Which physical finding is most indicative of gastric outlet obstruction?

• A. Succussion splash
• B. Murphy sign
• C. Rovsing sign
• D. Psoas sign

Answer: (A)

The main idea is that a gastric outlet obstruction causes the stomach to become distended with both gas and liquid. The classic physical finding is a succussion splash: when you gently rock the patient from side to side, you can hear or feel a slosh in the upper abdomen, produced by the retained gastric contents sloshing back and forth. This sign directly reflects delayed gastric emptying due to obstruction and is the best clue among the choices.

The other signs point to different problems. Murphy sign is associated with acute cholecystitis, Rovsing sign with appendicitis, and Psoas sign with irritation of the iliopsoas muscle often from retroperitoneal inflammation or appendiceal involvement. None of these indicate a distended stomach from gastric outlet obstruction, so they are less specific for this condition.