History and exam
Key diagnostic factors
common
right upper quadrant or epigastric pain (typically lasting >30 minutes)
presence of risk factors
Key factors include: increasing age; female sex; obesity (BMI ≥30), diabetes and metabolic syndrome; family history, pregnancy; exogenous oestrogen; non-alcoholic liver disease; prolonged fasting/rapid weight loss; total parenteral nutrition; certain medications (e.g., octreotide, glucagon-like peptide-1 analogues, ceftriaxone), terminal ileum disease; haemoglobinopathies; and Native American/Hispanic ethnicity.[1][2][3][4][5][6][19][22][53][55][56][103]
Other diagnostic factors
common
postprandial pain
Onset of pain may be after a meal (typically around 1 hour after eating).[1]
right upper quadrant or epigastric tenderness
Tenderness to palpation in the right upper quadrant (RUQ) or epigastric area is the most common feature on examination in patients with symptomatic cholelithiasis.
Murphy’s sign (respiratory arrest upon deep inspiration on palpation of the biliary fossa) is more suggestive of cholecystitis.[82]
uncommon
nausea
More often accompanies pain from acute cholecystitis.[1]
jaundice
Uncommon in simple acute cholecystitis except for Mirizzi syndrome (a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder, causing compression or causing inflammation of the common bile duct or common hepatic duct, resulting in obstruction and jaundice).[33] Jaundice develops primarily in patients with choledocholithiasis, and is characteristic of cholangitis.[1]
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