A 50-year-old man presented with intermittent right upper quadrant pain and a positive Murphy sign on physical examination. Further laboratory tests including liver enzymes and imaging studies such as ultrasound and CT were performed to check for gallbladder inflammation or stones since physical examination alone is not sufficient to diagnose cholecystitis. The patient's family questioned if imaging and labs were needed given limitations, but they help establish a clear diagnosis beyond physical exam findings.

1. CHOLESISTITIS

2. SCENARIO
• A fifty year old man arrived with a penetrating scar on his forehead. The
pain comes and disappears. There are no complaints about defecation or
urination. People enjoy eating fried foods and sugar-free foods. The results of
the physical examination showed an indication of Murphy (+). The doctor
carries out further examinations in the laboratory, such as ALP (alkaline
phosphatase) and GGT (gamma glutamyl transferase) examinations, in addition
to radiological examinations (USG and CT) to find out whether there is
bleeding or pus in the patient's stomach. The patient's relatives asked whether
physical examination alone was not enough to establish a diagnosis,
considering the limitations of laboratory examinations or abdominal radiology
examinations in identifying the patient's disease.

3. QUESTION
• When a patient with a Murphy sign (+) is 50 years old, how does the performance of radi
ology or laboratory examinations compare to physical examinations in the diagnosis of c
holesystitis or cholelithiasis?
• PICO
• Problem : 50-year old female patient with lower right abdomen pain and Murphy sign (+)
• Intervention : Imaging and labs examinations
• Comparison : physical examination
• Outcome :Making a cholecystitis or cholelithiasis diagnosis

4. PUBMED