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The abdomen
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
Gallstones may be asymptomatic or cause biliary colic, cholecystitis, obstructive jaundice and/or acute pancreatitis. The pain of biliary colic is usually located in the epigastrium or right upper quadrant. Vomiting is common and there is tenderness in the right upper quadrant, with a positive Murphy sign. If the gallstone obstructs the common bile duct, the child will become jaundiced and pass dark urine and pale stools. Occasionally, the child will present with gallstone pancreatitis.
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Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Murphy Sign Patient is unable to take a deep breath when the examiner exerts digital pressure over the gallbladder in the hypochondrium, in cases of cholecystitis. Described by Chicago surgeon, John Benjamin Murphy (1857–1916).
Gastrointestinal and Genitourinary Imaging
Published in Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain, On Call Radiology, 2015
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain
Cholecystitis due to gallstones classically occurs in middle-aged women, with obesity being a well-recognised predisposing factor. Acute cholecystitis secondary to gallstones should be differentiated from acalculous cholecystitis, the latter occurring more commonly in critically unwell and paediatric patients without underlying gallstone disease. Symptoms and signs, regardless of the underlying cause, can include right upper quadrant abdominal pain and tenderness, fever and nausea and vomiting. The patient may have a positive Murphy sign, defined as pain on inspiration while palpating the right upper quadrant. Elevated inflammatory markers are a common, but non-specific, associated finding.
Gallbladder torsion: a cholecystectomy that cannot be delayed
Published in Acta Chirurgica Belgica, 2020
Mazy David, Bez Mattia, Gunes Seda, Nebbot Benjamin, Herve Jerome
An 89-year-old woman was admitted to the emergency department for crampoid abdominal pain in the right hypochondrium associated with vomiting. This pain had been present for 24 hours and was of increasing intensity. She had no fever. Her parameters were in normal range apart from hypertension. The patient’s medical history included arterial hypertension, Alzheimer’s disease, Parkinson’s disease, hypercholesterolemia, moderate chronic renal failure and advanced multi-level spondylodiscarthrosis with the narrow lumbar canal. The surgical history included a knee prosthesis, hysterectomy, and appendectomy. The physical examination showed a sensitive abdomen with a positive Murphy sign and an absence of peristalsis on auscultation. The blood test showed white blood cells at 11,600/mm3, a C-reactive protein at 1.5 mg/L, a creatinine at 0.9 mg/dL with no alteration of liver tests and ionogram. An abdominal CT scan without contrast injection was performed and showed a gallbladder hydrops with a 6.5 cm transverse diameter (Figure 1). Based on the pain of the patient, the decision was taken to perform an exploratory laparoscopy on the day of admission. Preoperatively, a 360° clockwise torsion of the gallbladder around its pedicle was discovered with parietal necrosis, without attachment to the gallbladder bed (Figure 2). Histology revealed a necrotic haemorrhagic gallbladder. The postoperative follow-up was simple and the patient was discharged on day two after surgery.