Abstract
An investigation into the diagnosis of gall-bladder disease in general practice by simple clinical methods was carried out over seven years; 916 patients were seen in 1018 episodes of illness. These patients were examined particularly for oedema in the skin and subcutaneous tissue of the right hypochondrium, Murphy's sign, clinical jaundice and bilirubinuria.
Oedema was found in 89% of the episodes of confirmed gall-bladder disease and in 74% of the suspected cases, but in only 4% of the other abdominal and thoracic conditions studied. Clinical jaundice or bilirubinuria or both occurred in 28% of the confirmed episodes of gall-bladder disease and in 12% of the suspected ones.
If oedema, Murphy's sign and jaundice were all present there was a 72% probability of the condition being gall-bladder disease.
During the study, there was a 45% increase in the number of new cases of gall-bladder disease correctly diagnosed each year compared with the previous three and a half years, and an 89% decrease in the number of cases missed.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Borgwardt G. Probleme der Betreuung von Gallenwegserkrankungen durch den Facharzt für Allgemeinmedizin. Z Arztl Fortbild (Jena) 1971 Nov 1;65(21):1141–1143. [PubMed] [Google Scholar]
- Bouchier I. A. Imaging procedures to diagnose gall bladder disease. Br Med J (Clin Res Ed) 1984 Jun 2;288(6431):1632–1633. doi: 10.1136/bmj.288.6431.1632. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Calabrese C., Pearlman D. M. Gallbladder disease below the age of 21 years. Surgery. 1971 Sep;70(3):413–415. [PubMed] [Google Scholar]
- Essenhigh D. M. Management of acute cholecystitis. Br J Surg. 1966 Dec;53(12):1032–1038. doi: 10.1002/bjs.1800531206. [DOI] [PubMed] [Google Scholar]
- Glenn F. Pain in biliary tract disease. Surg Gynecol Obstet. 1966 Mar;122(3):495–508. [PubMed] [Google Scholar]
- Gunn A., Keddie N. C., Fox H. Acalculous gall-bladder disease. Br J Surg. 1973 Mar;60(3):213–215. doi: 10.1002/bjs.1800600312. [DOI] [PubMed] [Google Scholar]
- HINSHAW D. B., CARTER R. Acute obstructive cholecystitis. Pathogenesis and surgical aspects. Am J Surg. 1962 Aug;104:216–223. doi: 10.1016/0002-9610(62)90321-5. [DOI] [PubMed] [Google Scholar]
- Leake R. A. A new physical sign in biliary-tract disease. Practitioner. 1968 Nov;201(205):804–809. [PubMed] [Google Scholar]
- Meyer K. A., Capos N. J., Mittelpunkt A. I. Personal experinces with 1,261 cases of acute and chronic cholecystitis and cholelithiasis. Surgery. 1967 May;61(5):661–668. [PubMed] [Google Scholar]
- Reid D. R., Rogers I. M. The negative cholecystogram in gallbladder disease. Br J Surg. 1975 Jul;62(7):581–583. doi: 10.1002/bjs.1800620721. [DOI] [PubMed] [Google Scholar]
- SPARROW E. M. An analysis of 76 gallbladder cases. S Afr Med J. 1961 Sep 30;35:805–806. [PubMed] [Google Scholar]
- Sloan A. W., Koeslag J. H. A trial of the ponderax skinfold caliper. S Afr Med J. 1973 Jan 27;47(4):125–127. [PubMed] [Google Scholar]
- WILSON J. B. Gastro-intestinal disease. Practitioner. 1962 Nov;189:613–618. [PubMed] [Google Scholar]
- Walker G. Emergencies in the home. The acute abdomen. Br Med J (Clin Res Ed) 1981 Aug 1;283(6287):351–353. doi: 10.1136/bmj.283.6287.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Watkin D. F., Thomas G. G. Jaundice in acute cholecystitis. Br J Surg. 1971 Aug;58(8):570–573. doi: 10.1002/bjs.1800580806. [DOI] [PubMed] [Google Scholar]
- YEATMAN C. Upper abdominal pain in general practice. Med J Aust. 1953 Feb 14;1(7):216–239. doi: 10.5694/j.1326-5377.1953.tb81639.x. [DOI] [PubMed] [Google Scholar]
- de Dombal F. T. Acute abdominal pain--an O.M.G.E. survey. Scand J Gastroenterol Suppl. 1979;56:29–43. [PubMed] [Google Scholar]