Clinical manifestations-cholecystitis

• History: RUQ/epigastric pain ± radiation to R shoulder/back, nausea, vomiting, fever

• Physical exam: RUQ tenderness, Murphy’s sign = ↑ RUQ pain and inspiratory arrest with deep breath during palpation of R subcostal region, ± palpable gallbladder

• Laboratory evaluation: may see ↑ WBC, ± mild ↑ bilirubin, Aϕ, ALT/AST, amylase; if AST/ALT >500 U/L, bili >4 mg/dL or amylase >1000 U/L → choledocholithiasis

• cholecystitis