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Top 10 signs in gastroenterology
1.
2. TOP 10 SIGNS IN GASTROENTEROLOGY…
Dr.S.Easwaramoorthy
Chairman Elect
ASITN & P Chapter
3. Approach to Your patient
Detailed history
Careful Examination
Key clinical signs
Appropriate investigation
Holistic treatment
Non operative
Operative
4. Top 10 signs in Gastroenterology
1. McBurney’s Sign
5. McBurney’s Sign
•Sign ofAcute appendicitis
•Tenderness at McBurney’s Point which is the
Junction of lateral 1/3rd and medial 2/3rd in the spino umblical line
6. 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 theVermiform Appendix“
NewYork Medical Journal, 1889, 50: 676–684 [pg 678].
12. Top 10 signs in Gastroenterology
1. McBurney’s Sign
2. Rovsing’s Sign
3. Psoas Sign
13. Psoas Sign
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
14. Zachary Cope
British Surgeon
1881-1971
Cope, Zachary; Silen,William (January
2010). Cope's Early Diagnosis of the Acute
Abdomen (22nd ed.). NewYork: Oxford
University Press. ISBN 978-0-19-973045-2
15. Top 10 signs in Gastroenterology
1. McBurney’s Sign
2. Rovsing’s Sign
3. Psoas Sign
4. Murphy’s Sign
16. 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
18. 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
20. 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
29. 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!!
35. Cullen’s Sign
Peri umbilical ecchymosis/ blue discolouration
Causes
•Ectopic pregnancy
•Blunt injury abdomen with hemoperitoneum
•Haemorrhagic pancreatitis
•Ruptured aortic aneurysm
36. Thomas Stphen Cullen
•Canadian Gynaecologist working at
John Hopkins University, USA
•1868-1953
•Popularized extensive use of diagrams in
biomedical publishing
38. Grey Turner’s Sign
•Flank ecchymosis
•Seen in case of Haemorrhagic pancreatitis/retro peritoneal haem
39. 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".
Rovsing's work covered abdominal pathologies, including cystitis, tuberculosis of theurinary tract, gallstone disease and appendicitis. He published about 200 papers and earned an international reputation. His writings on abdominal surgery were translated intoGerman and English. He was an honorary member of the Edinburgh Medico-Chirurgical Society and of the Association of Surgeons of Great Britain and Ireland. He founded the Danish Surgical Society with Eilert A. Tscherning in 190
Boas was one of the leading authorities on gastroenterology in Europe. Alone, and with Professor Ewald, he made several contributions regarding the pathology andphysiology of digestion. He described Lactobacillus acidophilus, a bacillus found in the gastric juice of individuals with stomach carcinoma. This bacterium is sometimes referred to as the "Boas-Oppler bacillus".
Kehr's sign (pain in the left shoulder) is a well-known sign for a rupture of the spleen. After a thorough investigation into the body of research conducted by Hans Kehr, one must come to the conclusion that there is insufficient evidence that the term refers to his own work. The question of why the violent pain in the left shoulder during rupture of the spleen is named after the German gall bladder surgeon will remain a mystery of medical history
Ballance is remembered for his pioneer work involving nerve grafting and neurologic surgery. He is credited as being the first physician to perform a facial nerve to spinal accessory nerve anastomosis for treatment of facial palsy. He also did the first operation for complete removal of a cerebellopontine angle tumor, as well as being one of the first surgeons to perform a radical mastoidectomy with ligation of the jugular vein. Ballance is also remembered for successfully sectioning thevestibulocochlear nerve (cranial nerve VIII) as a remedy for intractable vertigo.
Ballance published over 75 articles during his career, his best known work being the 1919 "Essays on the Surgery of theTemporal bone"