Gallbladder
The gallbladder usually projects over the abdominal wall in the triangle formed by the lateral edge of the rectus abdominis muscle and the right costal arch. A healthy gallbladder is intangible and painless. The tenderness of the follicle depends on the rate of bile pressure build-up and the presence of an inflammatory process in its wall.
When a plaque is wedged in the alveolar neck or alveolar duct, the bile pressure in the alveolus rises sharply and the gallbladder walls become distended. These phenomena cause severe pain in the right upper abdomen, which usually radiates to the right shoulder blade. The classic symptom confirming gallbladder disease is Chełmoński’s symptom. This symptom is caused by hitting the right fist on the dorsal surface of the left hand, placed under the right costal arch of the examined person. The Chełmoński symptom is examined at the peak of inspiration (Fig. 31 AB).
DIG. 31. Examination of pain reaction to shaking (Chełmoński symptom). Placing the left hand under the patient’s right costal arch (A). Shaking of the hand by the clenched right hand as the patient breathes in deeply (B).
In about 30% of patients with acute cholecystitis, it is felt as a round and painful formation. In the remaining patients, it is difficult to reach the follicle with the hand due to the reflex increase in the tone of the abdominal muscles. In patients with acute cholecystitis, the increase in pain during inhalation is accompanied by reflex breath holding (Murphy’s symptom).
Chronic hypertension in the bile ducts caused by an obstruction in the drainage of the bile located downstream of the cystic duct (neoplastic or non-neoplastic stenosis) causes distension of the gallbladder. Such a bubble is felt as a round and painless formation (Courvoisier symptom). The gallbladder is uterine in approximately 25% of patients with pancreatic head cancer.
Source: Abdominal PHYSICAL TEST WITH ELEMENTS OF DIFFERENTIAL DIAGNOSTICS; Czelej Publishing House