Signs Murphy’s sign Used to diagnose acute cholecystitis Ask the patient to exhale while the examiner places their hand below the right intercoastal margin. The ask the patient to inhale deeply. If there is pain and the patient stops inhalation -> sign is positive. Courvoisier’s sign Painless enlargement of the gallbladder accompanied by jaundice. Suggests that jaundice is unlikely to be caused by a gallstone but rather by a malignancy. For example: Pancreatic cancer Biliary tract cancer. Gradual onset of cancer: Allows for gallbladder to distend without causing any pain. Gallstone ileus Rare form of small bowel obstruction. Caused by a gallstone passing through a fistula between the gallbladder and the small intestine. Stone is usually lodged in the ileocecal valve. Leads to features of: Colicky abdominal pain Abdominal distension. Charcot’s triad Triad of: Fever with chills RUQ pain Jaundice Capillary leakage Pancreatic enzymes -> inflammation -> cytokines -> vasodilation and increased capillary permeability -> fluid leakage -> third spacing -> edema and hypovolemia, warm and flushed skin. Pancreatic necrosis -> decrease end organ perfusion Hypocalcaemia -> lipase breaks down peripancreatic fat -> release free fatty acids -> binds to calcium -> hypocalcaemia.