About 80% of patients with acute cholecystitis give a history compatible with chronic cholecystitis. Acute cholecystitis begins as an attack of biliary colic, but in contrast to biliary colic, the pain does not subside; it is unremitting and may persist for several days.
The pain is typically in the right upper quadrant or epigastrium, and may radiate to the right upper part of the back or the interscapular area. It is usually more severe than the pain associated with uncomplicated biliary colic. The patient is often febrile, complains of anorexia, nausea, and vomiting, and is reluctant to move, as the inflammatory process affects the parietal peritoneum. This process will cause an arrest of inspiration with gentle pressure under the right costal margin, a fnding known as Murphy’s sign. 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
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