Physical examination of acute cholecystitis

           Physical examination may be normal, but mild epigastric or right upper quadrant tenderness as well as mild icterus are common.
          The symptoms may also be intermittent, such as pain and transient jaundice caused by a stone that temporarily impacts the ampulla but subsequently moves away, acting as a ball valve.A small stone may pass through the ampulla spontaneously with resolution of symptoms

          Tenderness  and  a positive Murphy’s sign help distinguish acute cholecystitis from biliary colic,  in which there  is no  infammatory process. Given that the common bile duct is not obstructed, profound jaundice in the setting of a picture of acute cholecystitis is rare and should raise  the suspicion  of  cholangitis,  with  obstruction  of  the common bile duct, or Mirizzi syndrome, in which infammation or a stone in the gallbladder neck leads to infammation of the adjoining  biliary  system,  with  obstruction  of  the  common hepatic duct.

Murphy’s sign