**Question:** Cullen's sign in seen in -

A. Inflammation of the gall bladder (cholecystitis)
B. Pneumonia
C. Inflammation of the liver (hepatitis)
D. Sepsis

**Core Concept:** Cullen's sign is a clinical sign that indicates the presence of ascites, specifically, peritoneal inflammation or infection. It is named after Sir William Gull, a British physician who first described this sign in 1889.

**Why the Correct Answer is Right:** Cullen's sign is typically seen in conditions involving the peritoneum or its adjacent organs, such as the gallbladder or liver. Among the given options, only Cullen's sign is associated with inflammation or infection of the liver (hepatitis) and gallbladder (cholecystitis).

**Why Each Wrong Option is Incorrect:**

A. Pneumonia: Cullen's sign is not associated with pneumonia, which is an infection of the lungs. Instead, the clinical sign for pneumonia is called Rourke's sign, which is a decrease in breath sounds on auscultation.

B. Sepsis: While sepsis can cause abdominal symptoms, it is not specifically associated with Cullen's sign. Sepsis is a systemic response to infection, often leading to multiple organ dysfunction, but it does not directly cause peritoneal inflammation.

C. Inflammation of the liver (hepatitis): Cullen's sign is associated with hepatitis, particularly acute hepatitis. Inflammation of the liver often leads to ascites, which can cause the clinical sign of Cullen's sign.

**Clinical Pearl:** Cullen's sign is a valuable clinical sign in the context of abdominal pain or tenderness. If a patient presents with abdominal symptoms and has a positive Cullen's sign, the clinician should consider potential causes like acute hepatitis or cholecystitis and proceed with further diagnostic tests to identify the underlying infection or inflammation.

**Correct Answer:** C. Inflammation of the liver (hepatitis)

**Core Concept:** Cullen's sign is a clinical sign indicating peritoneal inflammation or infection. It is typically observed in conditions affecting the peritoneum or adjacent organs, such as the liver and gallbladder. This sign is named after Sir Astley Cooper's student, Sir Astley Cooper, who first described the clinical presentation in 1846.