / No
Consistency and Tenderness
• Consistency: Soft / Firm / Hard
• Tenderness: Present / Absent
• Local rise of temperature: Present / Absent
Mobility
• Movement with respiration: Present / Absent
• Mobility: Restricted / Freely mobile
• Can be moved out of right iliac fossa: Yes / No
• Lower border: Palpable / Not palpable
• Upper border: Distinct / Indistinct
• Lateral border: Distinct / Indistinct
Signs of Localized Peritonitis
• Guarding in right iliac fossa: Present / Absent
• Rigidity in right iliac fossa: Present / Absent
• Rebound tenderness: Present / Absent
• Cough tenderness: Present / Absent
Special Signs
• Rovsing’s sign: Positive / Negative
• Psoas sign: Positive / Negative
• Obturator sign: Positive / Negative
Percussion
• Note over swelling: Dull / Resonant
• Evidence of free fluid: Present / Absent
Auscultation
• Bowel sounds: Normal / Sluggish / Absent
Associated Features
• Fever: Present / Absent
• Tachycardia: Present / Absent
• Nausea: Present / Absent
• Vomiting: Present / Absent
• Anorexia: Present / Absent
• Constipation: Present / Absent
• Diarrhea: Present / Absent
• Evidence of intestinal obstruction: Present / Absent
Examination of Hernial Orifices and External Genitalia
• Hernial orifices: Normal / Abnormal
• External genitalia: Normal / Abnormal
• Right-sided fullness: Present / Absent
• Per-rectal examination otherwise: Normal / Abnormal
Examination of Remaining Abdomen
• Abdomen soft: Yes / No
• Hepatomegaly: Present / Absent
• Splenomegaly: Present / Absent
• Other palpable masses: Present / Absent
• Generalized peritonitis: Present / Absent
Systemic Examination
Cardiovascular System:
Respiratory System:
Appendicular Lump Examination Summary
The patient is conscious and oriented to time, place and person. He/She is examined in a well-lit room, adequately exposed, in supine position, after taking verbal consent.
General physical examination revealed pulse _/min, blood pressure _ mmHg, respiratory rate _/min, temperature ___°F and BMI _. The patient is moderately built and nourished. Pallor/Icterus/Cyanosis/Clubbing/Lymphadenopathy/Pedal edema are present or absent accordingly. The patient is afebrile/febrile and appeared comfortable/toxic.
On inspection of the abdomen, the abdomen is symmetrical/asymmetrical and moved normally/restricted with respiration. Fullness is noted over the right iliac fossa. The overlying skin is normal with no scars, sinuses, dilated veins or visible peristalsis. The umbilicus is central and inverted.
On palpation, a solitary lump is palpable in the right iliac fossa measuring approximately __ × __ cm. The lump is oval/rounded in shape with well-defined/ill-defined margins and a smooth surface. The overlying skin is normal and pinchable.
The lump is soft/firm in consistency and tender/non-tender. Local rise of temperature is present/absent. The mass moved minimally with respiration and had restricted mobility. It could not be moved out of the right iliac fossa. The lower and medial borders are palpable, whereas the upper and lateral borders are indistinct/not well defined due to surrounding inflammatory adhesions.
Guarding and rigidity over the right iliac fossa are present/absent. Rebound tenderness is present/absent. Cough tenderness is present/absent. Rovsing’s sign, psoas sign and obturator sign are positive/negative as applicable.
The swelling is dull on percussion. There is no evidence of free fluid in the peritoneal cavity. On auscultation, bowel sounds are normal/sluggish/absent.
Examination for associated features revealed fever, tachycardia, nausea, vomiting, anorexia and constipation/diarrhea present/absent. There is no generalized abdominal distension or evidence of intestinal obstruction.
Examination of the hernial orifices and external genitalia is unremarkable. Per-rectal examination revealed right-sided rectal tenderness/fullness or is normal.
The remainder of the abdomen is soft, with no hepatosplenomegaly or palpable masses elsewhere. There is no clinical evidence of generalized peritonitis.
Systemic examination revealed normal cardiovascular and respiratory findings. Examination of other systems is unremarkable.
Summary
This is a case of an appendicular lump presenting as a tender, firm, ill-defined mass in the right iliac fossa associated with __ (fever, tachycardia, guarding, localized peritonitis, right-sided rectal tenderness, etc.), with no evidence of generalized peritonitis or intestinal obstruction.
One-line Case Presentation
This is a case of appendicular lump presenting as a tender, firm, ill-defined mass in the right iliac fossa with features of localized inflammation and no evidence of generalized peritonitis, suggestive of an inflammatory appendicular mass secondary to acute appendicitis.
