Prominent pulsations with lateral expansion suggest an abdominal aortic aneurysm. Involuntary resistance, progressive abdominal rigidity. Patient is unable to relax muscles. Body's protective function against pain. Localized tenderness - usually in RLQ or right flank pain.
Rectal exam reveals right sided rectal tenderness.
May indicate inflammatory process other than appendicitis. Place right hand above right knee of the patient. Have the patient flex right knee against resistance. Alternatively, have the patient turn to side, extend right leg at right hip. Pain with maneuvers suggests irritation of Psoas muscle.