Top 10 signs in gastroenterology
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CLINICAL SIGNS IN SURGERY
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Top 10 signs in gastroenterology
- 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].
- 7. Charles McBurney Roosevelt hospital,New York 1901
- 8. Signs of Appendicitis 1.Rovsing sign 2.Psoas sign 3.Obturator sign
- 9. Top 10 signs in Gastroenterology 1. McBurney’s Sign 2. Rovsing’s Sign
- 10. Rovsing’s Sign LIF palpation causing tenderness in the RIF
- 11. Niels Thorkild Rovsing Danish Surgeon 1862-1927
- 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
- 17. Boas sign Hyperaesthesia below right scapulaIsmar Isidor Boas, Germany
- 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
- 19. John Benjamin Murphy Chicago, USA SurgicalGenius of our Generation… William Mayo, USA
- 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
- 21. Top 10 signs in Gastroenterology 1. McBurney’s Sign 2. Rovsing’s Sign 3. Psoas Sign 4. Murphy’s Sign 5. Blumberg’s Sign
- 22. Blumberg Sign ReboundTenderness Release Sign Sign of Peritonitis Pain upon removal of Pressure
- 23. Jacob Moritz Blumberg German Jewish Surgeon & Gynaecologist 1873-1955
- 24. Top 10 signs in Gastroenterology 1. McBurney’s Sign 2. Rovsing’s Sign 3. Psoas Sign 4. Murphy’s Sign 5. Blumberg’s Sign 6. Kehr Sign
- 25. Kehr Sign Sign of Splenic Injury Referred pain to left shoulder -Because of diaphragmatic irritation due to hemoperitoneum
- 26. Hans Kehr, Germany •Famous biliary surgeon from Germany •Popularised Cholecystectomy for Gall stones •T tube for CBD repair
- 27. T tube
- 28. Top 10 signs in Gastroenterology 1. McBurney’s Sign 2. Rovsing’s Sign 3. Psoas Sign 4. Murphy’s Sign 5. Blumberg’s Sign 6. Kehr Sign 7. Balance Sign
- 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!!
- 30. Charles Alfred Balance English surgeon 1856-1936 Also known for his work in -Nerve grafting/Neurosurgical work
- 31. Top 10 signs in Gastroenterology 1. McBurney’s Sign 2. Rovsing’s Sign 3. Psoas Sign 4. Murphy’s Sign 5. Blumberg’s Sign 6. Kehr Sign 7. Balance Sign 8. Dance Sign
- 32. Dance Sign Better known as ‘Sign De Dance’ Sign of Intussusception Empty RLL and Mass RUQ
- 33. Jean Baptiste Hippolyte Dance French pathologist 1797-1832 Also described tetany due to hypoparathyroidism! Died early due to Cholera!
- 34. Top 10 signs in Gastroenterology 1. McBurney’s Sign 2. Rovsing’s Sign 3. Psoas Sign 4. Murphy’s Sign 5. Blumberg’s Sign 6. Kehr Sign 7. Balance Sign 8. Dance Sign 9. Cullen’s Sign
- 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
- 37. Top 10 signs in Gastroenterology 1. McBurney’s Sign 2. Rovsing’s Sign 3. Psoas Sign 4. Murphy’s Sign 5. Blumberg’s Sign 6. Kehr Sign 7. Balance Sign 8. Dance Sign 9. Cullen’s Sign 10. GreyTurner’s Sign
- 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".
- 40. Cullen’s sign & Grey Turner’s Sign
- 41. Cullen’s & Fox Sign Ecchymosis of thigh and inguinal region
- 42. Top 10 signs in Gastroenterology 1. McBurney’s Sign 2. Rovsing’s Sign 3. Psoas Sign 4. Murphy’s Sign 5. Blumberg’s Sign 6. Kehr Sign 7. Balance Sign 8. Dance Sign 9. Cullen’s Sign 10.GreyTurner’s Sign
Editor's Notes
- 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"