Cirujano General

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Cirujano General >Year 2015, Issue 1-2

de Rungs BDR, Baldin AV, Muñoz HJ, Valdés CA, Gómez PM
Physical exam of acute abdomen and its main signs as an evidence-based practice
Cir Gen 2015; 37 (1-2)

Language: Español
References: 21
Page: 32-37
PDF: 4. Kb.

Full text


Introduction: Evidence-based medicine combines the best scientific evidence available and clinical judgment in order to make medical decisions. The return to the ritual of the physical examination and its upgrading to evidence-based medicine are important in this age of technological medicine. Methods: A comparative meta-analysis was performed using eight databases, searching for articles in the past 50 years. A total of 90 articles were selected, which were then tested for homogeneity of data by using the odds ratio Breslow-Day statistic test. The studies found were combined and positive and negative predictive values ​​were calculated using the Cochran-Mantel-Haenszel test. Results: The three main causes of acute abdominal pain in the emergency department (n = 12,706), were determined as appendicitis, cholecystitis and intestinal occlusion, including the primary signs found in acute abdomen with a chronic digestive disease. Appendicitis (n = 9,478): right lower quadrant pain with a positive predictive value (PPV) of 7.9 (7.3-8.5), and Von Blumberg sign, McBurney’s point with a PPV of 4.2 (1.1-6.3). Cholecystitis (n = 5,716): positive Murphy sign with a PPV of 2.8 (0.8-8.6), and abdominal rigidity with a PPV of 1.6 (1.0-2.5). Intestinal occlusion (n = 2,275): visible peristalsis with a PPV of 9.5 (16.3-22.4), and abdominal distension with a PPV of 6.3 (9.3-12.3). Abdominal exploration in chronic liver diseases (n= 3,134): wave sign for finding free ascites with a PPV of 6 (3.3-11.0), palpation with the patient supine in the search of a splenomegaly with a PPV of 8.2 (5.8-12), and search for palpable hepatomegaly in the liver edge with a PPV of 2 (1.5-2.8). Conclusion: Physical examination has always been essential to reach an appropriate diagnosis since the beginning of semiotics. The three main pathologies detected in this study can have their presumptive diagnosis through an appropriate examination of the patient, demonstrating that evidence-based medicine and the ritual of the physical examination are the best diagnostic examination method.

Key words: Evidence-based medicine, physical examination, diagnosis, semiology, scientific proof.


  1. Purcell TB. Nonsurgical and extraperitoneal causes of abdominal pain. Emerg Med Clin North Am. 1989; 7: 721-740.

  2. Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976; 131: 219-223.

  3. Cummings S, Papadakis M, Melnick J, Gooding GA, Tierney LM, Jr. The predictive value of physical examinations for ascites. West J Med. 1985; 142: 633-636.

  4. Gerspacher-Lara R, Pinto-Silva RA, Serufo JC, Rayes AA, Drummond SC, Lambertucci JR. Splenic palpation for the evaluation of morbidity due to schistosomiasis mansoni. Mem Inst Oswaldo Cruz. 1998; 93: 245-248.

  5. Joshi R, Singh A, Jajoo N, Pai M, Kalantri SP. Accuracy and reliability of palpation and percussion for detecting hepatomegaly: a rural hospital-based study. Indian J Gastroenterol. 2004; 23: 171-174.

  6. Berry J Jr, Malt RA. Appendicitis near its centenary. Ann Surg. 1984; 200: 567-575.

  7. Nauta RJ, Magnant C. Observation versus operation for abdominal pain in the right lower quadrant. Roles of the clinical examination and the leukocyte count. Am J Surg. 1986; 151: 746-748.

  8. Izbicki JR, Knoefel WT, Wilker DK, Mandelkow HK, Muller K, Siebeck M, et al. Accurate diagnosis of acute appendicitis: a retrospective and prospective analysis of 686 patients. Eur J Surg. 1992; 158: 227-231.

  9. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986; 15: 557-564.

  10. Fenyö G. Routine use of a scoring system for decision-making in suspected acute appendicitis in adults. Acta Chir Scand. 1987; 153: 545-551.

  11. Pocock SJ. The historical development of clinical trials. Chapter 2. In: Clinical Trials. Toronto: John Wiley & Sons;1984. pp. 14-15

  12. Daniels M, Hill AB. Chemotherapy of pulmonary tuberculosis in young adults. BMJ. 1952; I: 1162-1168.

  13. Valdivieso V. La medicina basada en evidencias. Rev Med Chile. 1997; 125: 1103-1109.

  14. Guyatt G. Users’ guides to the medical literature: a manual for evidence-based clinical practice. Eds. G Guyatt, D Rennie, 2002. p. xiv.

  15. Evidence Based Medicine Working Group. Evidence Based Medicine. A new approach to teaching the practice of medicine. JAMA. 1992; 268: 2420-2425.

  16. Verdugo RJ, Salinas RS, Castillo J, Cea JG. Surgical versus non surgical treatment for carpal tunnel syndrome (Cochrane Review). In: The Cochrane Library. 2003; 2.

  17. Counsell C, Salinas R, Warlow C, Naylor R. Patch angioplasty versus primary closure for carotid endarterectomy (Cochrane Review). In: The Cochrane Library. 2003; 2.

  18. Rojas MP, Telaro E, Russo A, Fossati R, Palli D, Rosselli Del Turco M et al. Follow-up strategies for women treated for early breast cancer (Cochrane Review). In: The Cochrane Library. 2003; 2.

  19. Salinas RA, Alvarez G, Alvarez MI, Ferreira J. Corticosteroids for Bell’s palsy (idiopathic facial paralysis) (Cochrane Review). In: The Cochrane Library. 2003; 2.

  20. Salinas R, Counsell C, Prasad K, Gelband H, Garner P. Ministry of Health, Santiago, Chile. Treating neurocysticercosis medically: a systematic review of randomized, controlled trials. Trop Med Int Health. 1999; 4: 713-718.

  21. Letelier LM, Udol K, Ena J, Weaver B, Guyatt G. Effectiveness of amiodarone for conversion of atrial fibrillation to sinus rhythm: a meta-analysis. Arch Intern Med. 2003; 163: 777-785.

>Journals >Cirujano General >Year 2015, Issue 1-2

· Journal Index 
· Links 

Copyright 2019