Gallstone Gina — Cholecystitis & Cholelithiasis
RUQ pain after a fatty meal, radiating to the right shoulder — a positive Murphy's sign clinches it
Gina doubles over an hour after a plate of fried chicken, clutching her right upper abdomen as the pain radiates up toward her shoulder blade. When the nurse presses under her ribs during a deep breath, Gina gasps and stops breathing mid-inhale.
Gina's gallbladder forms stones from cholesterol-saturated bile, and a stone lodges in the cystic duct, causing inflammation and biliary colic. Pain classically follows fatty food intake, localizes to the right upper quadrant, and radiates to the right scapula or shoulder. Murphy's sign — inspiratory arrest on palpation of the RUQ — is a hallmark finding. If a stone obstructs the common bile duct, jaundice, clay-colored stools and dark urine follow, and untreated cholecystitis can progress to gallbladder rupture or ascending cholangitis.
Read Gallstone Gina's full story →The story arc
The setup
Gina, a middle-aged woman with a history of fatty food intolerance, develops intermittent RUQ discomfort after meals.
The turn
After a large fatty dinner, steady, severe RUQ pain develops, radiating to her right scapula, with nausea and vomiting.
The crisis
Gina's temperature rises to 38.9°C, she has a positive Murphy's sign, and her sclera begin to look faintly yellow with dark urine and pale stools.
The save
The nurse keeps Gina NPO, maintains IV fluids and antiemetics, monitors for worsening jaundice or rising bilirubin, and prepares her for an ultrasound and likely laparoscopic cholecystectomy.
NCLEX study section — Cholecystitis & Cholelithiasis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Gastrointestinal & Renal
Take this chapter into practice questions on the same topic.