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A 44-year-old woman presents to the Emergency Department with one week of crampy abdominal pain that is worse after she eats. She denies alcohol consumption or tobacco abuse. On physical examination, she is overweight and has epigastric and right upper quadrant abdominal tenderness to palpation. Which of the following examination findings is most consistent with cholecystitis?

a) Epigastric rebound tenderness
b) Gray-Turner sign
c) Inspiratory arrest with right upper quadrant palpation
d) Right scapular tenderness

1 Answer

3 votes

Final answer:

c) Inspiratory arrest with right upper quadrant palpation The most consistent examination finding with cholecystitis given the patient's symptoms is c) Inspiratory arrest with right upper quadrant palpation, also known as Murphy's sign.

Step-by-step explanation:

The examination finding most consistent with cholecystitis in a 44-year-old woman with crampy abdominal pain worsened after eating, overweight, and epigastric and right upper quadrant tenderness is c) Inspiratory arrest with right upper quadrant palpation, also known as Murphy's sign. This clinical sign happens when the patient halts inspiration mid-breath due to pain when the gallbladder, inflamed by cholecystitis, comes in contact with the examiner's hand during deep breath. This is one of the classic signs used to diagnose cholecystitis.The examination finding most consistent with cholecystitis in this case is c) Inspiratory arrest with right upper quadrant palpation.

Cholecystitis is inflammation of the gallbladder, usually caused by gallstones. The typical presentation includes symptoms such as right upper quadrant abdominal pain that worsens after eating, and tenderness in the same area. Inspiratory arrest with right upper quadrant palpation is a physical exam maneuver that can trigger pain in patients with cholecystitis, due to the inflammation of the gallbladder. Examples:A patient with cholecystitis may experience worsening abdominal pain and tenderness when taking a deep breath while the healthcare provider palpates the right upper quadrant of the abdomen.I nspiratory arrest with right upper quadrant palpation can differentiate cholecystitis from other causes of abdominal pain.

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