Appendicitis Right lower quadrant pain with palpation of the left lower quadrant Rovsing's sign Pelvic inflammatory disease Manipulation of cervix causes patient to lift buttocks off table Chandelier sign Retroperitoneal haemorrhage Discoloration of the flank Grey-Turner's sign Appendicitis Internal rotation of flexed right hip causing abdominal pain Obturator's sign Appendicitis Hyperextension of right hip causing abdominal pain Iliopsoas sign Acute cholecystitis Abrupt interruption of inspiration on palpation of right upper quadrant Murphy's sign Appendicitis Tenderness located 2/3 distance from anterior iliac spine to umbilicus on right side McBurney's sign Splenic rupture Ectopic pregnancy rupture Severe left shoulder pain Kehr's sign Retroperitoneal haemorrhage Bluish periumbilical discoloration Cullen's sign Association Finding Sign Important Signs in Patients with Abdominal Pain
Hx taking & physical examination are the basis of correct diagnosis 8
Hx, physical examination & lab investigations are often non-specific
CT is now 1st-line imaging modality in pts with APP.
MDCT is now faster with thinner slices
High diagnostic accuracy 9
8 Keeman JN, New diagnostic imaging technology offten offers no advantage in the differential diagnosis of acute abdomen. Ned Tijdschr Geneeskd. 1999. Nov. 6:143(45):2225-9 9 Leschka et al,Multi-detector computer tomography of acute abdomen. Eur Radiol. Dec;15(12):2435-47. 2005
May be a key to solving the diagnostic dilemma of NSAP.
10 Golash and Willson. Early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1320 patients. Surg Endosc. 2005 Jul;19(7):882-5 11 Keller et al. Diagnostic laparoscopy in acute abdomen. Chirurg. 2006 Nov;77(11):981-5