Top 10 signs in gastroenterology

CLINICAL SIGNS IN SURGERY

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

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

3. Top 10 signs in Gastroenterology McBurney’s Sign

4. 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

5. 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].

6. Charles McBurney Roosevelt hospital,New York 1901

7. Signs of Appendicitis Rovsing sign Psoas sign Obturator sign

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

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

10. Niels Thorkild Rovsing Danish Surgeon 1862-1927

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

12. 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

13. 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

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

15. 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

16. Boas sign Hyperaesthesia below right scapula Ismar Isidor Boas, Germany

17. 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

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

19. 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

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

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

22. Jacob Moritz Blumberg German Jewish Surgeon & Gynaecologist 1873-1955

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

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

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

26. T tube

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

28. 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

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

30. 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

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

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

33. 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

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

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

36. 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

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

38. 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 ".

39. Cullen’s sign & Grey Turner’s Sign

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

41. 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

42. Thank you…