History and exam
Key diagnostic factors
common
previous episode of biliary pain
About 50% of the patients who have had one episode of biliary pain will have another within 1 year.[44]
right upper quadrant pain
Usually intense, lasting more than 30 minutes.
May begin in the epigastrium or left upper quadrant and move to the right subcostal region. Most often occurs after eating a fatty meal.
positive Murphy sign
Palpation of the right subcostal region reveals tenderness. During deep inspiration, the tenderness suddenly becomes worse and produces inspiratory arrest. Can also be elicited during ultrasound exam.
abdominal mass
A distended, tender gallbladder may be palpable as a distinct mass in 30% to 40% of cases.[13]
Other diagnostic factors
common
right shoulder pain
Referred pain from the gallbladder may be felt in the right shoulder or interscapular region.
anorexia
Nonspecific symptom commonly associated with biliary disease.
nausea
Typically associated with constant right upper quadrant pain in patients with biliary disease.
fever
Persistent pain and fever suggest either more complicated disease such as abscess formation, perforation, or acalculous cholecystitis.
uncommon
vomiting
Nonspecific symptom commonly associated with biliary disease.
jaundice
Mild jaundice present in about 10% of patients with the condition.[1] Due to inflammation and edema around the biliary tract and direct pressure on the biliary tract from a distended gallbladder, calculi within the common bile duct, or obstruction by a stone impacted in the gallbladder neck (Mirizzi syndrome).
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