Grey Turner’s Sign
Ecchymosis of the flanks
around the umbilicus
Normal span of the liver
Normal span = 6‐12cm
Pain in the RLQ during Left‐sided pressure‐
referred rebound tenderness seen in appendicitis
rebound tenderness or pain 1/3 of the
distance from the ASIS to the umbilicus‐ may suggest appendicitis/peritoneal irritation.
tests for acute cholecystitis or
cholelithiasis. Palplate deeply during inspiration and
observe for pain.
Enlarged non‐tender gallbladder
secondary to pancreatic disease or cancer
Iliopsoas Muscle Test
Have the patient flex their hip against your resistance
‐ Increased abdominal pain is a
positive test. This suggests irritation of the psoas muscle from an inflamed appendix.
Obturator muscle test
Flex the patients right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. Right hypogastric pain is a positive test. This suggests
irritation of the obturator muscle from an inflamed appendix.
Lloyd punch/Kidney punch/Costovertebral Angle(CVA) Tenderness
gently tapping the area of the back overlying the kidney produces pain in people with an infection around the kidney (perinephric abscess) or pyelonephritis or renal
Patient supine. Doc strikes patient’s heel. Pain
upon striking could indicate appendicitis.