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Rebound Tenderness
Blumberg's sign (also referred to as rebound tenderness or Shchetkin–Blumberg's sign) is a clinical sign in which there is pain upon removal of pressure rather than application of pressure to the abdomen. (The latter is referred to simply as ''abdominal tenderness''.) It is indicative of peritonitis. It was named after German surgeon Jacob Moritz Blumberg. Procedure The abdominal wall is compressed slowly and then rapidly released. A positive sign is indicated by presence of pain upon removal of pressure on the abdominal wall. Clinical significance The sign indicates aggravation of the parietal peritoneum by stretching or moving. Positive Blumberg's sign is indicative of peritonitis, which can occur in diseases like appendicitis, and may occur in ulcerative colitis with rebound tenderness in the right lower quadrant. However, in recent years the value of rebound tenderness has been questioned, since it may not add any diagnostic value beyond the observation that the patient h ...
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Abdomen
The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. The area occupied by the abdomen is called the abdominal cavity. In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax. In humans, the abdomen stretches from the thorax at the thoracic diaphragm to the pelvis at the pelvic brim. The pelvic brim stretches from the lumbosacral joint (the intervertebral disc between L5 and S1) to the pubic symphysis and is the edge of the pelvic inlet. The space above this inlet and under the thoracic diaphragm is termed the abdominal cavity. The boundary of the abdominal cavity is the abdominal wall in the front and the peritoneal surface at the rear. In vertebrates, the abdomen is a large body cavity enclosed by the abdominal muscles, at front and to ...
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Peritonitis
Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part or the entire abdomen may be tender. Complications may include shock and acute respiratory distress syndrome. Causes include perforation of the intestinal tract, pancreatitis, pelvic inflammatory disease, stomach ulcer, cirrhosis, or a ruptured appendix. Risk factors include ascites (the abnormal build-up of fluid in the abdomen) and peritoneal dialysis. Diagnosis is generally based on examination, blood tests, and medical imaging. Treatment often includes antibiotics, intravenous fluids, pain medication, and surgery. Other measures may include a nasogastric tube or blood transfusion. Without treatment death may occur within a few days. About 20% of people with cirrhosis who are hospitalized have peritonitis. Signs and symptoms Abdo ...
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Jacob Moritz Blumberg
Jacob Moritz Blumberg (27 June 1873 – 1955) was a German Jewish surgeon and gynaecologist and inventor and namesake of Blumberg's sign. Life and work Blumberg was born in the Province of Posen and educated at the University of Breslau (Wrocław) where he received his doctorate in 1896. He went on to complete further training with Polish surgeon Jan Mikulicz-Radecki at the surgical clinic in Breslau, under German physician Albert Ludwig Sigesmund Neisser, the discoverer of ''Neisseria gonorrhoeae'', at the dermatological clinic, and under German physician Albert Fränkel at the women's clinic. He also trained with Paul Zweifel at the women's clinic in Leipzig. trained with Paul Zweifel and invented Blumberg's sign. Blumberg began his professional career in Berlin where he specialised in gynaecology and surgery. Early in his career he invented the Blumberg sign to indicate peritonitis. Investigating methods of sterilisation of the surgeon's hands resulted in his invention of ...
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Abdominal Wall
In anatomy, the abdominal wall represents the boundaries of the abdominal cavity. The abdominal wall is split into the anterolateral and posterior walls. There is a common set of layers covering and forming all the walls: the deepest being the visceral peritoneum, which covers many of the abdominal organs (most of the large and small intestines, for example), and the parietal peritoneum- which covers the visceral peritoneum below it, the extraperitoneal fat, the transversalis fascia, the internal and external oblique and transversus abdominis aponeurosis, and a layer of fascia, which has different names according to what it covers (e.g., transversalis, psoas fascia). In medical vernacular, the term 'abdominal wall' most commonly refers to the layers composing the anterior abdominal wall which, in addition to the layers mentioned above, includes the three layers of muscle: the transversus abdominis (transverse abdominal muscle), the internal (obliquus internus) and the exter ...
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Peritoneum
The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesothelium supported by a thin layer of connective tissue. This peritoneal lining of the cavity supports many of the abdominal organs and serves as a conduit for their blood vessels, lymphatic vessels, and nerves. The abdominal cavity (the space bounded by the vertebrae, abdominal muscles, diaphragm, and pelvic floor) is different from the intraperitoneal space (located within the abdominal cavity but wrapped in peritoneum). The structures within the intraperitoneal space are called "intraperitoneal" (e.g., the stomach and intestines), the structures in the abdominal cavity that are located behind the intraperitoneal space are called " retroperitoneal" (e.g., the kidneys), and those structures below the intraperitoneal space are calle ...
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Appendicitis
Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis. Appendicitis is caused by a blockage of the hollow portion of the appendix. This is most commonly due to a calcified "stone" made of feces. Inflamed lymphoid tissue from a viral infection, parasites, gallstone, or tumors may also cause the blockage. This blockage leads to increased pressures in the appendix, decreased blood flow to the tissues of the appendix, and bacterial growth inside the appendix causing inflammation. The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and tissue death. If this process is left untreated, the appendix may burst, releasi ...
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Ulcerative Colitis
Ulcerative colitis (UC) is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include abnormal dilation of the colon ( megacolon), inflammation of the eye, joints, or liver, and colon cancer. The cause of UC is unknown. Theories involve immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors. Rates tend to be higher in the developed world with some proposing this to be the result of less exposure to intestinal infections, or to a Western diet and lifestyle. The removal of the appendix at an early age may be protective. Diagnosis is typically by colonoscopy with tissue biopsies. It ...
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Right Lower Quadrant
The human abdomen is divided into quadrants and regions by anatomists and physicians for the purposes of study, diagnosis, and treatment. The division into four quadrants allows the localisation of pain and tenderness, scars, lumps, and other items of interest, narrowing in on which organs and tissues may be involved. The quadrants are referred to as the left lower quadrant, left upper quadrant, right upper quadrant and right lower quadrant. These terms are not used in comparative anatomy, since most other animals do not stand erect. The left lower quadrant includes the left iliac fossa and half of the flank. The equivalent in other animals is ''left posterior quadrant''. The left upper quadrant extends from the umbilical plane to the left ribcage. This is the ''left anterior quadrant'' in other animals. The right upper quadrant extends from umbilical plane to the right ribcage. The equivalent in other animals is ''right anterior quadrant''. The right lower quadrant extend ...
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Abdominal Exam
The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. The area occupied by the abdomen is called the abdominal cavity. In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax. In humans, the abdomen stretches from the thorax at the thoracic diaphragm to the pelvis at the pelvic brim. The pelvic brim stretches from the lumbosacral joint (the intervertebral disc between L5 and S1) to the pubic symphysis and is the edge of the pelvic inlet. The space above this inlet and under the thoracic diaphragm is termed the abdominal cavity. The boundary of the abdominal cavity is the abdominal wall in the front and the peritoneal surface at the rear. In vertebrates, the abdomen is a large body cavity enclosed by the abdominal muscles, at front and to the sides, ...
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Murphy's Sign
In medicine, Murphy's sign (also known as Sweeney’s sign) is a maneuver during a physical examination as part of the abdominal examination. It is useful for differentiating pain in the right upper quadrant. Typically, it is positive in cholecystitis, but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis. During physical examination Classically, Murphy's sign is tested for during an abdominal examination in supine position; it is performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder). The patient is then instructed to breathe in. Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner's fingers) and winces with a "catch" in ...
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Rovsing's Sign
Rovsing's sign, named after the Danish surgeon Niels Thorkild Rovsing (1862–1927), is a sign of appendicitis. If palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis. The phenomenon was first described by Swedish surgeon Emil Samuel Perman (1856-1945) writing in the journal ''Hygiea'' in 1904. In acute appendicitis, palpation in the left iliac fossa may produce pain in the right iliac fossa. Referral of pain This anomaly occurs because the pain nerves deep in the intestines do not localize well to an exact spot on the abdominal wall, unlike pain nerves in muscles. Pain from a stomach ulcer or gallstone can be interpreted by the brain as pain from the stomach, liver, gall bladder, duodenum, or first part of the small intestine. It will "refer" pain often to the mid upper abdomen, the epigastrum. Because the appendix is a piece ...
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