What assessment finding of a patient with acute pancreatitis would indicate a bluish discoloration around the umbilicus?
A. Grey-Turner's sign
B. Homan's sign
C. Rovsing's sign
D. Cullen's sign
Correct Answer: D. Cullen’s sign
Cullen’s sign is associated with pancreatitis when a hemorrhage is suspected. Cullen’s sign is described as superficial edema with bruising in the subcutaneous fatty tissue around the periumbilical region. It is also known as periumbilical ecchymosis. It is most often recognized as a result of hemorrhagic pancreatitis. The sign can take 2–3 days before appearance and may be used as a clinical sign to help the diagnosis of acute pancreatitis.
Option A: Grey-Turner’s sign is ecchymosis in the flank area suggesting retroperitoneal bleed. Grey Turner’s sign is an uncommon subcutaneous manifestation of intra-abdominal pathology that manifests as ecchymosis or discoloration of the flanks. Classically it correlates with severe acute necrotizing pancreatitis, often in association with Cullen’s sign (periumbilical ecchymosis).
Option B: Homan’s sign is called pain elicited by the dorsiflexion of the foot and suggests deep vein thrombosis. Homan’s sign test also called dorsiflexion sign test is a physical examination procedure that is used to test for deep vein thrombosis (DVT). A positive Homan’s sign in the presence of other clinical signs may be a quick indicator of DVT. Clinical evaluation alone cannot be relied on for patient management, but when carefully performed, it remains useful in determining the need for additional testing (like D-dimer test, ultrasonography, multidetector helical computed axial tomography (CT), and pulmonary angiography).
Option C: Rovsing’s sign is associated with appendicitis when pain is felt with pressure at McBurney’s point. Rovsing’s sign is a clinical finding that is indicative of acute appendicitis (the inflammation and possible infection of the appendix). A positive Rovsing’s sign is characterized by right lower abdominal pain upon palpation of the left side of the lower abdomen
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