Abdominal Signs + Tests

Question 1

What is a sign?

Answer 1

Sign is an indication of existence of an objective evidence of a disease, which is perceptible to the
examining physician, as opposed to the subjective sensation (symptoms) of the patient.

Question 2

Differentiate between pathognomonic, accessory and antecedent signs?

Answer 2

PATHOGNOMONIC SIGN (patho = disease, gnoma = signature, pathognomonic = signature of the
disease): Specially distinctive or characteristic sign of a disease or pathological condition on which a
diagnosis can be made.
ACCESSORY SIGN (Assident sign): Any nonpathognomonic sign of disease, which adds on to the surety
of the diagnosis when present.
ANTECEDENT SIGN: Any precursory indication of an attack of disease. These signs are to be identified
at the earliest

Question 3

What is rovsing’s sign?

Answer 3

On palpation of LIF, pain occurs in RIF which is due to shift of bowel loops which
irritates the parietal peritoneum (deep palpation of the LLQ causes RLQ referred pain) – finding in appendicitis

Question 4

What is blumberg’s sign?

Answer 4

Also referred to as rebound tenderness, Shyotkin-Blumberg sign). It is indicative of peritonitis. It’s a nonspecific clinical sign that refers to pain or tenderness that occurs upon sudden release of pressure on the abdomen Tenderness and rebound tenderness at McBurney’s point in right iliac fossa can also be elicited in acute appendicitis because of local peritonitis- finding in appendicitis

Question 5

What is pointing sign?

Answer 5

Pt is asked to point to where pain began and where it moved- Appendicitis

Question 6

What is the cope psoas test?

Answer 6

Hyperextension (in case of retrocaecal appendix) of right hip causes pain in right iliac
fossa due to irritation of psoas muscle – Appendicitis, Psoas abscess

Question 7

What is psoas sign?

Answer 7

At times, an inflamed appendix lies on psoas muscle, and pt, will lie with right hip flexed for
pain relief

Question 8

What is the obturator test?

Answer 8

OBTURATOR TEST; ZACHARY COPE – for pelvic appendix, rt hip is flexed and internally rotated causing pain in hypogastrium due to irritation and spasms of obturator internus muscle if inflamed appendix is in contact with it – appendicitis

Question 9

What is the baldwing test?

Answer 9

+ve in retrocaecal appendix—when legs are lifted off the bed with knee extended, the
patient complains of pain while pressing over the flanks- Appendicitis

Question 10

What is bastede sign?

Answer 10

An obsolete test in which the colon was inflated with air, and pain evoked in the right iliac fossa viewed as a sign of chronic appendicitis.

Question 11

What is dumphy’s sign?

Answer 11

DUMPHY’S cough tenderness sign- Sharp pain in the RLQ elicited by a voluntary cough. May indicate appendicitis. Named after Osborne Joby Dunphy (1898-1989), a British-American physician

Question 12

What is the bapat test?

Answer 12

BAPAT bed shaking test - If still in doubt whether early peritonitis is present, bed is shaken. This will cause pain at the site of inflammation

Question 13

What is the heel drop test?

Answer 13

HEEL DROP TEST aka MARKLE TEST, published in 1973- is elicited in pts with intraperitoneal inflammation by having to stand on his toes and suddenly dropping down onto the heels with an audible thump. If abdominal pain is localised as heels strike ground, Markle’s Sign is +ve – Appendicitis

Question 14

What is murphy’s sign?

Answer 14

Is performed by asking the patient to breathe in and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder) and is +ve if pt winces with pain and with abruptly ceasation of inspiration – cholecystitis.

Question 15

What is moynihan’s sign?

Answer 15

an adaptation of Murphy’s sign, a method used to differentiate pain in the right upper quadrant.

Question 16

What is boas sign?

Answer 16

Hyperesthesia below the wing of scapula. Sign named after Germany Isma Isdor Boas - acute cholecystitis

Question 17

What is kehr sign?

Answer 17

Sign of splenic injury with referred pain to the left shoulder because of diaphragmatic irritation due to haemoperitoneum. Occurrence of acute pain in the tip of Lf shoulder due to blood or other irritants in peritoneal cavity when a person is lying down with elevated legs. It’s a classic sign of Ruptured spleen

Question 18

WHAT IS BALLANCE SIGN?

Answer 18

Fixed dullness left frank, and shifting dullness in Rt frank due to clotted and fluid blood in the respective franks. Dullness to percussion in left flank LUQ and shifting dullness to percussion in right flank. Named after an English surgeon Charles Alfred Ballance. seen with splenic rupture/hematoma

Question 19

What is dance sign?

Answer 19

Better known as sign de dance – Empty RLQ and mass in RUQ. Sign of intussusception. A
feeling of emptiness on palpation of the right lower quadrant of the abdomen

Question 20

What is cullen’s sign?

Answer 20

Peri-umbulical ecchymosis / bluish skin discolouration. Caused by Ruptured ectopic preg, acute haemorrhagic necrotising pancreatitis, Abdominal blunt injury with heamoperitoneum and ruptured aortic aneurysm

Question 21

What is grey turner sign?

Answer 21

Retroperitoneal haemorrhagic spots and ecchymosis in the flanks. Sign of acute haemorrhagic pancreatitis and bleeding in the retroperitoneum.

Question 22

What is fox sign?

Answer 22

ecchymosis of the thigh and inguinal region. Finding in retroperitoneal haemorrhage: haemorrhagic pancreatitis, ruptured ectopic pregnancy,

Question 23

What is succussion splash?

Answer 23

SUCCUSSION SPLASH also known as a gastric splash, is a splashing sound heard during sudden movement of the patient on abdominal auscultation. It reflects the presence of gas and fluid in an obstructed organ, as in gastric outlet obstruction- Crohn’s disease; Gastric polyp; Hypertrophic pyloric stenosis; Bezoar , Cancer – (gastric, pancreatic, bile duct)

Question 24

WHAT IS GOLDSTEIN SALINE LOAD TEST?

Answer 24

Load test is used to determine presence or to estimate degree of gastric retention by using gastric NGT load of 750mls of saline. This test was first described by Goldstein & Boyle in 1965. Normal stomach can empty greater than 500ml of normal saline in 30 minutes, leaving no more than residual of 250ml. Normal average 30 minutes residual collection after Saline Load Test is 88ml. with the Standard deviation of 82ml. Average obstructed pts return 500m1 to 750ml after 30 minutes. Half an hour after installation of 750ml of saline, if volume remained and if more than 250ml is present, suggests obstruction.

Question 25

Discuss virchow nodes

Answer 25

VIRCHOW NODE (VN), Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node, known as the leading to an appreciable mass that can be recognized clinically — a Troisier sign (clinical finding of a hard and enlarged left supraclavicular node; called Virchow’s node-lies near to junction of thoracic duct and left subclavian vein). Finding in GIT malignancy, commonly of stomach, or less commonly, lung cancer. Tumour embolisation of
the GI cancers via the thoracic duct usually leads to the enlargement of left supraclavicular node

Question 26

What is COURVOISIER’S LAW?

Answer 26

COURVOISIER’S LAW (or Courvoisier syndrome, or Courvoisier’s sign or Courvoisier-Terrier’s sign) states that in the presence of a palpably enlarged gallbladder which is non-tender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones. Simply put; the presence of jaundice, a palpable gall bladder, makes the gall stone obstruction of CBD an likely cause. Chronic gall bladder stones cause relative fibrosis of gall bladder and is therefore non distensible

Question 27

What is the goodsall rule?

Answer 27

rule states that fistulas with an external opening anterior to a plane passing transversely through center of the anus will follow a straight radial course to the dentate line. Fistulas with their openings posterior to line will follow a curved course to the posterior midline. Exceptions to this rule are external openings lying more than 3 cm from the anal verge. These almost always originate as a primary or secondary tract from the posterior midline, consistent with a previous horseshoe
abscess.

Question 28

WHAT IS KRUKENBERG TUMOR?

Answer 28

refers to a malignancy in ovary that metastasized from a primary site, classically GIT esp Gastric adenocarcinoma at the pylorus is most common source

Question 29

WHAT IS CHARCOT’S TRIAD?

Answer 29

the combination of jaundice; fever, usually with rigors; and RUQ abdominal pain. Occurs in ascending cholangitis (an inflammation of bile duct)

Question 30

WHAT IS SISTER MARY JOSEPH’S NODULE?

Answer 30

SISTER MARY JOSEPH’S NODULE is a metastatic tumor deposited in the umbilicus and often represents advanced intra-abdominal malignancy with dismal prognosis. Refers to a palpable nodule bulging into the umbilicus as a result of metastasis or infiltration of a malignant cancer in the pelvis or abdomen. Named after Sister Mary Joseph (1856–1939), a surgical assistant for Dr. William Mayo, who noted the association between paraumbilical nodules observed during skin preparation for surgery and metastatic intraabdominal cancer confirmed at surgery. Suggested hypothesis for the etiology is direct extension of tumour to the umbilicus, lymphatic or haematogenous spread. Differential Dsis of an umblical nodule; primary umbilical hernia, sis Mary joseph’s nodule, umbilical/paraumbilical hernia, umbilical endometriosis, keloid, omphalith, pyoderma gangrenosum & foreign body.

Question 31

WHAT IS BLUMER’S SHELF SIGN?

Answer 31

a shelf palpable by rectal examination, due to metastatic tumor cells gravitating from an abdominal cancer and growing in the rectovesical or rectouterine (pouch of Douglas or peritoneal cul-de-sac) that indicates tumor metastasis, usually from cancers of the lung, pancreas, and stomach. It is due to metastatic tumor cells gravitating from an abdominal cancer and growing in the rectovesical or rectouterine pouch

Question 32

WHAT IS IRISH’S NODE?

Answer 32

Left anterior axillary lymph node, a site often involved by metastatic gastric Ca

Question 33

WHAT IS LLOYD’S SIGN?

Answer 33

is a sign of renal calculus or pyelonephritis when Pain is elicited by deep percussion in the back between 12th rib and the spine. Its closely related to costovertebral angle tenderness in that the area of percussion is the same

Question 34

WHAT IS COSTOVERTERBRAL ANGLE TENDERNESS?

Answer 34

COSTOVERTERBRAL ANGLE TENDERNESS (renal angle tenderness) - A classic presentation in acute pyelonephritis is a triad of Fever, costoverterbral angle tenderness and nausea and or vomiting. It’s performed by the junction of 12th rib with the paravertebral muscles which run parallel to and on both sides. You strike the fist on one hand, against the dorsal surface of the other, placed flat along the posterior CVA margin. Can also be positive in calculi, renal artery occlusion and perinephric abscess

Question 35

WHAT IS AARON’S SIGN?

Answer 35

A sensation of pain and/or distress in the epigastric or precordial region on pressure over McBurney’s point in appendicitis.

Question 36

WHAT IS BAID SIGN?

Answer 36

Described for pancreas pseudocyst and is well appreciated in thin individuals. When Ryle’s tube is passed into the stomach, may be palpated over the swelling because the stomach is displaced anteriorly by the pseudocyst pancreas.

Question 37

WHAT ABDOMINAL SIGNS AND TESTS ARE INDICATIVE OF APPENDICITIS?

Answer 37

ROVSING’S SIGN
BLUMBERG’S SIGN
POINTING SIGN
COPE PSOAS TEST
OBTURATOR TEST; ZACHARY COPE
BASTEDE SIGN
DUMPHY’S cough tenderness sign
MARKLE TEST
AARON’S SIGN

Question 38

WHAT ABDOMINAL SIGNS AND TESTS ARE INDICATIVE OF CHOLECYSTITIS?

Answer 38

MURPHY’S SIGN
BOAS SIGN

Question 39

WHAT ABDOMINAL SIGNS AND TESTS ARE INDICATIVE OF RUPTURED SPLEEN?

Answer 39

KEHR SIGN
BALLANCE SIGN