Boas sign in Cholecystitis - USMLE Forums
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Old 06-11-2011
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Liver Boas sign in Cholecystitis

In acute cholecystitis area of hyperaesthesia over the right side between 9_11th rib postero_ laterally i. e boas sign is +ve. Why it happens?

Help please.
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Old 06-11-2011
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I think it's due to the irritation of the phrenic nerve
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Old 06-11-2011
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yes it is due to irritation of the phrenic nerve..


some more diagnostic findings include the following:

Murphy's sign- tender RUQ
Ortner's sign - tenderness when hand taps the edge of right costal arch.
Georgievskiy - Myussi's sign (phrenic nerve sign) - pain when press between edges of sternocleidomastoid
Boas' sign - Increased sensitivity below the right scapula (also due to phrenic nerve irritation).
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Old 06-12-2011
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I fail to see why irritation of the phrenic nerve (C3,4,5) will refer pain to a region below the scapula. Irritation of this nerve tends to refer pain towards the shoulder tips as far as I know (hence why diaphragmatic pleural pain can refer here).

On the other hand according to Last's Anatomy, afferent pain fibres travel with right-sided sympathetic fibres to T7-9 (some may run with phrenic nerve). The T7-9 dermatome is actually localised below the scapula.
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Old 06-12-2011
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Courvoisier-Terrier's sign
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Old 06-13-2011
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Default Signs

Quote:
Originally Posted by rochalimea View Post
Courvoisier-Terrier's sign
Same as courvoisier's law, which states that non tender enlargement of the Gallbladder associated with Jaundice is not due to Gallstones.
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Old 06-13-2011
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i had the same doubt as AlittleTeaPOt as in why would the pain not go to shoulder ???
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Old 03-19-2012
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Ok I was researching this and it confirms phrenic nerve irritation, gallbladder gets so big that it touches the diaphragm and pain is referred to the shoulder.

http://books.google.com/books?id=5HE...rve%22&f=false

Pain also can radiate to right scapula because that is supplied by T7, which also supplies gall bladder.
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Old 03-19-2012
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Quote:
Originally Posted by ALittleTeaPot View Post
I fail to see why irritation of the phrenic nerve (C3,4,5) will refer pain to a region below the scapula. Irritation of this nerve tends to refer pain towards the shoulder tips as far as I know (hence why diaphragmatic pleural pain can refer here).

On the other hand according to Last's Anatomy, afferent pain fibres travel with right-sided sympathetic fibres to T7-9 (some may run with phrenic nerve). The T7-9 dermatome is actually localised below the scapula.
yes u are right thats y it pains not IN the scapula its the TIP of the scapula and in some people BELOW the scapula
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Clinical-Signs, Gastrointestinal-Tract-, Pathology-, Physiology-

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