Clinical features

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.