00:01
Okay, let's review the content that
we've learned during this lecture.
00:06
Alright,
so this is a busy slide.
00:07
And I'm just going to hone in
on one or two findings
as we go through each row.
00:12
With cholecyctitis there's
that classic Murphy's sign
where you're having the patient
take a deep breath
while you're pushing in the area
and the right upper quadrant.
00:21
Patients with cirrhosis have
a variety of manifestations,
so called
stigmata of liver disease,
but perhaps one of the most
significant ones to look for
is ascites on the exam.
00:32
Palmar erythema
and telangiectasia or spider angioma
over the chest wall
are also very useful findings.
00:40
Gastric ulcer.
00:41
If you're looking for just pain
in the epigastrium
patients with appendicitis will
classically have a McBurney's point
and perhaps a positive Psoas Sign
with diverticulitis over
in the left lower quadrant
you're simply looking with pain,
with palpation.
00:56
With bowel obstruction, you may have
diffuse tympany on the abdomen
and potentially
some high pitched noises
on auscultation of the abdomen.
01:05
And then with acute peritonitis,
you're looking for diffuse
discomfort on the abdomen,
as well as rigidity
which is involuntary.
01:12
You can't get the patient to relax
when somebody has acute peritonitis,
which of course can be
a surgical emergency.
01:19
So the stigmata of cirrhosis
include each of the following except
bulging flanks,
pedal edema,
palmar erythema, Terry's nails,
or a positive Carnett's sign.
01:37
Well, each of those
first four things
that are mentioned there
are characteristic of patients
with advanced liver disease
and contrast a
positive Carnett's sign
would indicate not
intra-abdominal problems
but instead an abdominal wall cause
for the patient's discomfort.
01:55
The findings associated
with acute appendicitis
include each
of the following except:
Castell's sign, Psoas sign,
the Obturator sign,
McBurney's sign or McBurney's point,
or rebound tenderness.
02:14
So Castell's sign is referring
to patients with splenomegaly
over at Castell's point at the
bottom of the Traube's space,
so that's not really a
feature of acute appendicitis.
02:25
In contrast,
with acute appendicitis,
you may see Psoas sign, or
its accompanying Obturator sign,
you may see pain over McBurney's
point so called McBurney's sign,
and you certainly may see
rebound tenderness,
particularly in patients who have
a perforated appendix.