clinical features

Last edited 02/2022

Clinical features of acute cholecystitis include:

  • constant, severe pain in the epigastrium or right hypochondrium which:
    • radiates throughout the abdomen and to the back
    • may be preceded by attacks of biliary colic or may have been asymptomatic until the presenting episode
    • lasts for more than 12 hours
    • is worse on movement and inspiration
  • pyrexia
  • nausea and vomiting
  • palpation of the right hypochondrium demonstrates tenderness, guarding and occasionally a palpable, tender mass
  • positive Murphy's sign
    • arrest of inspiration while palpating the gallbladder during a deep breath
  • abdominal distension
  • loss of appetite
  • normal bowel habit

Note:

  • TG18/TG13 Diagnostic criteria for acute cholecystitis (4):
    • A. Local signs of inflammation etc:
      (1) Murphy’s sign, (2) right upper quadrant pain/mass/tenderness
    • B. Systemic sings of inflammation etc:
      (1) fever, (2) elevated CRP, (3) elevated WBC count
    • C. Imaging findings:
      Imaging findings characteristic of acute cholecystitis
    • Suspected diagnosis: one item in A + one item in B.
    • Definite diagnosis: one item in A + one item in B + C.
    • Note: acute hepatitis, other acute abdominal disease, and chronic cholecystitis should be excluded.
  • In some patients, acute cholecystitis may coexist with choledocholithiasis, cholangitis, or gallstone pancreatitis (3).

References:

  1. Dawson J. Acute cholecystitis. GPonline 2009
  2. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002;325(7365):639-43
  3. Strasberg SM. Clinical practice. Acute calculous cholecystitis. N Engl J Med. 2008;358(26):2804-11.  
  4. Yokoe M, et al.Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54. doi: 10.1002/jhbp.515. Epub 2018 Jan 9. PMID: 29032636.