ZyraDoc #23 - August 24, 2026

A 42-year-old woman presents with severe postprandial right upper quadrant abdominal pain radiating to her right scapula, fever, and nausea.

Physical examination reveals localized peritonitis in the right upper quadrant with inspiratory arrest during deep palpation (positive Murphy's sign).

Abdominal ultrasound confirms gallbladder wall thickening (5 mm), sonographic Murphy sign, and pericholecystic fluid, and the intern suggests conservative outpatient management.

Case Summary

Clinical Focus:

A 42-year-old female presents with acute calculous cholecystitis with classic sonographic and physical examination findings.

Diagnostic Features of Acute Cholecystitis:

Physical sign: Murphy's sign (sudden arrest of inspiration during deep palpation of the right upper quadrant)
Systemic signs: Fever, leukocytosis, elevated C-reactive protein
Ultrasound findings: Gallbladder wall thickening (> 3 mm), pericholecystic fluid, gallstones, and sonographic Murphy sign

Acute cholecystitis requires bowel rest, empiric intravenous antibiotics, and urgent surgical consultation for early cholecystectomy.

Here is the Management Strategy:

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