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THE GALLBLADDER
MALIGNANCY
COURVOISIERS SIGN A PALPABLE NONTENDER GALL BLADDER IN A PATIENT WITH JAUNDICE SUGGESTING EXTRAHEPATIC OBSTRUCTUON OF THE BILIARY SYSTEM SECONDARY TO MALIGNANCY (ORIGINAL DESCRIPTION).
CHOLECYSTITIS
MURPHYS SIGN WITH THE EXAMINERS FINGERS POSITIONED ALONG THE INFERIOR BORDER OF THE LIVER IN THE RIGHT COSTAL ARCH THE PATIENT IS ALLOWED TO INSPIRE. DURING INSPIRATION THE INFLAMED GALLBLADDER TOUCHES THE EXAMINERS FINGERS RESULTING IN THE SUDDEN CESSATION OF INSPIRATION. BOAS SIGN HYPERESTHESIA AND REFERRED PAIN TO THE RIGHT COSTOPHRENIC ANGLE IN PATIENTS WITH ACUTE CHOLECYSTITIS.
PERITONITIS
COUGH TEST
CARNETTS SIGN ABDOMINAL WALL TENDERNESS TEST
PSOAS SIGN
PRINCIPLE - STRETCH OF PELVIC MUSCULATURE (ILIOPSOAS MUSCLE) WILL ELICIT PAIN. ROLL THE PATIENT ON THEIR LEFT SIDE AND HYPEREXTEND THE RIGHT HIP. PAIN WITH EXTENSION IS A POSITIVE SIGN
COPES EARLY DIAGNOSIS OF THE ACUTE ABDOMEN, 19TH ED. OXFORD UNIVERSITY PRESS, 1996
OBTURATOR SIGN
PRINCIPLE SAME AS PSOAS SIGN. THE EXAMINER FLEXES THE PATIENTS RIGHT HIP AND INTERNALLY ROTATES THE RIGHT HIP. PAIN WITH INTERNAL ROTATION IS A POSITIVE SIGN.
COPES EARLY DIAGNOSIS OF THE ACUTE ABDOMEN, 19TH ED. OXFORD UNIVERSITY PRESS, 1996
APPENDICITIS
ROVSINGS SIGN ALSO KNOW AS INDIRECT TENDERNESS. THE SIGN IS POSITIVE WHEN PRESSURE APPLIED TO THE LEFT LOWER QUADRANT RESULTS IN RIGHT LOWER QUADRANT PAIN. PSOAS SIGN SEE PREVIOUS SLIDES. OBTURATOR SIGN SEE PREVIOUS SLIDES. RECTAL TENDERNESS PATIENTS WITH APPENDICITIS INVOLVIN/G THE PELVIS MAY HAVE RECTAL TENDERNESS ON EXAMINATION.
MC BURNEYS POINT TENDERNESS A POINT 1 -2 INCHES FROM THE ANTERIOR SUPERIOR SPINOUS PROCESS OF THE ILEUM ON A STRAIGHT LINE DRAWN FROM THAT PROCESS TO THE UMBILICUS. IN 1889 CHARLES MCBURNEY STATED THAT ALL PATIENTS WITH APPENDICITIS HAD MAXIMAL PAIN AT THIS POINT.
J EMERG MED 1986;4:57-63 HAMILTON BAILEYS DEMONSTRATIONS OF PHYSICAL SIGNS IN CLINICAL SURGERY, BRISTOL, 1986, WRIGHT
PLACE BOTH HANDS ON THE ABDOMEN WITH THE INDEX FINGER ON EITHER SIDE OF THE PULSATING AORTA. ESTIMATE THE WIDTH ( NL <2.5CM IN WIDTH).
JAMA 1999;281:77-81