Which sign is indicative of acute cholecystitis, characterized by hyperesthesia below the right scapula?

Boas sign is indeed indicative of acute cholecystitis and refers to the phenomenon of hyperesthesia (increased sensitivity to stimuli) in the area below the right scapula. This sign arises because irritation of the diaphragm due to an inflamed gallbladder can refer pain to the right shoulder region. It occurs due to the shared nerve pathways between the visceral organs and the somatic structures in that area.

In the context of acute cholecystitis, the inflammation of the gallbladder can lead to irritation of the phrenic nerve, which innervates the diaphragm. When the diaphragm is irritated, it can manifest as referred pain in areas that are innervated by the same spinal cord segments, including the dermatomes of the right shoulder and the area beneath the right scapula.

Other signs and tests mentioned in the options have different clinical implications. For example, the psoas stretch sign is primarily associated with appendicitis, where pain occurs upon stretching the psoas muscle. McBurney’s point is another reference point for appendicitis rather than cholecystitis, while shifting dullness is a sign used to detect fluid in the abdominal cavity, commonly seen in conditions like ascites. Therefore