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Difficulty: EasyGastrointestinal and Abdominal Surgery

A thorough physical examination is critical in evaluating patients presenting with an acute abdomen or jaundice. Match each classic physical examination finding with the most likely associated abdominal pathology.

  • Inspiratory arrest upon deep palpation of the right upper quadrantAcute cholecystitis
  • Referred pain to the left shoulder, particularly when lying supineSplenic rupture
  • Right lower quadrant pain elicited by deep palpation of the left lower quadrantAcute appendicitis
  • Palpable, non-tender gallbladder in a patient with painless jaundicePancreatic head adenocarcinoma

Answer

Inspiratory arrest matches Acute cholecystitis (Murphy sign); Left shoulder pain matches Splenic rupture (Kehr sign); RLQ pain on LLQ palpation matches Acute appendicitis (Rovsing sign); Palpable non-tender gallbladder matches Pancreatic head adenocarcinoma (Courvoisier sign).
Each physical exam finding uniquely corresponds to a specific pathophysiology: acute gallbladder inflammation (Murphy sign), diaphragmatic irritation from splenic bleeding (Kehr sign), localized peritonitis (Rovsing sign), and malignant distal biliary obstruction causing slow dilatation (Courvoisier sign).

Step-by-Step Solution

1
Analyze the first finding: Inspiratory arrest on right upper quadrant palpation.
This is Murphy's sign.
It indicates localized peritonitis due to gallbladder inflammation rubbing against the anterior abdominal wall during a deep breath.
2
Analyze the second finding: Referred left shoulder pain.
This is Kehr's sign.
It is caused by phrenic nerve irritation from free intraperitoneal blood, which is most common following a splenic rupture.
3
Analyze the third finding: Right lower quadrant pain on left lower quadrant palpation.
This is Rovsing's sign.
Palpating the left lower quadrant increases pressure and stretches the peritoneum, causing pain in the inflamed right lower quadrant overlying the appendix.
4
Analyze the fourth finding: Palpable non-tender gallbladder with painless jaundice.
This is Courvoisier's sign.
It indicates a slow, malignant obstruction of the common bile duct (such as from pancreatic cancer), allowing the gallbladder to dilate without the acute inflammation seen in gallstone disease.

Key Concept

Classic physical examination eponyms in gastrointestinal surgery are highly specific for particular intra-abdominal pathologies and are crucial for guiding the initial diagnostic workup.
Estimated Time:1m 0s
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Topics

Gastrointestinal and Abdominal Surgery

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