Top 10 signs in Gastroenterology

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important signs of acute abdomen for undergraduates

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Top 10 signs in gastroenterology…:

Top 10 signs in gastroenterology… Dr.S.Easwaramoorthy Chairman Elect ASI TN & P Chapter

Approach to Your patient:

Approach to Your patient Detailed history Careful Examination Key clinical signs Appropriate investigation Holistic treatment Non operative Operative

Top 10 signs in Gastroenterology:

Top 10 signs in Gastroenterology McBurney’s Sign

McBurney’s Sign:

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

Charles McBurney :

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 McBurney Roosevelt hospital,New York 1901:

Charles McBurney Roosevelt hospital,New York 1901

Signs of Appendicitis:

Signs of Appendicitis Rovsing sign Psoas sign Obturator sign

Top 10 signs in Gastroenterology:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign

Rovsing’s Sign:

Rovsing’s Sign LIF palpation causing tenderness in the RIF 2

Niels Thorkild Rovsing:

Niels Thorkild Rovsing Danish Surgeon 1862-1927

Top 10 signs in Gastroenterology:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign Psoas Sign

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:

Zachary Cope British Surgeon 1881-1971 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:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign Psoas Sign Murphy’s Sign

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 Modification Of eliciting Murphy’s sign Using left thumb 4

Boas sign:

Boas sign Hyperaesthesia below right scapula Ismar Isidor Boas, Germany

Murphy’s sign 2:

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 Murphy Chicago, USA :

John Benjamin Murphy Chicago, USA Surgical Genius of our Generation… William Mayo, USA

Plenty in his name!:

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:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign Psoas Sign Murphy’s Sign Blumberg’s Sign

Blumberg Sign:

Blumberg Sign Rebound Tenderness Release Sign Sign of Peritonitis Pain upon removal of Pressure 5

Jacob Moritz Blumberg:

Jacob Moritz Blumberg German Jewish Surgeon & Gynaecologist 1873-1955

Top 10 signs in Gastroenterology:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign Psoas Sign Murphy’s Sign Blumberg’s Sign Kehr Sign

Kehr Sign:

Kehr Sign Sign of Splenic Injury Referred pain to left shoulder -Because of diaphragmatic irritation due to hemoperitoneum 6

Hans Kehr, Germany:

Hans Kehr , Germany Famous biliary surgeon from Germany Popularised Cholecystectomy for Gall stones T tube for CBD repair

T tube:

T tube

Danforth Sign:

Danforth Sign William Clark Danforth , US O & G Surgeon Pain on the shoulders on inspiration Hemoperitoneum due to ruptured ectopic

Top 10 signs in Gastroenterology:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign Psoas Sign Murphy’s Sign Blumberg’s Sign Kehr Sign Balance Sign

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:

Charles Alfred Balance English surgeon 1856-1936 Also known for his work in -Nerve grafting/Neurosurgical work

Top 10 signs in Gastroenterology:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign Psoas Sign Murphy’s Sign Blumberg’s Sign Kehr Sign Balance Sign Dance Sign

Dance Sign:

Dance Sign Better known as ‘Sign De Dance’ Sign of Intussusception Empty RLL and Mass RUQ 8

Jean Baptiste Hippolyte Dance:

Jean Baptiste Hippolyte Dance French pathologist 1797-1832 Also described tetany due to hypoparathyroidism ! Died early due to Cholera!

Top 10 signs in Gastroenterology:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign Psoas Sign Murphy’s Sign Blumberg’s Sign Kehr Sign Balance Sign Dance Sign Cullen’s Sign

Cullen’s Sign:

Cullen’s Sign Peri umbilical ecchymosis / blue discolouration Causes Ectopic pregnancy Blunt injury abdomen with hemoperitoneum Haemorrhagic pancreatitis Ruptured aortic aneurysm 9

Thomas Stphen Cullen:

Thomas Stphen Cullen Canadian Gynaecologist working at John Hopkins University, USA 1868-1953 Popularized extensive use of diagrams in biomedical publishing

Top 10 signs in Gastroenterology:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign Psoas Sign Murphy’s Sign Blumberg’s Sign Kehr Sign Balance Sign Dance Sign Cullen’s Sign Grey Turner’s Sign

Grey Turner’s Sign:

Grey Turner’s Sign Flank ecchymosis Seen in case of Haemorrhagic pancreatitis/retro peritoneal haem 10

George Grey Turner:

George Grey Turner British Surgeon (1877-1951) He also had interest in cancer research He 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 sign & Grey Turner’s Sign

Cullen’s & Fox Sign:

Cullen’s & Fox Sign Ecchymosis of thigh and inguinal region

Top 10 signs in Gastroenterology:

Top 10 signs in Gastroenterology McBurney’s Sign Rovsing’s Sign Psoas Sign Murphy’s Sign Blumberg’s Sign Kehr Sign Balance Sign Dance Sign Cullen’s Sign Grey Turner’s Sign

Slide 44:

Thank you…

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