Match each distinct abdominal or gastrointestinal physical examination finding with its corresponding pathophysiological mechanism.
- Palpable, non-tender gallbladder in a patient with progressive jaundice (Courvoisier sign)Malignant extrinsic compression of the distal common bile duct leading to biliary tree dilation
- Periumbilical ecchymosis and discoloration (Cullen sign)Tracking of retroperitoneal hemorrhagic exudate along the gastrohepatic and falciform ligaments
- Sharp arrest of inhalation during deep manual pressure on the right subcostal margin (Murphy sign)Contact of an acutely inflamed gallbladder wall against the highly innervated parietal peritoneum during diaphragmatic excursion
- Pain referred to the left shoulder that worsens with deep breathing while supine (Kehr sign)Irritation of the left hemidiaphragm causing referred pain via the sensory distribution of the phrenic nerve
Answer
Courvoisier sign pairs with malignant distal common bile duct compression; Cullen sign pairs with tracking of retroperitoneal hemorrhage; Murphy sign pairs with contact of an inflamed gallbladder against the parietal peritoneum; Kehr sign pairs with irritation of the left hemidiaphragm referring pain via the phrenic nerve.
Each physical examination finding represents a specific pathophysiological process: Courvoisier sign occurs in malignancy causing painless biliary dilation; Cullen sign is the visible manifestation of retroperitoneal hemorrhage; Murphy sign demonstrates localized peritoneal irritation from an inflamed gallbladder; and Kehr sign exemplifies somatic referred pain from diaphragmatic irritation.
Step-by-Step Solution
Key Concept
Clinical correlation of eponymous abdominal physical examination signs with their underlying anatomical and pathophysiological mechanisms.
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