Clinical features

Possible symptoms of cholecystitis include:

• pain in the right upper quadrant radiating to the right shoulder
• nausea
• vomiting
• fever

Possible signs include:

• tenderness over the right upper quadrant
• tenderness over the gallbladder that is demonstrable on inspiration
• Boas' sign (hyperaesthesia below the right hypochondrium or 12th rib region)
• gallbladder is usually impalpable
• jaundice only occurs in the minority of patients
• check for Murphy’s sign (where the examiner's hand rests along the costal margin and deep inspiration causes pain).

References

1. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002 Sep 21;325(7365):639-43.
2. Yokoe M, Hata J, Takada T, 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.