B Gallstones and gallbladder disease
Definition
Obstruction of the cystic duct by gallstones results in acute, severe midepigastric pain, typically radiating to the right abdomen. Inspiratory effort usually accentuates the pain (Murphy’s sign).
Clinical manifestations
Increases in plasma bilirubin, alkaline phosphatase, and amylase levels frequently occur. Ileus and localized tenderness may indicate perforation with peritonitis. Leukocytosis and fever are often present. The presence of jaundice indicates complete obstruction of the cystic duct. Symptoms are frequently confused with those of myocardial infarction. Differential diagnosis is accomplished through serial electrocardiogram (ECG) evaluations and laboratory analysis of serum enzymes that are specific to cardiac muscle. Cholescintigraphy (a contrast study that evaluates gallbladder excretion of a radiographically labeled substance) and ultrasonography are often used for clinical confirmation of the diagnosis.
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