A 44-year-old female presents to urgent care with right upper quadrant pain radiating to the right shoulder along with nausea and vomiting. Which positive physical exam finding raises the nurse practitioner’s suspicions of acute cholecystitis?
Murphy’s sign is the most indicative finding for acute cholecystitis. It occurs when palpation of the right upper quadrant during inspiration causes the patient to stop breathing abruptly due to pain, which suggests gallbladder inflammation. This happens because the diaphragm pushes the inflamed gallbladder downward, causing significant pain upon contact with the examiner’s fingers. In this case, the patient’s right upper quadrant pain, radiating to the shoulder, along with nausea, further supports the diagnosis of cholecystitis. Cullen’s sign is indicative of abdominal trauma that has led to hemorrhage (bluish discoloration around the umbilicus) and is associated with conditions like pancreatitis or ruptured ectopic pregnancy; Blumberg’s (rebound tenderness) more often points to peritonitis or appendicitis and McBurney’s point tenderness is more specific to appendicitis (rebound tenderness which is located one-third of the distance from the anterior superior iliac spine to the umbilicus in the right lower quadrant).
In acute cholecystitis, Murphy’s sign—characterized by pain in the right upper quadrant during palpation upon inhalation—is a hallmark physical exam finding. Other symptoms include right upper quadrant pain, nausea, vomiting, and fever. Common risk factors include gallstones, obesity, age over 40, female gender, rapid weight loss, and a high-fat, low-fiber diet.