Murphy's sign: Inspiratory arrest with right upper quadrant palpation, cholecystitis. Charcot's sign: Right upper quadrant pain, jaundice, fever; gallstones. Courvoisier's sign: Palpable, nontender gallbladder with jaundice; pancreatic malignancy. McBurney's point tenderness: Located two thirds of the way between umbilicus and anterior superior iliac spine; appendicitis. Iliopsoas sign: Elevation of legs against examiner's hand causes pain, retrocecal appendicitis.
Obturator sign: Flexion of right thigh and external rotation of thigh causes pain in pelvic appendicitis.
Rovsing's sign: Manual pressure and release at left lower quadrant colon causes referred pain at McBurney's point; appendicitis. Cullen's sign: Bluish periumbilical discoloration;
peritoneal hemorrhage. Grey Turner's sign: Flank ecchymoses; retroperitoneal hemorrhage. Percussion: Loss of liver dullness (perforated viscus, free air in peritoneum); liver and spleen span by percussion.
Rectal Examination: Masses, tenderness, impacted stool; gross or occult blood.
Genital/Pelvic Examination: Cervical discharge, adnexal tenderness, uterine size, masses, cervical motion tenderness.
Extremities: Femoral pulses, popliteal pulses (absent pulses indicate ischemic colitis), edema.
Skin: Jaundice, dependent purpura (mesenteric infarction), petechia (gonococcemia).
Labs: CBC, electrolytes, liver function tests, amylase, lipase, UA, pregnancy test. ECG.
Chest X-ray: Free air under diaphragm, infiltrates, effusion (pancreatitis).
X-rays of abdomen (acute abdomen series): Flank stripe, subdiaphragmatic free air, distended loops of bowel, sentinel loop, air fluid levels, thumbprinting, mass effects, calcifications, fecaliths, portal vein gas, pneumatobilia.
Was this article helpful?