38 yrwoman with right upper quadrant pain and bouts of vom

Discussion in 'Question Zone' started by hopeful, Mar 25, 2006.

  1. hopeful

    hopeful Guest

    A 38 year old woman presents with right upper quadrant pain and bouts of vomiting. She is known to have gallstones and has had similar episodes in the past. Which of the following might support a diagnosis of acute cholecystitis rather than biliary colic?
    A. duration of symptoms
    B. Severity of vomiting
    C. Presence of Murphy's sign
    D. Presence of gas under right hemidiaphragm on erect CXR
  2. Guest

    Guest Guest

    Answer: Murphy's sign. This feature, evident as a limitation of deep inspiration whilst the right hypochondrium is being palpated gently, is caused by local peritonism. It suggests inflammation rather than an attack of colic. Its significance is that antibiotics would be warranted in such cases.
    Gas under the diaphragm signifies perforation of a hollow viscus, such as from a duodenal ulcer. It is essential to rule out such an event even in the presence of history and findings that bias one towards a less dramatic diagnosis.

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