Specific Signs on Palpation

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).

Stigmata of Liver Disease: Spider angiomata, periumbilical collateral veins (Caput medusae), gynecomastia, ascites, hepatosplenomegaly, testicular atrophy.

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.

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