Q: Which of the following may have a rocking tenderness on the physical exam? (select one)
A) Pyogenic liver abscess
B) Acute cholecystitis
Answer: A
Rocking tenderness is demonstrated by gently rocking the patient's abdomen, particularly the right upper quadrant. It is one of the associated signs of pyogenic liver abscess. Other clinical signs and symptoms are pain, guarding, tenderness or rebound tenderness, hepatomegaly, and jaundice. Although their absence does not rule out the disease.
These findings should be combined with laboratory and imaging findings. In this regard, often ignored are the associated findings on chest x-ray which may show an elevated right hemidiaphragm, right basilar infiltrate, or/and right-sided pleural effusion.
#hepatology
References:
1. Mohsen AH, Green ST, Read RC, McKendrick MW. Liver abscess in adults: ten years experience in a UK centre. QJM 2002; 95:797.
2. Longworth S, Han J. Pyogenic liver abscess. Clin Liver Dis (Hoboken). 2015;6(2):51-54. Published 2015 Aug 24. doi:10.1002/cld.487
3. Serraino C, Elia C, Bracco C, et al. Characteristics and management of pyogenic liver abscess: A European experience. Medicine (Baltimore). 2018;97(19):e0628. doi:10.1097/MD.0000000000010628
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