top 10 signs in gastroenterology

TOP 10 SIGNS IN GASTROENTEROLOGY…

Dr.S.EaswaramoorthyChairman Elect

ASI TN & P Chapter

Approach to Your patient Detailed history Careful Examination

Key clinical signs Appropriate

investigation Holistic treatment

Non operative Operative

Top 10 signs in Gastroenterology

1. McBurney’s Sign

McBurney’s Sign

•Sign of Acute appendicitis•Tenderness at McBurney’s Point which is the Junction of lateral 1/3rd and medial 2/3rd in the spino umblical line

1

Charles McBurney

The seat of greatest pain, determined by the pressure of one finger, has been very exactly between an inch and a half and two inches from the anterior spinous process of the ilium on a straight line drawn from that process to the umbilicus

— Charles McBurney, "Experience with Early Operative Interference in Cases of Disease of the Vermiform Appendix“New York Medical Journal, 1889, 50: 676–684 [pg 678].

Charles McBurneyRoosevelt hospital,New York 1901

Signs of Appendicitis

1.Rovsing sign

2.Psoas sign3.Obturator

sign

Top 10 signs in Gastroenterology

1. McBurney’s Sign2. Rovsing’s Sign

Rovsing’s Sign

LIF palpation causing tenderness in the RIF

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Niels Thorkild Rovsing

Danish Surgeon1862-1927

Top 10 signs in Gastroenterology

1. McBurney’s Sign2. Rovsing’s Sign3. Psoas Sign

Psoas Sign 3

Pain on hyperextension of right hip While Patient is lying left lateral with knee extended

Also in Psoas abscess/ retroperitoneal bleed due to ruptured iliac vessel

Zachary Cope

British Surgeon1881-1971

Cope, Zachary; Silen, William (January 2010). Cope's Early Diagnosis of the Acute Abdomen (22nd ed.). New York: Oxford University Press. ISBN 978-0-19-973045-2

Top 10 signs in Gastroenterology

1. McBurney’s Sign2. Rovsing’s Sign3. Psoas Sign4. Murphy’s Sign

Murphy’s Sign•Sign of Acute Cholecystitis•How to elicit:• Place the hand below right costal margin

along the mid clavicular line. • Ask the patient to breath in deep• Patient experiences pain at the peak of

Inspiration.

Moynihan’s ModificationOf eliciting Murphy’s signUsing left thumb

4

Boas sign

Hyperaesthesia below right scapulaIsmar Isidor Boas, Germany

Murphy’s sign 2

 Ask the patient to make a fist, then assess contour of MCP joints If third metacarpal is level with second and fourth metacarpals, lunate dislocation is suspected

John Benjamin MurphyChicago, USA

Surgical Genius of ourGeneration…

William Mayo, USA

Plenty in his name!

Sign Acute Cholecystitis

Punch or Fist Sign of renal infarct/pyonephrosis

Triad Pain, Vomit & fever in that sequence

indicative of appendicitis

Top 10 signs in Gastroenterology

1. McBurney’s Sign2. Rovsing’s Sign3. Psoas Sign4. Murphy’s Sign5. Blumberg’s Sign

Blumberg Sign

Rebound TendernessRelease Sign Sign of Peritonitis

Pain upon removal of Pressure

5

Jacob Moritz Blumberg

German Jewish Surgeon & Gynaecologist1873-1955

Top 10 signs in Gastroenterology

1. McBurney’s Sign2. Rovsing’s Sign3. Psoas Sign4. Murphy’s Sign5. Blumberg’s Sign6. Kehr Sign

Kehr Sign

Sign of Splenic InjuryReferred pain to left shoulder

-Because of diaphragmatic irritation due to hemoperitoneum

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Hans Kehr, Germany

•Famous biliary surgeon from Germany•Popularised Cholecystectomy for Gall stones•T tube for CBD repair

T tube

Top 10 signs in Gastroenterology

1. McBurney’s Sign2. Rovsing’s Sign3. Psoas Sign4. Murphy’s Sign5. Blumberg’s Sign6. Kehr Sign7. Balance Sign

Balance Sign

•Sign of Splenic rupture•Fixed dullness left flank and shifting dullness right flank!

Due to clotted blood left flank but fluid blood right flank!!

7

Charles Alfred Balance

English surgeon1856-1936Also known for his work in -Nerve grafting/Neurosurgical work

Top 10 signs in Gastroenterology

1. McBurney’s Sign2. Rovsing’s Sign3. Psoas Sign4. Murphy’s Sign5. Blumberg’s Sign6. Kehr Sign7. Balance Sign8. Dance Sign

Dance Sign

Better known as ‘Sign De Dance’Sign of IntussusceptionEmpty RLL and Mass RUQ

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Jean Baptiste Hippolyte Dance

French pathologist1797-1832Also described tetany due to hypoparathyroidism!Died early due to Cholera!

Top 10 signs in Gastroenterology

1. McBurney’s Sign2. Rovsing’s Sign3. Psoas Sign4. Murphy’s Sign5. Blumberg’s Sign6. Kehr Sign7. Balance Sign8. Dance Sign9. Cullen’s Sign

Cullen’s Sign

Peri umbilical ecchymosis/ blue discolourationCauses•Ectopic pregnancy•Blunt injury abdomen with hemoperitoneum•Haemorrhagic pancreatitis•Ruptured aortic aneurysm

9

Thomas Stphen Cullen

•Canadian Gynaecologist working atJohn Hopkins University, USA

•1868-1953•Popularized extensive use of diagrams in biomedical publishing

Top 10 signs in Gastroenterology

1. McBurney’s Sign2. Rovsing’s Sign3. Psoas Sign4. Murphy’s Sign5. Blumberg’s Sign6. Kehr Sign7. Balance Sign8. Dance Sign9. Cullen’s Sign10.Grey Turner’s Sign

Grey Turner’s Sign

•Flank ecchymosis•Seen in case of Haemorrhagic pancreatitis/retro peritoneal haem

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George Grey Turner

British Surgeon (1877-1951)He also had interest in cancer researchHe predicted the role of chemotherapy!

"We shall never overcome cancer by surgery: it will be something we will inject".

Cullen’s sign & Grey Turner’s Sign

Cullen’s & Fox Sign

Ecchymosis of thigh and inguinal region

Top 10 signs in Gastroenterology

1. McBurney’s Sign

2. Rovsing’s Sign3. Psoas Sign4. Murphy’s Sign5. Blumberg’s

Sign6. Kehr Sign7. Balance Sign8. Dance Sign9. Cullen’s Sign10.Grey Turner’s

Sign

Thank you…