Acute and chronic cholecystitis: The Daily PANCE Blueprint

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Acute and chronic cholecystitis: The Daily PANCE Blueprint

Which of the following best describes Murphy’s sign?

A. Pain when the patient exhales while closing their mouth and pinching their nose at the same time
B. Pain upon removal of pressure
C. Deep tenderness at McBurney's point
D. Right lower quadrant pain elicited by pressure applied on the left lower quadrant
E. Pain during inspiration while deep palpation of the right upper quadrant

Answer and topic summary

The answer is E. Pain during inspiration while deep palpation of the right upper quadrant

Acute cholecystitis is inflammation of the gall bladder that occurs most commonly due to a gallstone (90% of the time). Clinical features include RUQ pain, fever, malaise, nausea/emesis, pain radiation to the R scapular, and positive Murphy sign (pain during inspiration while palpation of RUQ). Labs may show mild elevations in AST and ALT; if ALP or GGT are elevated, consider cholangitis instead. RUQ transabdominal ultrasound is the preferred initial imaging test. Classically it will show thickening of the gallbladder wall (>3 – 5 mm). Treatment includes fluids, empiric antibiotics, and general surgery consult for evaluation for laparoscopic cholecystectomy.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Biliary Disorders  ⇒ Acute and chronic cholecystitis

Also covered as part of the Emergency Medicine EOR, Internal Medicine EOR, General Surgery EOR, and Family Medicine EOR topic lists

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