<div style="margin: 12px 0px; font-family: arial; color: #333333; background: #ffffff; border: solid 4px #e5e5e5; width: 100%; clear: left;"><div class="CM_CTB_Content_Wrap" style="margin: 0px; padding: 0px;background-color: #ffffff;"><div style="border-bottom: solid 1px #dcdcdc; white-space: nowrap; margin-bottom: 8px; background-color: #eeeeee ;background-image: url(http://clipmarks.com/images/source-bg.gif); background-repeat: repeat-x; height: 24px; line-height: 24px; vertical-align: middle; padding-bottom: 4px; color: #666666; font-size: 10px;" ><a href="http://clipmarks.com/clip-to-blog/" title="see clips that are hot right now"><img src="http://content.clipmarks.com/blog_embed/6c1eb264-fea2-45d6-bcfd-00b457bb123e/37F576F6-3747-4C9C-9A7F-ED1FF8D03E3B/" alt="" width="19" height="19" border="0" style="vertical-align: middle; margin: 0px 4px; display: inline; border: none; float:none;" /></a>clipped from <a title="http://www.uptodateonline.com.ezproxylocal.library.nova.edu/online/content/topic.do?topicKey=biliaryt/6853&selectedTitle=8~150&source=search_result" href="http://www.uptodateonline.com.ezproxylocal.library.nova.edu/online/content/topic.do?topicKey=biliaryt/6853&selectedTitle=8~150&source=search_result" style="font-size: 11px;">www.uptodateonline.com.ezproxylocal.library.nova.edu</a></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.uptodateonline.com.ezproxylocal.library.nova.edu/online/content/topic.do?topicKey=biliaryt/6853&selectedTitle=8~150&source=search_result"><P> <SPAN class="h1"><A name="7"></A>CLINICAL MANIFESTATIONS</SPAN> — Patients with acute cholecystitis typically complain of abdominal pain, most commonly in the right upper quadrant or epigastrium. The pain may radiate to the right shoulder or back. Characteristically, acute cholecystitis pain is steady and severe. Associated complaints may include nausea, vomiting, and anorexia. There is often a history of fatty food ingestion about one hour or more before the initial onset of pain.</P></blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.uptodateonline.com.ezproxylocal.library.nova.edu/online/content/topic.do?topicKey=biliaryt/6853&selectedTitle=8~150&source=search_result"><P> <SPAN class="h2"><A name="8"></A>Physical examination</SPAN> — Patients with acute cholecystitis are usually ill appearing, febrile, and tachycardic, and lie still on the examining table because cholecystitis is associated with true local parietal peritoneal inflammation that is aggravated by movement. Abdominal examination usually demonstrates voluntary and involuntary guarding.</P></blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.uptodateonline.com.ezproxylocal.library.nova.edu/online/content/topic.do?topicKey=biliaryt/6853&selectedTitle=8~150&source=search_result"><STRONG class="greenheader">Clinical features and diagnosis of acute cholecystitis</STRONG></blockquote></div><div style="margin: 0px 6px 6px 4px;"><table style="font-size: 11px;border-spacing: 0px;padding: 0px;" cellpadding="0" cellspacing="0" width="100%"><tr><td style="background:transparent;border-width:0px;padding:0px;">&nbsp;</td><td align="right" style="background:transparent;border-width:0px;padding:0px;width:107px" width="107"><a href="http://clipmarks.com/share/37F576F6-3747-4C9C-9A7F-ED1FF8D03E3B/blog/" title="blog or email this clip"><img src="http://content8.clipmarks.com/images/c2b-foot.png" border="0" alt="blog it" width="107" height="17" style="border-width:0px;padding:0px;margin:0px;" /></a></td></tr></table></div></div>

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