Which physical findings suggest biliary colic and cholecystitis?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Vital signs parallel the degree of illness. Patients with cholangitis are more likely to have fever, tachycardia, and/or hypotension. Patients with gallbladder colic have relatively normal vital signs. In a retrospective study, only 32% of patients with cholecystitis had fever. Fever may be absent, especially in elderly patients.

Patients with cholecystitis are usually more ill appearing than simple biliary colic patients, and they usually lie still on the examination table, as any movement may aggravate any peritoneal signs. In elderly patients and those with diabetes, occult cholecystitis or cholangitis may be the source of fever, sepsis, or mental status changes.

Jaundice is unusual in the early stages of acute cholecystitis and may be found in fewer than 20% of patients. Frank jaundice should raise suspicion of concomitant choledocholithiasis or Mirizzi syndrome (obstruction of the bile duct as a result of external compression of a stone in the gallbladder or cystic duct).

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