5] The vomiting, upper right quadrant pain, positive Murphy's sign on sonography and leucocytosis observed in our patients are similar to the findings described in other types of cholecystitis.
Physical examination is usually unremarkable except possibly for a positive Murphy's sign when acute cholecystitis is present.
A physical examination revealed an absence of Murphy's sign
Physical exam showed no evidence of tenderness in the right upper quadrant and negative Murphy's sign
13] Patients who presented with fever, a thickened gallbladder wall, and a positive Murphy's sign
on abdominal sonography were diagnosed as having acute acalculous cholecystitis.
His exam revealed significant local tenderness over right abdomen, including epigastric pain and positive Murphy's sign
, obturator sign and tenderness over McBurney's point.
Clinical diagnosis to differentiate complicated acute cholecystitis (empyema/gangrene) from non-complicated acute cholecystitis is extremely difficult because often clinical features are the same as biliary colic7 and Murphy's sign
is positive in only one-third of gangrenous gall bladder because of the denervation by necrosis.
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A positive Murphy's sign
was observed at physical abdominal examination.
Sonographic findings were a thickened gallbladder wall (defined as wall thickness > 4 mm) in absence of ascitis and hypoalbuminemia, a positive sonographic Murphy's sign
(defined as maximum tenderness of the sonographically localized gallbladder), pericholecystic fluid collection, and no stone(s) in the gallbladder (4).
The biliary tree was normal in calibre and ultrasound Murphy's sign
was positive in 38 cases; 31 patients had complaint of nausea.