Internal Diseases · MU Sofia

Practical · 22. Physical methods of examination of the biliary tract and pancreatic gland

Covers the physical examination of the biliary tract and pancreas, taking inspection, palpation, percussion and auscultation for each in turn. For the biliary tract it describes signs such as jaundice, the palpable gallbladder, Murphy's sign and Courvoisier's sign. For the pancreas it describes epigastric findings, board-like rigidity, Cullen's sign and Grey-Turner's sign.

Inside: 3 sections · 4 labelled pictures · 13 flashcards · 2 min

Topic 79 of 88 in the MU Sofia syllabus for Internal Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 3 sections, about 224 words (2 min of reading), with 13 flashcards.

In this note

  1. Physical Methods of Examination of the Biliary Tract and Pancreatic Gland
  2. I. Biliary Tract Examination (Liver, Gallbladder, Bile Ducts)
  3. II. Pancreas Examination

I. Biliary Tract Examination (Liver, Gallbladder, Bile Ducts)

1. Inspection

  • Observe for:
  • Jaundice (yellowing of skin/sclera) → suggests biliary obstruction.
  • Scratch marks → from cholestatic pruritus.
  • Dilated veins (in chronic liver disease).

2. Palpation

  • Gallbladder: Normally not palpable.
  • If palpable:
  • Smooth, tense, and painful: Acute cholecystitis.
  • Non-tender, enlarged gallbladder + jaundice: Courvoisier’s sign → suspect malignancy of pancreatic head or common bile duct.
  • Murphy’s Sign:
  • Palpate RUQ and ask patient to inhale.
  • Positive if patient halts inspiration due to pain → suggests acute cholecystitis.

3. Percussion

  • Over the right subcostal area.
  • Tenderness may be present in inflammation.

4. Auscultation

  • Usually not helpful unless vascular bruits are suspected (rare).

II. Pancreas Examination

Note: The pancreas lies retroperitoneally, so it’s not directly palpable unless massively enlarged or displaced due to a mass or cyst.

1. Inspection

  • Epigastric fullness in pancreatic cysts or pseudocysts.
  • Jaundice if pancreatic head tumor compresses bile duct.

2. Palpation

  • Deep palpation in the epigastrium may elicit:
  • Tenderness in acute pancreatitis.
  • A mass (e.g., cancer, cyst).
  • A board-like rigidity in severe peritonitis (pancreatic rupture/necrosis).
  • Cullen’s Sign: Bluish discoloration around umbilicus → hemorrhagic pancreatitis.
  • Grey-Turner’s Sign: Bluish discoloration of flanks → retroperitoneal bleeding.

3. Percussion

  • Not diagnostic for the pancreas itself.
  • May reveal dullness in the upper abdomen in large masses or fluid collections.

4. Auscultation

  • Usually non-contributory.
  • In rare cases, a bruit may be heard in vascular tumors or aneurysms involving the pancreatic region.

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