Hukum Courvoisier

Kandung empedu yang teraba pada ikterus tidak mungkin disebabkan oleh batu kandung empedu. Hal
ini biasanya menunjukkan adanya striktur neoplastik tumor (tumor pankreas, ampula, duodenum, CBD),
striktur pankreatitis kronis, atau limfadenopati portal.

Murphys sign
To assess the abdomen for Murphys sign:
- Lie the patient supine (as you would during any other abdominal assessment);
- Instruct the patient to breath out;
- Place your palpating hand just below the costal margin, approximately mid-clavicularly (this is
just above the gallbladder);
-Then instruct the patient to slowly breath in;
A positive Murphys sign is identified when the patient stops breathing in due to pain -- this is
caused by the move of the diaphragm pushing the inflamed gallbladder into the palpating hand.
A negative Murphys sign is identified when the patient comfortable breaths all the way in
without any pain -- in this case, the diaphragm pushes the non-inflamed gallbladder into the
palpating hand with nil changes in the patients level of comfort.
A positive Murphys sign often indicates Cholycystitis, where as a negative Murphys sign may
suggest pyelonephritis, and ascending cholangitis.
Trias Charcot : Nyeri kuadran kanan atas, ikterik, demam / menggigil

Panca Reynold : Trias Charcot + syok dan perubahan status mental