What should be included in abdominal assessment of biliary colic and acute 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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Answer

Answer

As in all patients with abdominal pain, perform a complete physical examination, including rectal and pelvic examinations in women.

Abdominal examination in gallbladder colic and cholecystitis is remarkable for epigastric or right upper quadrant tenderness and abdominal guarding. The Murphy sign (an inspiratory pause on palpation of the right upper quadrant) can be found on abdominal examination. Singer et al noted that a positive Murphy sign was extremely sensitive (97%) and predictive (positive predictive value [PPV], 93%) for cholecystitis. [12] However, in elderly patients, this sensitivity may be decreased.

A palpable fullness in the RUQ may be appreciated in 20% of cases after 24 hours of symptoms, but this finding is rarely present early in the clinical course.

When observed, peritoneal signs should be taken seriously. Most uncomplicated cholecystitis does not have peritoneal signs; thus, search for complications (eg, perforation, gangrene) or other sources of pain.


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