Kehr and Ortner's symptom for cholecystitis. Manifestation of symptoms and their location

Georgievsky Mussi's symptom occurs during the progression of processes of inflammatory etiology in the cavity of the biliary tract. Acute cholecystitis, like pancreatitis, can occur in any person due to the abuse of fatty and fried foods, as well as spicy and smoked foods. In this article, we will take a closer look at how to check this symptom, and also consider what a phrenicus symptom is.

Who developed the technique

The doctor who developed this technique for diagnosing acute abdomen was born in 1857 in Chicago. His name is John B. Murphy. The symptom, the pattern of manifestation of which was established by an observant physician, made it possible to determine the cause of pain in many thousands of patients. By profession, John B. Murphy was a surgeon and diagnostician. He was lucky to study with a brilliant specialist of those years - Billroth. Murphy worked in his native Chicago. In addition to surgery, the doctor trained specialists, introducing the author’s methodology into practice. John B. Murphy is also the originator of the practice of treating tuberculosis using artificial pneumothorax.

What does the technique look like?

According to the Murphy method, the symptom of gallbladder inflammation is defined as follows:

the patient lies flat on the couch face up;
the doctor places the thumb of the left hand over the projection area of the gallbladder (free fingers are placed along the line of the ribs);
the patient needs to take a deep breath.

If the patient has an inflamed gallbladder, then a deep breath will be involuntarily interrupted, as pain will arise at the point pressed by the thumb. By the way, the pressure zone is called “Ker’s point”. According to the medical description, this is the place where the costal arch connects to the outer edge of the rectus abdominis (right) muscle.

This simplest manipulation practically does not fail. It is widely used by modern doctors. However, Mr. Murphy could determine the symptom of acute cholecystitis in several other ways.

First additional method: capture

In addition to intermittent breathing while pressing on the Kera point, Murphy introduced the grasping method into practice. To do this, the doctor grabbed the gallbladder with his fingers and squeezed it. If the organ was inflamed, the patient experienced severe sharp pain. In contrast, opinions were put forward that the gallbladder, when captured, would become painful in any pathology. But Murphy proved that there is no pain with kinks, tumors or scars, only with the inflammatory process.

When performing the Murphy capture, the symptom of acute cholecystitis was accurately determined. But modern surgeons do not use this method.

What to do?

Sometimes seeking medical help may not be possible, for example for rural residents. The first thing that can be done for the patient is to give him a comfortable position in bed, which will relieve intense pain in the hypochondrium. Then you should check for other signs of cholecystitis. If they are positive, a visit to the doctor will be mandatory. After the first signs appear, smoked meats, pickled vegetables, fatty foods, and alcohol should be excluded from the diet. This will help not to aggravate the inflammatory process and eliminate the development of complications.

Second additional method: hammer percussion

An outstanding surgeon developed this additional method for identifying inflammatory processes in the gallbladder for overweight people. Due to the layer of subcutaneous fat, it was simply impossible to palpate the organ by hand. Murphy suggested using the percussion method. A more understandable synonym for the word is tapping. That is, the doctor (in the classic case) detects the difference in sound by tapping individual areas of the body.

In practice, in relation to the gallbladder, it looks like this:

the patient is on the couch;
the doctor is placed to the right of the patient;
the doctor’s index finger is bent at a right angle and placed under the right hypochondrium near the abdominal wall;
the patient must take a full breath so that the gallbladder rises to the abdominal wall;
the doctor, using the edge of the left palm, strikes the bent phalanx;
if the blow causes pain, then this is a symptom of inflammation.

Treatment of cholecystitis

Treatment of cholecystitis should begin before the patient is hospitalized. Drugs are administered intravenously that help reduce pain (the No-shpy injection solution is most often used) and reduce pressure in the gallbladder due to improved flow of bile into the small intestine.

Ker's symptom in cholecystitis is the reason for immediate hospitalization of the patient, followed by surgical or conservative intervention by medical staff.

Timely attention to the presence of the described symptoms and the ability to distinguish them from differential diseases helps to increase the chance of a quick recovery without surgical intervention.

Accuracy of Murphy's technique

The main method for determining intermittent inspiration when pressing in the right hypochondrium (Keur's point) is quite informative. With proper palpation during further diagnosis, acute cholecystitis is confirmed in almost 80% of patients.

Additionally, the doctor conducts a survey and determines the presence of nausea, vomiting and pain in the upper right abdomen. If during palpation the breath is intermittent, but the patient complains of pain in the lower back, then this is not cholecystitis, but most likely pancreatitis or kidney disease. Murphy's symptom is not indicative of pancreatitis. If inflammation of the pancreas is suspected, the Mayo-Robson symptom is noted (pain is concentrated in the costovertebral angle). Also informative are the symptoms of Bliss, Voskresensky, Kerte and many other specialists studying the pancreas.

Uncomplicated cholecystitis

Catarrhal (simple) cholecystitis can be calculous or acalculous, primary or as an exacerbation of chronic recurrent cholecystitis. Clinically, in most cases it proceeds calmly. The pain is usually dull and appears gradually in the upper abdomen; intensifying, localized in the right hypochondrium.

On palpation, pain is noted in the area of the gallbladder, and there are also positive Grekov-Ortner and Murphy symptoms. There are no peritoneal symptoms, the number of leukocytes is in the range of 8.0 – 10.0 – 109/l, temperature is 37.6 °C, rarely up to 38 °C, no chills.

Attacks of pain continue for several days, but after conservative treatment they disappear.

Acute destructive cholecystitis can be calculous or acalculous, primary or an exacerbation of chronic recurrent cholecystitis.

Destruction can be phlegmonous, phlegmonous-ulcerative or gangrenous in nature.

With phlegmonous cholecystitis, the pain is constant and intense. Dry tongue, repeated vomiting. There may be a slight yellowness of the sclera and soft palate, which is due to infiltration of the hepatoduodenal ligament and inflammatory swelling of the mucous membrane of the bile ducts. Urine is dark brown. Patients lie on their backs or on their right side, afraid to change their position in the back, since in this case severe pain occurs.

On palpation of the abdomen, a sharp tension in the muscles of the anterior abdominal wall in the area of the right hypochondrium is observed, and positive Grekov-Ortner, Murphy, Shchetkin-Blumberg symptoms also occur there. The temperature reaches 38 °C and higher, leukocytosis is 12.0 – 16.0 – 109 / l with a shift in the leukocyte formula to the left. When the inflammatory process spreads to the entire gallbladder and pus accumulates in it, gallbladder empyema is formed.

Sometimes phlegmonous cholecystitis can develop into hydrocele of the gallbladder.

Gangrenous cholecystitis in most cases is a transitional form of phlegmonous, but can also arise as an independent disease in the form of primary gangrenous cholecystitis of vascular origin.

The clinical picture initially corresponds to phlegmonous inflammation, then so-called imaginary well-being may occur: pain decreases, symptoms of peritoneal irritation are less pronounced, and the temperature decreases. However, at the same time, the phenomena of general intoxication increase: rapid pulse, dry tongue, repeated vomiting, sharpened facial features.

Relevance of palpation of the gallbladder (Murphy's symptom)

The achievements of modern medicine make it possible to determine acute cholecystitis using hardware and instrumental methods. The most revealing can be considered MRI and ultrasound. Murphy's symptom serves as a reason for prescribing this diagnosis.

Despite hardware methods, Murphy's symptom remains relevant, since treatment often needs to be started urgently; there is simply no time or opportunity to take the patient for a more accurate diagnosis. For example, the patient is in a remote village, in a hunters' or shepherds' camp, where it is impossible to deliver medical equipment.

Modern methods make it possible to identify the disease (acute cholecystitis) with an ultrasound Murphy sign. The accuracy of this method exceeds 90%. For diagnosis, a special probe is used to determine the location of the gallbladder. Next, the patient should take a deep breath, and the doctor should sharply press the probe on the bubble. If the patient experiences pain at the time of pressure, then acute cholecystitis is present. If pain does not occur, then there is no inflammation, there are simply stones in the bile duct.

More about bladder symptoms

Murphy's symptom for cholecystitis is not the only method for determining the disease. A number of prominent doctors have made their contribution to medicine by developing techniques for identifying signs of gallbladder problems. For example, surgeon Vasilenko determined that at the early stage of cholecystitis, when tapping on the right costal arch at the point of projection of the gallbladder, pain occurs.

Ortner's symptom is considered indicative. He found that with cholecystitis, pain occurs if you tap along the edge of the costal arch. But it is necessary to carry out the manipulation on both sides in order to compare the patient’s sensations.

The Mussi-Georgievsky symptom, also called the Phrenicus symptom, is still used. Using this method, pathologies of the organs of the upper abdomen are determined. The manifestation of the Mussi-Georgievsky symptom is a painful sensation during palpation in the area of the legs of the sternocleidomastoid muscle. Pain occurs with cholecystitis on the right side and radiates downwards.

Doctor Lepen established the dependence of painful sensations in the area of the gallbladder during cholecystitis, if effleurage is performed with a bent finger. This symptom is called "Lepen's symptom."

Murphy's sign for pancreatitis

What does the technique look like?

According to the Murphy method, the symptom of gallbladder inflammation is defined as follows:

the patient lies flat on the couch face up;
the doctor places the thumb of the left hand over the projection area of the gallbladder (free fingers are placed along the line of the ribs);
the patient needs to take a deep breath.

This simplest manipulation practically does not fail. It is widely used by modern doctors. However, Mr. Murphy could determine the symptom of acute cholecystitis in several other ways.

Second additional method: hammer percussion

If the organ was inflamed, the patient experienced severe sharp pain. In contrast, opinions were put forward that the gallbladder, when captured, would become painful in any pathology.

But Murphy proved that there is no pain with kinks, tumors or scars, only with the inflammatory process.

When performing the Murphy capture, the symptom of acute cholecystitis was accurately determined. But modern surgeons do not use this method.

An outstanding surgeon developed this additional method for identifying inflammatory processes in the gallbladder for overweight people.

Due to the layer of subcutaneous fat, it was simply impossible to palpate the organ by hand. Murphy suggested using the percussion method. A more understandable synonym for the word is tapping.

That is, the doctor (in the classic case) detects the difference in sound by tapping individual areas of the body.

In practice, in relation to the gallbladder, it looks like this:

the patient is on the couch;
the doctor is placed to the right of the patient;
the doctor’s index finger is bent at a right angle and placed under the right hypochondrium near the abdominal wall;
the patient must take a full breath so that the gallbladder rises to the abdominal wall;
the doctor, using the edge of the left palm, strikes the bent phalanx;
if the blow causes pain, then this is a symptom of inflammation.

Such tapping is painful with cholecystitis, since the organ is entangled in a network of nerve fibers that respond to shocks.

Accuracy of Murphy's technique

We will start with the symptoms of acute and chronic appendicitis, which is dangerous by the development of infectious-toxic shock and peritonitis. With appendicitis, abdominal pain appears:

At first the pain is aching, located in the center of the abdomen, gradually shifting to the right iliac region. This is the Volkovich-Kocher symptom. It appears at the beginning of the disease.
Voskresensky's symptom is also recorded - when holding the hand from the right edge of the costal arch with the palm down, the pain intensifies.
Rovsing's sign is determined by pressure on the left iliac region. In this case, gases move in the descending colon, which provoke increased pain on the right.
Sitkovsky’s method - when the patient turns on his left side, the pain intensifies in the area of the ileocecal angle, that is, in the right iliac region.
The Bartholomew-Michelson maneuver is similar to the previous one, however, here the area of the ileocecal angle is palpated with the patient positioned on the left side, as a result of which the pain intensifies.
S. Dumbadze – there is pain in the umbilical region of the abdomen.
Psoas symptom, or Obraztsov’s symptom, when when raising the right leg, abdominal pain intensifies upon palpation.
Volkovich's syndrome is a symptom of chronic appendicitis - hypotrophy and even atrophy of the muscles of the anterior abdominal wall appear in the right iliac region, and when palpating the cecum and retracting it outward, the pain increases.

Cholecystitis is an inflammatory disease of the gallbladder, which can cause great discomfort to the patient. Let's consider a number of symptoms that will help identify this pathology:

Sm Murphy. The initial position of the patient is on his back. The left hand is on the stomach just below the right costal arch. The thumb is located in the projection of the gallbladder. When you take a deep breath, the stomach does not rise to the highest point, as its movement is interrupted by a sharp pain under the thumb of the left hand.
Sm Ortner-Grekov. The patient's position is also on his back. When you tap on the right costal arch with the edge of your palm, pain will appear.
Sm Georgievsky-Mussi, or phrenicus syndrome. If you press your finger above the collarbone between the legs of the sternocleidomastoid muscle, pain will be detected.
Sm Kera. When inhaling during palpation of the abdomen, pain appears in the right hypochondrium.
Sm Boas. Hyperesthesia in the lumbar region of the back.
Sm Zakharyin. Pain appears in the projection of the gallbladder when pressing and tapping. These are symptoms of acute cholecystitis.

Pancreatitis is inflammation of the pancreas. Pancreatitis is often associated with malnutrition, alcohol abuse, and hereditary pathology. Its symptoms upon objective examination are as follows:

Sm Mayo-Robson. Pain is detected in the region of the costovertebral angle on the left.
Sm Voskresensky - the pulsation of the aorta below the celiac trunk disappears.
S-Kacha is a sign of chronic pancreatitis - hyperesthesia in the area of innervation of the Th8 nerve, which corresponds to the 8th intercostal space on the left and right. This symptom is related to the girdling pain during an attack of pancreatic pain.

S. Krymova talks about perforation of the ulcer - pain when palpating the navel with a fingertip.
Boas's point - a pain point is determined in the back at the level of Th12 (12 pair of thoracic nerves, 12 segment of the thoracic spine) on the left.
The “splashing noise” occurs when there is stenosis of the pyloric part of the stomach, that is, the part that is connected to the duodenum.

These are the most important symptoms of gastric and duodenal ulcers.

Quite specific symptoms will be determined in diseases of the urinary system:

S-Pasternatsky - when tapping the lumbar region on the right or left, pain is determined on the affected side, and also after this manipulation, blood cells, in particular, red blood cells, appear in the urine test.
S-th effleurage - in the presence of kidney pathology, pain will be detected at the site of effleurage.
Guyon's method - palpation of the kidney reveals its pathological mobility. This symptom in most cases indicates a tumor.

Vascular lesions are quite a big problem and many people cannot decide to go to the doctor. We have collected several symptoms for some angiopathy that will help you decide on further examination and treatment.

Trendelenburg's syndrome occurs with varicose veins, when the venous valves function poorly or do not function at all. The patient is asked to lie down and raise the affected leg up until the vessels are empty. Then the saphenous vein is clamped with a finger and the patient is asked to quickly take a vertical position. If pathology occurs, when the fingers are removed, the venous vessels immediately fill.
Moshkovich's test - when removing the elastic bandage, the rate of increase in hyperemia and its intensity is much less on the sore leg than on the healthy leg. This test reveals obliterating angiopathy.
S-Hackenbruch-Sicard - when coughing, a shock is detected during palpation of the femoral vein. This is a positive symptom that informs about the presence of valvular insufficiency.
Hm, or Kazachescu's test. Using this test, thrombolytic pathology of the arteries is detected. A line is drawn along the entire leg with a blunt object. Where blood circulation is impaired, the redness of the line breaks off.
Sm Delbe-Perthes. An elastic bandage is applied to the upper third of the thigh, which prevents the outflow of blood through the veins. When in this state for several minutes, usually from 3 to 5, if the filling of the veins with blood decreases, it means that the deep vessels are passable; if filling occurs, we can talk about deep venous pathology.

In fact, to determine venous and arterial insufficiency, there are many methods and symptoms that are less significant, so we will not describe them.

Summer brings us not only joy and fun, but also trauma. How to identify this or that damage? The symptoms below will help: Symptoms when injuries occur

S-m balloting of the patella. This symptom indicates that there is fluid in the joint (synovitis, arthritis, hemarthrosis).
Beler's syndrome occurs only with a meniscus injury located in the knee joint. It manifests itself as increased pain in the joint when walking backwards.
Weinstein's S is determined by habitual dislocation of the shoulder. The patient is asked to abduct both shoulders 90 degrees and bend the arm at the elbow joints at a right angle. In this position, difficulties in outward rotational movements are identified.
S-M Vereneya is a sign of a fracture of the pelvic bones. Pain appears when the pelvic bones are gently squeezed in the transverse direction (where the iliac crests are located).
Sm Gorinevskaya, or the “sticky heel” symptom. This is a sign of a fracture of the superior ramus of the pubis. Its manifestations are that the patient cannot lift his leg in an extended position, but must certainly pull it towards the body. If someone else lifts the leg, the patient can easily hold it on his own.
With the development of peritonitis, that is, inflammation of the peritoneum, pain appears on palpation of the abdomen. When you press on the stomach and suddenly remove your hands, the pain instantly intensifies. This is a symptom of an acute abdomen - the Shchetkin-Blumberg symptom.
Valya's symptom indicates intestinal obstruction. Its essence lies in the appearance of local accumulation of gases in the intestine or protrusion of the proximal intestine.

That's all the information. We have given you only the most necessary and useful things, so after reading about these symptoms, you may suspect a particular disease. However, there is no need to exaggerate your strength and still, if necessary, you should consult a doctor.

S-Möbius. Relevant for thyrotoxicosis (excessive thyroid function). If you ask the patient to look closely at an object, he will not be able to carry out this action for a long time and one of the eyes will move outward.
C-telegraph pole - trembling of the whole body during thyrotoxicosis.
Graefe's sign is determined by the presence of a strip of sclera between the iris and the upper eyelid. This symptom will always be present with thyrotoxic exophthalmos.
Sm Valsalva. When the patient coughs, an enlarged thyroid gland in the form of a goiter is visualized.

More about bladder symptoms

Doctor Lepen established the dependence of painful sensations in the area of the gallbladder during cholecystitis, if effleurage is performed with a bent finger. This symptom is called "Lepen's symptom."

Source: //alfastroy-n.ru/simptom-merfi-pankreatite/

How to check a symptom?

To diagnose the Mussi-Georgievsky symptom, you need to press with your index finger on the middle part between the mastoid processes of the muscles of the sternum and clavicle. You need to press carefully, on the right. In patients with progression of inflammatory processes in the body, the Georgievsky Mussi symptom for cholecystitis will immediately manifest itself as a feeling of sharp pain of an acute nature in the area of the right hypochondrium. But, against what background does such intense pain occur? The anatomy of the human body will help answer this question.

What happens if you don't provide help?

The acute period of cholecystitis requires special enzyme therapy. Without proper treatment, the disease becomes chronic with phases of exacerbation and remission. The chronic condition is much more difficult to cure, since the pancreas and intestines are involved in the process. Moreover, food is poorly digested, which means that the body will not be able to obtain the required amount of vitamins, fats, proteins, carbohydrates, and minerals.

Most often, the Georgievsky-Mussy symptom signals the severity of the inflammatory process. Complications may be:

fistula formation;
development of acute pancreatitis;
gallbladder abscess;
blood poisoning (sepsis).

Even with a weakly positive symptom, it is recommended to go to the nearest hospital to the office of the surgeon on duty.

Physiological basis for Mussy's symptom

Strict control over the entire system of internal organs of the human body is exercised by the central nervous system department, which is responsible for all functioning processes of human life support. The occurrence of inflammatory processes provokes a pathological impairment of the functional performance of the following organs:

of cardio-vascular system;
excretory system;
biliary system;
respiratory system.

Impaired functioning of anatomical structures contributes to the development of local pain syndrome. But it is worth noting that during these processes, nerve fibers responsible for specific organs may also be involved. The bundle of nerve fibers is localized just in the area of the legs of the mastoid muscle fiber in the area of the borders of the clavicle and chest. Here, the nerve fibers of not only the organs of the neck region are intertwined, but also the organs whose anatomical location is in the peritoneal area.

As the pressure is applied, the nerve plexuses begin to become irritated, and then a characteristic feeling of acute pain appears in the place where the inflammatory process is localized.

The liver is controlled by the phrenic nerve, which ensures the formation of the hepatic plexus. It is located next to the mastoid-shaped muscle fiber at the border of the chest and clavicular joint, which provides pathophysiological explanations for the formation of a positive symptom of St. George's Mussi, which affects the gallbladder with acute painful sensations.

Preventive measures

Prevention of gallbladder diseases includes a balanced diet, moderate physical activity and monitoring the state of the gastrointestinal tract. A diet with an increased risk of developing pathology completely excludes spicy, fried, fatty foods and smoked foods. Basic nutritional recommendations:

Start your morning with 2 tbsp. l. olive oil, and then 100 ml of freshly squeezed citrus juice.
Take 100 ml of beetroot juice twice a day to restore intestinal microflora.
For inflammation of the gallbladder, take 2 tsp. hemp oil.
Serve avocado for breakfast 2-3 times a week. It contains essential essential oils and vitamins.
To remove waste and toxins from drinks, choose clean water, green tea and decoctions of choleretic herbal teas.

Remember that the health of the excretory system largely depends on the condition of the gastrointestinal tract.

How to determine pancreatitis

Pancreatitis can also be determined due to a positive reaction of the Georgievsky-Mussy symptom, but with the formation of pain on the left and not on the right. Georgievsky-Mussi symptom, or phrenicus symptom with a positive reaction, indicates a critical situation of the patient, requiring immediate hospitalization. Pain on the left side begins to appear in the following situations:

in case of violation of the integrity or trauma of the spleen;
with acute insufficiency of pancreatic secretory functionality;
when transferring an embryo into the cavity of the fallopian tubes, accompanied by intense bleeding;
when an abscess forms in the cavity of the prediaphragm;
with perforation of a gastric ulcer.

These conditions require emergency medical care.

It is also worth noting that the initial etiology of pancreatic damage to the pancreas consists of such symptoms as the appearance of nausea, vomiting and pain in the left hypochondrium area.

The occurrence of pain on the right during deep palpation examination of the right hypochondrium and when tapping the costal side of the palm along the arch of the ribs, Ker Ortner's symptoms, signals that acute cholecystitis is progressing.

Frenicus symptom

A positive reaction of the frenicus symptom in pancreatitis is manifested by the appearance of pain in the area of localization of the left phrenic nerve fiber, diagnosed by palpation pressing on the pit spaces between the legs of the sternocleidomastoid muscle fibers and the medial ends of the clavicle.

The appearance of the phrenicus symptom, both on the right side and on the left, can be positive and observed in the following cases: