A 52-year-old female presents with acute severe right upper quadrant pain and fever. On examination, deep palpation beneath the right costal margin causes abrupt inspiratory arrest as the gallbladder touches the examiner's fingers (Murphy sign). What is the diagnosis?
Answer and explanation
Correct answer: B. Acute calculous cholecystitis
- Step 1: Murphy sign (inspiratory arrest elicited by palpation of the right upper quadrant during deep inspiration) is highly sensitive for acute cholecystitis.
- Step 2: It occurs when the inflamed gallbladder fundus descends and contacts the peritoneum compressed by the examining hand.
- Step 3: Ultrasound demonstrating gallbladder wall thickening (> 3 mm), pericholecystic fluid, and sonographic Murphy sign confirms the diagnosis.
Answer
Acute calculous cholecystitis.
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