Clinical Skills 2 (Appendicitis)

abdo_10a_n.jpg and abdo_10b_n.jpg: Performance of rectal examination. A differentiated rectal examination with movements of the index finger is only useful in cooperative schoolchildren. In younger children a simple rectal examination is only indicated if findings should be excluded, such as Douglas' abscess, torsion of the ovary in cysts or tumors, low intussusception or rectal polyp, pelvic tumor or other pathologies. abdo_10a_n.jpg: Position of the fingers. The examination is performed at best with a latex-free glove. With the remaining fingers in an ulnar deviation the index finger is used lubricated by oil. abdo_10b_n.jpg: After pausing with the index finger introduced into the anus and calming the patient the child may be asked about pain in the Douglas' cul-de-sac. The up and down movements of the examining index finger can be demonstrated to the child by simultaneous movements of the index finger of the other hand. Only after that the rectal lumen and its environment is palpated.