‘Cough sign’: A reliable test in the diagnosis of intra-abdominal inflammation

Kovachev, L

doi:10.1002/bjs.1800811052

Cited by 3 publications

(4 citation statements)

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“…Originally described by Rostovzev in 1909, this test seeks evidence of peritoneal irritation by having the patient cough 42. Jeddy and colleagues43 described a positive test as a cough causing a sharp, localized pain.…”

Section: Physical Examinationmentioning

confidence: 99%

“…Originally described by Rostovzev in 1909, this test seeks evidence of peritoneal irritation by having the patient cough. 42 Jeddy and colleagues 43 described a positive test as a cough causing a sharp, localized pain. They applied this prospectively to patients with right lower quadrant pain and found it to have near perfect sensitivity with a specificity of 95% for the detection of appendicitis or peritonitis (one patient with perforated diverticulitis).…”

Section: Physical Examinationmentioning

confidence: 99%

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Evaluation and management of acute abdominal pain in the emergency department

Macaluso¹,

McNamara²

2012

IJGM

125

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Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain.

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Section: Physical Examinationmentioning

confidence: 99%

Section: Physical Examinationmentioning

confidence: 99%

Evaluation and management of acute abdominal pain in the emergency department

Macaluso¹,

McNamara²

2012

IJGM

125

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“…Thus, the liver capsule irritation sign is a useful physical finding as one of the peritoneal irritation signs, along with the cough sign and percussion tenderness, as observed in this case. In the future, more case reports demonstrating the usefulness of this sign for diagnosing perihepatitis other than Fitz-Hugh-Curtis syndrome will be needed [ 7 , 8 ], to determine the likelihood ratio of this sign.…”

Section: Discussionmentioning

confidence: 99%

“…The abdomen was flat and soft, with tenderness in the right upper quadrant. There was no rebound pain or muscular defense, but the cough sign was positive [ 7 ]. When the patient was placed in the left lateral recumbent position and the abdomen was palpated (as per the procedure described in Figure 1 ), tenderness and spontaneous pain in the right upper abdomen increased (liver capsule irritation sign), which led to the possibility of Fitz-Hugh-Curtis syndrome being considered.…”

Section: Case Presentationmentioning

confidence: 99%

Two Cases of Perihepatitis With the Liver Capsule Irritation Sign: A New Physical Examination Technique

Kaga¹,

Itô²,

Ueda³

2023

Cureus

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Perihepatitis, including Fitz-Hugh-Curtis syndrome, is an uncommon, chronic manifestation of pelvic inflammatory disease usually affecting premenopausal women. It causes right upper quadrant pain due to inflammation of the liver capsule and adhesion of the peritoneum. Since delayed diagnosis of Fitz-Hugh-Curtis syndrome can lead to infertility and other complications, physical examination findings need to be investigated to predict perihepatitis in the early stages of the disease. Here, we hypothesized that perihepatitis is characterized by increased tenderness and spontaneous pain in the right upper abdomen when the patient is placed in the left lateral recumbent position (we termed this indication the "liver capsule irritation sign"). We examined the patients physically for the presence of this liver capsule irritation sign for an early diagnosis of perihepatitis. We report the first two cases of perihepatitis due to Fitz-Hugh-Curtis syndrome in which the liver capsule irritation sign observed during the physical examination was used for diagnosis. The liver capsule irritation sign is caused by two mechanisms: first, the liver falls gravitationally into the left lateral recumbent position, which makes the liver easier to palpate; and second, the peritoneum is stretched and thus stimulated. The second mechanism is that the transverse colon running around the right upper abdomen slumps gravitationally when the patient is in the left lateral recumbent position, allowing for direct palpation of the liver. The liver capsule irritation sign can be a useful physical finding, suggestive of perihepatitis due to Fitz-Hugh-Curtis syndrome. It may also be suitable in cases of perihepatitis caused by factors other than Fitz-Hugh-Curtis syndrome.

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Approach to Acute Abdominal Pain

McNamara

Dean

2011

Emergency Medicine Clinics of North America

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‘Cough sign’: A reliable test in the diagnosis of intra-abdominal inflammation

Cited by 3 publications

References 0 publications

Evaluation and management of acute abdominal pain in the emergency department

Evaluation and management of acute abdominal pain in the emergency department

Two Cases of Perihepatitis With the Liver Capsule Irritation Sign: A New Physical Examination Technique

Approach to Acute Abdominal Pain

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