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Zorluk: KolayGastrointestinal and Abdominal Surgery

Match each classic clinical presentation to its most likely acute surgical diagnosis.

  • A 42-year-old female presents with acute right upper quadrant pain, fever, and inspiratory arrest upon deep palpation of the right costal margin.Acute cholecystitis
  • A 25-year-old male involved in a motor vehicle collision develops acute left shoulder pain and hypotension.Splenic rupture
  • A 55-year-old male with chronic alcohol use disorder presents with severe epigastric pain radiating to the back and bluish discoloration of the flanks.Hemorrhagic pancreatitis
  • A 22-year-old male with right lower quadrant pain experiences increased pain in that area when the examiner applies pressure to the left lower quadrant.Acute appendicitis

Cevap

The first presentation matches with acute cholecystitis, the second matches with splenic rupture, the third matches with hemorrhagic pancreatitis, and the fourth matches with acute appendicitis.
Each vignette describes a pathognomonic physical examination finding associated with a specific anatomic location. Inspiratory arrest on right upper quadrant palpation is Murphy sign (gallbladder/acute cholecystitis). Referred left shoulder pain in trauma is Kehr sign (diaphragm/splenic rupture). Flank ecchymosis is Grey Turner sign (retroperitoneum/severe hemorrhagic pancreatitis). Right lower quadrant pain upon left lower quadrant palpation is Rovsing sign (peritoneum/acute appendicitis).

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1
Analyze the first clinical vignette for key physical examination findings.
Identified inspiratory arrest upon right upper quadrant palpation (Murphy sign).
Recognizing eponymous signs rapidly localizes the intra-abdominal pathology.
2
Analyze the second vignette involving blunt trauma.
Identified left shoulder pain in the setting of trauma (Kehr sign).
Shoulder pain without direct shoulder trauma suggests referred pain from diaphragmatic irritation via the phrenic nerve.
3
Analyze the third vignette detailing severe epigastric pain.
Identified flank ecchymosis (Grey Turner sign).
This sign indicates retroperitoneal hemorrhage.
4
Analyze the fourth vignette describing lower quadrant pain.
Identified right lower quadrant pain upon left lower quadrant palpation (Rovsing sign).
This represents localized peritoneal irritation.

Anahtar Kavram

Classic eponymous physical examination signs in acute abdominal pathology
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