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How accurate is clinical diagnosis at identifying patients with cholecystitis?

Three Part Question

In [patients with right upper quadrant pain] does [clinical examination] accurately exclude [diagnosis of cholecystitis]?

Clinical Scenario

A patient presents to the accident and emergency department with acute onset of right upper quadrant pain. They have some associated clinical findings such as a positive murphy’s sign and you wonder if this is enough to evidence to make a diagnosis of cholecystitis.

Search Strategy

MEDLINE (1950-2008) and EMBASE database searches
[(exp cholecystitis OR OR exp cholangitis OR OR exp biliary tract diseases OR exp gall bladder diseases OR exp gall stones OR gall OR right upper quadrant pain .mp OR RUQ (exp physical examination OR clinical or clinical]

Search Outcome

1324 articles. Of which 1 was a systematic review and 1 other was relevant but not included in the review

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses


Clinical diagnosis using all the available clinical signs results is accurate at diagnosing cholecystitis. It seems that Murphy’s sign has high specificity, meaning that patients presenting with this sign are likely to have cholecystitis. Right upper quadrant pain may also be a good indicator of cholecystitis. However, at present it seems that no single clinical finding is adequate to diagnose or rule out cholecystitis

Clinical Bottom Line

If Murphy’s sign is positive in the presence of RUQ pain, this is sufficiently specific for a diagnosis of cholecystitis. If no Murphy’s sign is present, the patient may still have cholecystitis


  1. Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA 2003 Jan 1;289(1):80-6.
  2. Mills LD, Mills T, Foster B. Association of clinical and laboratory variables with ultrasound findings in right upper quadrant abdominal pain. South Med J. 2005 Feb;98(2):138.