Cholecystitis - Abdominal Examination

Abdominal Examination — Acute Cholecystitis

General Inspection

• Patient appears uncomfortable and slightly febrile.
• Breathing is shallow due to right upper quadrant (RUQ) pain.
• May prefer lying still, avoiding deep breaths or movement.
• Mild tachycardia and low-grade fever may be noted.
• No jaundice unless choledocholithiasis present.

Inspection of the Abdomen

• Abdomen moves minimally with respiration.
• Localized fullness or distension in RUQ may be visible.
• No scars unless previous biliary surgery.
• Skin normal; no dilated veins or visible pulsations.

Palpation

• Tenderness localized to RUQ and epigastrium.
• Murphy’s sign positive: pain and inspiratory arrest on deep palpation of gallbladder area.
• Guarding may be localized to RUQ.
• No palpable mass unless gallbladder is distended (Courvoisier’s sign in malignancy).
• No hepatomegaly or splenomegaly usually.

Percussion

• Tenderness over RUQ on gentle percussion.
• Percussion note otherwise tympanic; no free fluid.

Auscultation

• Normal or slightly reduced bowel sounds.
• No bruits or venous hums.

Special Tests

• Murphy’s sign: pathognomonic for cholecystitis (loss of inspiration on palpation of gallbladder area).
• Check for referred pain to right shoulder or scapular area.
• Examine for jaundice (suggesting CBD involvement).

Findings consistent with acute cholecystitis — localized RUQ tenderness and positive Murphy’s sign. No hepatosplenomegaly or ascites. Suggest correlation with laboratory results (WBC, LFTs) and ultrasound abdomen for gallbladder wall thickening or stones.

Clinical Tips:

• Murphy’s sign is best elicited during deep inspiration.
• If jaundice is present, consider choledocholithiasis or cholangitis.
• Differentiate from peptic ulcer (epigastric tenderness without Murphy’s) and pancreatitis (central tenderness radiating to back).
• Courvoisier’s sign (palpable, non-tender gallbladder with jaundice) suggests malignancy, not stones.
• Always assess hydration and vital signs for sepsis.
• Document whether Murphy’s sign is true (pain + inspiratory arrest) or only tenderness.