top 10 signs in gastroenterology
TRANSCRIPT
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
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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
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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
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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!!
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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
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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…