Differential Diagnosis for Gallbladder Distension with Positive Murphy's Sign
Single Most Likely Diagnosis
- Acute Cholecystitis: This condition is characterized by inflammation of the gallbladder, often due to obstruction of the cystic duct. The presence of a positive Murphy's sign (tenderness in the right upper quadrant that increases with deep inspiration) is highly suggestive of acute cholecystitis. Gallbladder distension and the absence of stones could indicate a stone obstructing the cystic duct that has not been visualized or another cause of obstruction.
Other Likely Diagnoses
- Chronic Cholecystitis: Although chronic cholecystitis may not always present with acute symptoms, it can cause gallbladder distension and intermittent symptoms. The absence of transaminitis and normal bilirubin levels does not rule out this condition.
- Biliary Dyskinesia: This condition involves abnormal contraction of the gallbladder, which can lead to distension and pain, even in the absence of gallstones. A positive Murphy's sign can sometimes be seen due to the gallbladder's abnormal function.
Do Not Miss Diagnoses
- Gallbladder Cancer: Although rare, gallbladder cancer can present with gallbladder distension and a positive Murphy's sign. It is crucial to consider this diagnosis, especially in older patients or those with risk factors, as it requires prompt intervention.
- Mirizzi Syndrome: This is a rare condition where a gallstone becomes impacted in the cystic duct or the neck of the gallbladder, causing obstruction of the common bile duct. It can lead to jaundice, but in early stages, bilirubin levels might be normal. The absence of stones on initial imaging does not rule out this condition.
Rare Diagnoses
- Porcelain Gallbladder: This condition involves calcification of the gallbladder wall, which can lead to chronic inflammation and potentially to gallbladder cancer. While it might not directly cause distension, it's a rare condition that could be associated with chronic symptoms.
- Xanthogranulomatous Cholecystitis: A rare form of chronic cholecystitis characterized by intense gallbladder inflammation and the presence of xanthoma cells. It can mimic gallbladder cancer in its presentation and is often diagnosed after surgical removal of the gallbladder.