Palpation of the gallbladder

When does the gallbladder become accessible for palpation?

If a physician detects the gallbladder during a manual examination, it always indicates a pathology leading to its significant enlargement.

Among the main causes of this condition are:

• Hydrops of the gallbladder (accumulation of mucous secretion during cystic duct blockage).
• Empyema (severe purulent inflammation of the organ).
• Chronic cholecystitis (long-standing inflammation altering the structure of the walls).
• Gallbladder cancer (malignant neoplasm).

Upon palpation, the enlarged organ is usually felt as a specific sac-like formation. Depending on the nature of the pathological process, its consistency may be either elastic or dense. An enlarged gallbladder should be sought in the area located between the lower edge of the liver and the lateral border of the rectus abdominis muscle.

Signs of inflammation (gallbladder symptoms of cholecystitis)

To confirm the inflammatory nature of the disease (e.g., cholecystitis), the physician checks a number of specific pain symptoms. They are based on mechanical impact on the affected organ or its associated nerve plexuses.

1. Murphy's sign — the patient involuntarily holds their breath (interrupts inspiration) during deep palpation in the right upper quadrant. The reflex respiratory arrest is caused by sharp pain upon contact of the diaphragm and the inflamed organ with the physician's hand.
2. Kehr's sign — the occurrence or intensification of pain when the physician palpates the right upper quadrant precisely on the patient's inspiration.
3. Ortner's sign — diagnosed by lightly tapping the edge of the hand along the costal arch. Pain on the right side (when compared to the left side) indicates inflammation.
4. Mussy-Georgievsky sign (also known as the phrenic nerve sign) — pain occurs when pressing on the point located between the heads of the right sternocleidomastoid muscle. This happens due to the radiation of pain along the course of the phrenic nerve.

How to recognize tumor obstruction?

If the biliary tract is blocked not by inflammatory edema or a stone, but by a tumor, the clinical picture changes. The main marker of tumor obstruction is Courvoisier's sign.

Its main characteristics are:

• The gallbladder is significantly enlarged and tense.
• The walls of the organ retain elasticity.
• Palpation is completely painless.
• The condition is accompanied by jaundice.

This symptom complex develops due to the mechanical obstruction of the common bile duct. Most often, the cause is a tumor localized in the head of the pancreas or in the region of the major duodenal papilla. Bile accumulates, overdistending the walls, but without active inflammation, pain upon palpation is absent.

Auscultation of the liver region

In addition to palpation, listening (auscultation) to the liver region plays an important diagnostic role. This method allows for the detection of both peritoneal lesions and serious vascular disorders.

What can be heard during auscultation:

• Peritoneal friction rub. Its appearance is a sure sign of perihepatitis (an inflammatory process affecting the liver capsule).
• Systolic vascular murmurs. They are heard over superficially located nodes of vascularized tumors or during the formation of arteriovenous fistulas.
• Venous hum. Occurs in portal hypertension when recanalization of the umbilical vein takes place. The murmur is localized over the expanded network of veins of the anterior abdominal wall (a sign known as "caput medusae").

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• The mechanism of development of hydrops and empyema of the gallbladder
• Anatomical and physiological features of pain radiation along the phrenic nerve
• Topographic anatomy of the major duodenal papilla and the head of the pancreas
• Mechanisms of umbilical vein recanalization in portal hypertension syndrome
• Hemodynamic causes of systolic murmurs over the liver

Other topics in the section "Liver, Biliary Tract, and Spleen"

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