• Charcot triad: its presence indicates acute cholangitis in 70% of cases

1. Biliary pain

2. Jaundice

3. Fever (with chills and rigor)

• Raynold's pentad: only positive in 10% of patients with cholangitis

1-3. Charcot triad

4. Mental confusion

5. Refractory sepsis manifested by hypotension

• Common MANEUVERS/SIGNS and their associations:

1. Cullen sign, Turner sign: hemorrhagic pancreatitis

2. Murphy sign: acute cholecystitis

3. Caput medusae: liver cirrhosis

4. Courvoisier gallbladder: cancer of the biliary tract or pancreatic head

5. Kehr sign: splenic rupture

6. Obturator test, reverse psoas maneuver: retrocecal appendicitis

7. Markle sign (jar tenderness): specific for peritonitis

8. Succussion splash: intestinal obstruction or gastric dilatation

• Bedside maneuvers to detect ASCITES:

1. Inspection for bulging flanks

2. Percussion for flank dullness

3. Puddle sign

4. Shifting dullness maneuver

5. Fluid wave maneuver

Best clues to make a diagnosis of ASCITES:

1. Focused history (history of liver disease)

2. Recent weight gain

3. Ankle edema

4. Increased abdominal girth

Causes of CIRRHOSIS: mnemonic: ABCDEF

Alpha 1-antitrypsin deficiency

Budd-Chiari syndrome, hepatitis B

Hepatitis C, Copper overload



Fe overload

Physical findings seen in HEMOCHROMATOSIS:

1. Bronzed skin pigmentation (sun-exposed areas)

2. Hepatomegaly with or without cirrhosis

3. Degenerative arthritis of the hands and fingers (proximal PIPs)

4. Testicular atrophy

Irreversible complications of HEMOCHROMATOSIS (despite therapy):

1. Arthropathy

2. Hypogonadism

3. Cirrhosis

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