ACUTE ABDOMEN Part 01

SPECIFIC "SIGNS" ON PHYSICAL EXAMINATION   Blumberg's sign (rebound tenderness): constant, held pressure with sudden ...

SPECIFIC "SIGNS" ON PHYSICAL EXAMINATION 

Blumberg's sign (rebound tenderness):

• constant, held pressure with sudden release causes severe tenderness (peritoneal irritation) 

Courvoisier's sign:

• palpable non-tender gall bladder in jaundiced patient suggesting malignant common bile duct obstruction 

Cullen's sign:

• purple-blue discoloration around umbilicus (peritoneal hemorrhage) 

Grey Turner's sign:

• flank discoloration (retroperitoneal hemorrhage)

Iliopsoas sign:

• flexion of hip against resistance or passive hyperextension of hip causes pain (retrocecal appendix)

Murphy's sign:

• inspiratory arrest on deep palpation of RUQ (cholecystitis) 

McBurney's point tenderness:

• 1/3 from anterior superior iliac spine to umbilicus; indicates local peritoneal irritation (appendicitis) 

Obturator sign:

• flexion then external or internal rotation about the right hip causes pain (pelvic appendicitis) 

Percussion tenderness: often good substitute for rebound tenderness 

Rovsing's sign:

• palpation pressure to left abdomen causes RLQ McBurney's point tenderness (appendicitis) 

Shake tenderness:

• Peritoneal irritation (bump side of bed in suspected malingerers)

EVALUATION

History pain

location of pain

Right Upper Quadrant

1. gallbladder/biliary tract
2. hepatitis, hepatic abscess
3. peptic ulcer
4. pancreatitis
5. MI
6. pneumonia/pleurisy
7. empyema, pericarditis

Left Upper Quadrant

1. pancreatitis
2. splenic rupture, infarct
3. splenic aneurysm
4. gastritis
5. MI
6. pneumonia
7. empyema

Right Lower Quadrant

1. appendicitis
2. intestinal obstruction
3. diverticulitis
4. ulcer perforation
5. ectopic pregnancy
6. ovarian cyst or torsion
7. salpingitis
8. ureteral calculi
9. endometriosis
10. typhlitis

Left Lower Quadrant

1. leaking aneurysm
2. intestinal obstruction
3. diverticulitis
4. psoas abscess
5. ectopic pregnancy
6. ovarian cyst or torsion
7. salpingitis
8. ureteral calculi
9. endometriosis

also consider: abdominal wall disorders (e.g. hematoma, herpes zoster)

Referred pain

1. biliary colic: right shoulder or scapula
2. renal colic: to groin
3. appendicitis: periumbilical-----> RLQ
4. pancreatitis: to back
5. ruptured aortic aneurysm: to back or flank
6. perforated ulcer: to RLQ (right paracolic gutter)

Associated symptoms

1. general: fevers, chills, weight loss, jaundice
2. gastrointestinal: anorexia, nausea, vomiting, diarrhea,
3. constipation, obstipation, melena, hematochezia
4. urinary: dysuria, hematuria, urinary frequency
5. gynecological: 1st day LMP, vaginal discharge, previous STD, IUD use