18. Caput Medusae
• Dilated veins around a porto-
systemic anastmosis in the
umbilical veins
• Dilated abdominal veins can be
distinguished with Harvey's test: -
determines direction of flow
– SVC obstruction: direction of flow
above umbilicus downwards
– IVC obstruction: direction of flow below
umbilicus upwards
– Caput medusae: direction of flow away
from umbilicus
Maria Carmela L. Domocmat, RN, MSN
84. McBurney’s Point (Appendicitis)
• Pain in the right lower
quadrant one third the
distance from the anterior
iliac crest to the umbilicus.
• Caused by the inflamed
appendix or bowel coming
into contact with the
peritoneum.
Maria Carmela L. Domocmat, RN, MSN
85. Blumberg's sign
• pain on abrupt release of steady pressure
(rebound tenderness) over the site of a
suspected abdominal lesion, indicative of
peritonitis.
Maria Carmela L. Domocmat, RN, MSN
87. Rovsing’s sign (Appendicitis)
• Pain described in the right lower quadrant
(RLQ) when the left lower quadrant (LLQ)
is palpated.
http://www.impactednurse.com/?p=1835 Maria Carmela L. Domocmat, RN, MSN
88. Psoas sign (Appendicitis)
• Pain on passive extension of the right thigh. Patient lies on left side.
Examiner extends patient's right thigh while applying counter
resistance to the right hip (asterisk).
Maria Carmela L. Domocmat, RN, MSN
89. • Anatomic basis for
the psoas sign:
inflamed appendix is
in a retroperitoneal
location in contact
with the psoas
muscle, which is
stretched by this
maneuver.
Maria Carmela L. Domocmat, RN, MSN
91. Obturator sign
• Pain on passive
internal rotation of
the flexed thigh.
• Examiner moves
lower leg laterally
while applying
resistance to the
lateral side of the
knee (asterisk)
resulting in
internal rotation of
the femur. http://www.aafp.org/afp/991101ap/2027.html
Maria Carmela L. Domocmat, RN, MSN
92. Anatomic basis for the obturator sign:
• inflamed appendix in
the pelvis is in
contact with the
obturator internus
muscle, which is
stretched by this
maneuver.
Maria Carmela L. Domocmat, RN, MSN
93. Hypersensitivity
test
or
Pinch-an-Inch Test
(Appendicitis)
http://www.ispub.com/ispub/ijs/volume_12_number_2/the_pinch_an_inch_test_is_more_comfort
able_than_rebound_tenderness/pinch-fig1.jpg Maria Carmela L. Domocmat, RN, MSN
95. Murphy’s sign (Cholecystitis):
• Pain on inspiration
during gentle
palpation below the
right subcostal
arch.
• As the patient
breathes in, the
liver moves down
exposing the
gallbladder to
pressure from the
examiners hand.
• Murpy’s sign may
also be present
with hepatitis.
Maria Carmela L. Domocmat, RN, MSN
97. Balance’s Sign
(Splenic Injury):
• Dullness on
percussion of
the left upper
quadrant of the
abdomen due
to collection of
blood in the
subcapsular or
extracapsular
layers of a
ruptured
spleen.
Maria Carmela L. Domocmat, RN, MSN
98. Kehr’s Sign
(Splenic injury / ruptured ectopic)
• Severe left shoulder (tip)
pain following injury to the
spleen.
May also arise following
other forms of intra-
abdominal bleeding such
as ruptured ectopic
pregnancy.
The pain is due to
irritation of the left
diaphragm and phrenic
nerve by intraperitoneal
blood, or air when the
patient is in the supine
position.
Maria Carmela L. Domocmat, RN, MSN
99. Grey-Turners Sign
( Pancreatitis)
• A bluish discoloration
that occurs on the
lower back and
abdominal flanks.
May also occur
following bleeding
originating from the
kidney or with pelvic
fractures following
traumatic injury.
Usually occurs 6-24
hours after onset of
any retroperitoneal
bleeding.
Maria Carmela L. Domocmat, RN, MSN
100. Cullen’s Sign ( Pancreatitis)
• Is a bluish or blue-black
discoloration around the
umbilicus.
Over time this discoloration
can fade to green-brown or
yellow.
Often appears 1 to 2 days
after the onset of symptoms
of pancreatitis.
Cullen’s sign may also arise
in association with
haemoperitoneum due to a
ruptured ectopic pregnancy.
Maria Carmela L. Domocmat, RN, MSN