Which sign is seen in pancreatitis?

Appeared in: JIPMER Nursing Officer - 2020

Explanation

Cullen sign is characterized by superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
It is a sign of retroperitoneal hemorrhage, where blood from the inflamed pancreas tracks along the falciform ligament to the periumbilical area.
While rare, its presence indicates severe necrotizing pancreatitis and is associated with increased morbidity and mortality.

Option B: Kernig sign is a neurological sign used to diagnose meningitis, not pancreatitis. It assesses for meningeal irritation.
Option C: Murphy sign is specific to gallbladder inflammation (acute cholecystitis). It is elicited by palpating the right upper quadrant.
Option D: Psoas sign indicates irritation of the iliopsoas muscle, which is most commonly associated with appendicitis, especially a retrocecal appendix.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of acute pancreatitis as background academic context rather than a clinical decision trigger.
Recognizing Cullen's and Grey Turner's signs is critical for nurses as they are indicators of severe, life-threatening pancreatitis. Their presence warrants immediate escalation to the medical team.
A nurse's thorough abdominal assessment, including inspection for discoloration, is vital for early detection of complications.
What if? If a patient with known pancreatitis suddenly develops periumbilical bruising (Cullen's sign), the nurse's priority action is to assess vital signs for shock (hypotension, tachycardia) and notify the physician immediately, as this indicates a significant decline.

How to Approach the Question

First, identify the core concept of the question, which is 'pancreatitis'.
Next, recall the specific clinical signs associated with pancreatitis from your knowledge base.
Evaluate each option. Cullen sign is known to be associated with hemorrhagic pancreatitis.
Systematically rule out the other options by linking them to their correct associated conditions: Kernig sign with meningitis, Murphy sign with cholecystitis, and Psoas sign with appendicitis.
This process of association and elimination leads to the correct answer.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 p. 649-651

E6 Medicine Macleod Clinical Examination 15e p. 126-128

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