Acute Abdomen

Front 1

What is Grey Turner's sign

Back 1

Is a bluish discoloration of the left flank is a sign of retroperitoneal bleeding seen in acute hemorrhagic pancreatitis

Front 2

What is Cullens sign

Back 2

Bluish discoloration around the umbilicus has been described in acute pancreatitis, rectus sheath hematoma, splenic rupture, perforated ulcer, intra-abdominal cancer, and ruptured ectopic pregnancy, and as a complication of anticoagulation

Front 3

Classical signs for acute appendicitis

Back 3

1.Right lower quadrant pain

2.Shifting pain, initially on umbilicus & later shifts to right illiac fossa w onset of peritoneal peritonitis

3. Pain worsenes w walking & relieved on sitting

Front 4

What is Blumberg's sign/release sign

Back 4

Rebound tenderness

Front 5

Rovsing's sign

Back 5

Press on the left illiac fossa causes pain to be felt on the right iliac fossa due to acute appendicitis

Front 6

Cope's psoas test

Back 6

A retrocaecal appendix lies on the Psoas major muscle.Inflammation of this appendix will cause irritation of Psoas major muscle, which is concerned with flexion of the hip joint. When the right hip joint of the patient is hyperextended this muscle is stretched. This will initiate pain in case of retrocaecal appendicitis.

Front 7

The obturator test

Back 7

A pelvic appendix may lie on the obturator internus muscle.When this appendix becomes inflamed internal rotation of the hip joint will stretch the obturator internus and the patient will wince in pain.

Front 8

Baldwing test

Back 8

A hand is placed over the flank of the patient. The patient is now asked to raise the right lower limb off the bed keeping the knee extended. The patient will immediately complain of pain in case of retrocaecal appendicitis. Retrocaecal appendix remains in close contact with the Psoas major muscle which becomes contracted during flexion of the hip joint.

Front 9

Types of muscle guarding

Back 9

1. Involuntary- due to disease ie. peritonitis

2. Voluntary- due to fear during examination

You can differentiate the two by asking the pt. to inhale & exhale during palpation in involuntary guarding the muscles will relax on exhaling

Front 10

Pathophysiology of appendicitis

Back 10

Appendicitis is caused by obstruction of the appendeceal lumen. On obstruction there is pressure increase inside the lumen as there is continous secretions of fluid & mucus at the same time intestinal bacteria multiply leading to recruitment of white blood cells & formation of pus when pressure keep increasing venous return is impared, ischaemia followed perforation & periappendicular abscess or peritonitis may occur.

Causes of obstruction can be IBD or infections, feacoliths, parasites, tumors ,kinking/twisting

Front 11

Types of appendicitis

Back 11

1. Acute simple appendicitis

2. Acute purulent appendicitis

3. Perforation & gangrenous appendicitis

4. Appendiceal abscess