Gallstone disease physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Patients with gallstones are usually not ill-appearing and don’t have fever or tachycardia. Physical examination of patients with gallstones is sometimes remarkable for right upper quadrant pain, epigastric tenderness, guarding and jaundice. Symptoms occurs when stones reach more than 8 mm in size. Courvoisier’s sign (a palpable gallbladder on physical examination) may be palpated when the common bile duct becomes obstructed and the gallbladder becomes dilated. This mostly occurs with malignant common bile duct obstruction, but has been reported with gallstone disease.

• Gallstones are usually asymptomatic.
• This means that gallstones are discovered incidentally when imaging studies are obtained for another reason.
• Physical findings become relevant when a stone blocks the common bile duct, this could lead to the development of biliary colic up to obstructive jaundice.
• The pain is usually referred to the back, ordinarily between the shoulder blades, or there is pain under the right shoulder (Collins’ sign). Eventually, the pain subsides.^[1][2]

• Patients with gallstones usually appear to be well.
• Patients with obstructive jaundice may exhibit a yellowish discoloration of the skin and sclera of the eyes.

• Fever
• Tachycardia with regular pulse

• Jaundice

• Abdominal distention
• Abdominal tenderness in the right upper abdominal quadrant
• Rebound tenderness (positive Blumberg sign)
• A palpable abdominal mass in the right upper abdominal quadrant (positive Courvoisier’s sign)
• Guarding may be present

• Icteric sclera

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