Abdominal Assessments

McBurney's Point is a key test for appendicitis.

• 1.5 to 2 inches from the Anterior Superior Iliac Spine (ASIS) on straight line to the umbilicus.

Psoas/Illiopsoas Sign suggests appendicitis.

• Patient lies in supine position with right leg raised; apply downward pressure on the leg. Positive if RLQ abdominal pain occurs with passive right hip extension.

Obturator Sign suggests appendicitis, but low sensitivity.

• Internal rotation of the hip causes RLQ abdominal pain.

Rovsing's Sign suggests appendicitis; low sensitivity.

• Referred pain to RLQ with deep palpation of LLQ.

Markle Test (heel jar test) suggets appendicitis.

• Patient raises heels, drops them suddenly, causing RLQ pain.

Guarding can be involuntary or voluntary; involuntary guarding is a reflexive contraction of the abdominal muscles upon palpation and suggests peritonitis. Rebound Tenderness suggests peritonitis. Abdominal pain worsens after palpation stops compared to abdominal pain during* palpation. Suggests peritonitis. Murphy's Sign/Maneuver cholecystitis or gallbladder disease.

• Mid-inspiratory arrest and pain in RUQ when clinician presses deeply under right costal border (RUQ) during inspiration.

Carnett's Sign Indicates source of abdominal pain.

• Positive (increased pain) indicates that the abdominal wall is the source of abdominal pain.
• Negative (decreased pain) indicates that the pain arises from an intra-abdominal organ.
• Patient lies supine with arms crossed over chest; patient then lifts shoulders off table to tighten rectus abdominus muscles.

Cullen's sign suggests intraperitoneal or retroperitoneal hemorrhage as seen in (pancreatitis, ectopic pregnancy, etc).

• Edema, bruising around umbilicus.

Grey Turner's sign suggests retroperitoneal hemorrhage as seen in pancreatitis. Rarely seen.

• Bruising/bluish discoloration of the flank.