Ultrasound uses sound waves to produce pictures of the gallbladder and the bile ducts. It is used to identify signs of inflammation involving the gallbladder and is very good at showing gallstones. Your doctor may suggest: fasting to rest the gallbladder a special, low-fat diet pain medication antibiotics to treat infection However, because the condition may come back often, your doctor may recommend you have your gallbladder removed using either: laparoscopic surgery.
The surgeon uses the belly button and several small cuts to insert a laparoscope to see inside the abdomen and remove the gallbladder. You will be asleep for the surgery. The surgeon makes a cut in the abdomen and removes the gallbladder. See the Anesthesia Safety page for more information. This may be done by: Percutaneous cholecystostomy: This procedure is done by a radiologist. It places a tube through the skin directly into the gallbladder using ultrasound or CT guidance.
Blocked or infected bile is removed to reduce inflammation. This procedure is typically done in patients who are too sick to have their gallbladder removed. You will be sedated for this procedure.
The tube typically has to stay in for at least a few weeks. Endoscopic retrograde cholangiopancreatography ERCP : This procedure is typically done by a doctor who specializes in abdominal disorders a gastroenterologist. A camera on a flexible tube is passed from the mouth through the stomach and into the beginning of the small bowel.
This is where the common bile duct meets the small intestine. The valve mechanism called the sphincter at the end of the bile duct can be examined and opened to clear blocked bile and stones, if necessary. Doctors can also insert a small tube into the main bile duct and inject contrast material to better see the duct.
They also may use a laser fiber to destroy small gallstones or use a basket or balloon to retrieve stones or stone fragments. All of this may be done without making any incisions in the abdomen. This procedure poses a small, but real risk of pancreas inflammation or injury. Percutaneous transhepatic cholangiography PTC : This procedure is done by a radiologist. A needle is placed in the bile ducts within the liver using imaging guidance.
Contrast material is injected to help locate gallstones that may be blocking bile flow. Some stones can be removed during a PTC. Others may be bypassed by leaving a small stent in place to allow bile to get around the area of blockage.
This helps reduce inflammation. Palpation of the gallbladder is performed alongside palpation of the liver. It lies adjacent to the liver at the right subcostal margin. The gallbladder is usually not palpable, but it may be in a diseased state. Figure 2. The gallbladder is located in the right upper quadrant at the subcostal margin. To palpate, place one hand inferior to the right costal margin and the left hand to support the inferior aspect of the rib cage.
A healthy gallbladder is not normally palpable. Normally, the spleen lies in the left upper quadrant and is quite posterior. Therefore, it is not always palpable.
Then, use your left hand to palpate along the left costal margin. Have the patient take a deep breath. During the inspiration, perform deep palpation on the inferior edge of the spleen. Figure 3.
The spleen is located in the left upper quadrant. To palpate it, place your left hand just inferior to the left costal margin and place the right under the inferior rib cage for support. Palpate with deep pressure as the patient takes a deep breath. In this video from our Abdominal Examination Essentials Course , the examiner is palpating along the left costal margin to palpate the spleen:. The organs located in the epigastric region are the stomach, pancreas, and duodenum.
These organs can be palpated with a combination of deep and light palpation. The stomach can also be palpated in the left upper quadrant or left hypochondriac region. Figure 4. In the epigastric region, organs that can be palpated include the stomach, pancreas, and duodenum.
Check out this video clip from our Abdominal Examination Essentials Course for a demonstration of how to palpate the epigastrium region:. The kidneys are bilaterally located in the retroperitoneal space e. Specifically, the kidneys lie between the 12 th rib and the anterior superior iliac spine ASIS.
Note: Murphy originally described his sign as palpation under the right costal margin with the patient upright in a seated position on deep inspiration. If the liver is swollen as the result of the attack i. In such cases it is found that pain is induced when, during a deep inspiration, pressure is made with the hand as far upwards as possible beneath the right costal border. At the moment when the liver impinges upon the tips of the fingers the patient experiences a deep-seated pain which sometimes radiates over the entire hepatic region and on to the epigastrium.
By no means rarely, however, the tenderness of the liver is only manifested by tension of the muscles of the anterior abdominal wall on the right side, and in such cases the difference in tension of the right and left side respectively is best observed in the rectus abdominis.
Murphy — described his clinical examination sign in patients with acute cholecystitis. Murphy examined the sitting patient from behind with fingers gripped under the right costal margin. Pain elicited at the height of inspiration evokes a positive test.
The diaphragm forces the liver down until the sensitive gall-bladder reaches the examining fingers, when the inspiration suddenly ceases as though it had been shut off.
I have never found, this sign absent in a calculous or infectious case of gall-bladder, or duct disease. Ann Emerg Med. A positive sign is useful, however a negative sign is not reliable to rule out acute cholecystitis and further diagnostic tests should be instigated. This site uses Akismet to reduce spam. Learn how your comment data is processed. Murphy Shows the surgeons hands hooked under the costal arch to determine the sensitiveness of the gallbladder.
The patient cannot inspire against the pressure with an acutely inflamed or distended gall-bladder — Murphy Fig 2; Shows the hand elevated, with the middle finger flexed perpendicularly at the tip of the ninth costal cartilage.
Fig 3; Shows the finger struck with the right hand when the patient is in deep inspiration.
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