Eponymous Signs in Abdominal and Liver Disease
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Direct answer
Several named abdominal signs point to a specific organ or complication, and they are classic viva material for NEET-PG. Cullen and Grey Turner signs indicate haemorrhage, most classically from acute haemorrhagic pancreatitis, while Murphy sign and Charcot triad point to gallbladder inflammation and biliary infection.
What you must remember
- Cullen sign: periumbilical bruising, a late sign of haemorrhagic pancreatitis or intra-abdominal bleeding.
- Grey Turner sign: bruising of the flanks, reflecting retroperitoneal haemorrhage, most often from pancreatitis.
- Courvoisier law: a palpable, non-tender gallbladder with painless obstructive jaundice suggests malignant obstruction, such as a pancreatic head carcinoma, rather than stones.
- Murphy sign: inspiratory arrest on palpation below the right costal margin, indicating acute cholecystitis.
- Charcot triad: fever, jaundice and right upper quadrant pain, indicating ascending cholangitis.
- Reynolds pentad: Charcot triad with hypotension and altered mental status, indicating severe suppurative cholangitis that needs urgent biliary drainage.
- Sister Mary Joseph nodule: a firm periumbilical nodule, usually signalling metastatic intra-abdominal malignancy, most often gastric or ovarian.
Sorting an acutely painful or jaundiced abdomen with signs
Abdominal signs are most useful when read in sequence, since each one narrows the differential. The steps below run from the systemic picture to the skin.
- Systemic picture: fever, jaundice and right upper quadrant pain together form Charcot triad, which points to ascending cholangitis.
- Severity check: hypotension and confusion added to Charcot triad make up Reynolds pentad, signalling severe cholangitis that needs urgent drainage.
- Murphy sign: inspiratory arrest on palpation below the right costal margin suggests acute cholecystitis rather than a biliary obstruction alone.
- Gallbladder palpation: a palpable, non-tender gallbladder with painless jaundice raises the possibility of malignant obstruction, as Courvoisier law states.
- Skin bruising: periumbilical bruising (Cullen sign) or flank bruising (Grey Turner sign) suggests haemorrhage into the abdomen or retroperitoneum, most often in acute haemorrhagic pancreatitis.
- Umbilical nodule: a firm periumbilical nodule (Sister Mary Joseph nodule) suggests metastatic intra-abdominal malignancy, with gastric and ovarian cancers as classic primaries.
Traps in abdominal sign questions
Abdominal eponyms are easily confused with one another, and the region examined is usually the decisive clue.
- Trap: reading Murphy sign as appendicitis Correct: Murphy sign localises gallbladder inflammation, whereas appendicitis is suggested by McBurney point tenderness and rebound.
- Trap: attributing a non-tender palpable gallbladder with jaundice to gallstones Correct: Courvoisier law favours malignant obstruction, because stones usually cause fibrosis that leaves the gallbladder impalpable.
- Trap: confusing Charcot triad with Reynolds pentad Correct: Reynolds pentad adds hypotension and altered mental status, which signals severe cholangitis and a surgical or endoscopic emergency.
Frequently asked questions
What is the difference between Cullen and Grey Turner signs?
Cullen sign is periumbilical bruising, while Grey Turner sign is bruising of the flanks, and both reflect intra-abdominal or retroperitoneal haemorrhage. They are most classically linked to acute haemorrhagic pancreatitis, and they often appear some time after the onset of illness.
Which sign suggests malignant obstruction in obstructive jaundice?
Courvoisier law states that a palpable, non-tender gallbladder with painless obstructive jaundice points towards malignant obstruction, most often of the pancreatic head. Gallstones usually produce a shrunken, impalpable gallbladder because of chronic inflammation and fibrosis.
Which triad indicates ascending cholangitis?
Charcot triad of fever, jaundice and right upper quadrant pain indicates ascending cholangitis, usually from an infected obstructed bile duct. When hypotension and altered mental status are added, the picture is called Reynolds pentad, which signals severe disease needing urgent drainage.
What does a Sister Mary Joseph nodule suggest?
A Sister Mary Joseph nodule is a firm periumbilical nodule that suggests metastatic spread from an intra-abdominal malignancy. Gastric and ovarian cancers are the classic primary sources, so the finding should prompt a search for both.