( Before proceeding, review the general approach to examining a swelling or lump )
• Conscious and oriented to time, place and person• Built and nourishment: _______________
Vitals
• Pulse: __________/min
• Blood Pressure: ______ mmHg
• Respiratory Rate: __________/min
• Temperature: ______ °F
• BMI: _____kg/m²
General Examination
• Pallor: Present / Absent
• Icterus: Present / Absent
• Cyanosis: Present / Absent
• Clubbing: Present / Absent
• Lymphadenopathy: Present / Absent
• Pedal edema: Present / Absent
Abdominal Examination
Inspection
Shape and Contour
• Abdomen symmetrical/asymmetrical
• Movement with respiration: Normal / Restricted
• Fullness in:
- Right hypochondrium: Present / Absent
- Epigastrium: Present / Absent
Skin Over Abdomen
• Scars: Present / Absent
• Dilated veins: Present / Absent
• Sinuses: Present / Absent
• Visible peristalsis: Present / Absent
• Umbilicus: Inverted / Everted
Palpation
Local Examination of Lump
• Site: ________________________________
• Extent:
• Size:___ × ___cm
• Shape: Oval / Globular / Irregular
• Surface: Smooth / Nodular / Irregular
• Margins: Well defined / Ill defined
• Overlying skin: Normal / Abnormal
• Skin pinchable: Yes / No
• Tenderness: Tender / Non-tender
Mobility
• Moves with respiration: Yes / No
• Side-to-side mobility: Present / Restricted
• Vertical mobility: Present / Restricted / Absent
Borders
• Lower border: Palpable / Not palpable
• Upper border: Reachable / Not reachable (disappears beneath right costal margin)
Relationship to Right Iliac Fossa
• Fingers can be insinuated between lump and right iliac fossa: Yes / No
Special Tests
• Bimanually palpable: Yes / No
• Ballotable: Yes / No
Other Findings
• Local rise of temperature: Present / Absent
• Guarding: Present / Absent
• Rigidity: Present / Absent
• Tenderness elsewhere: Present / Absent
• Signs of peritonitis: Present / Absent
Percussion
• Note over swelling: Dull / Resonant
• Continuous with liver dullness: Yes / No
• Fluid thrill: Present / Absent
• Shifting dullness: Present / Absent
Auscultation
• Bruit: Present / Absent
• Venous hum: Present / Absent
Examination for Associated Features
• Icterus: Present / Absent
• Scratch marks: Present / Absent
• Palpable lymph nodes: Present / Absent
• Hepatomegaly: Present / Absent
• Ascites: Present / Absent
• Other abdominal masses: Present / Absent
• Pedal edema: Present / Absent
• Stigmata of chronic liver disease: Present / Absent
Examination of Other Regions
External Genitalia
• Normal / Abnormal
Hernial Orifices
• Normal / Abnormal
Systemic Examination
Cardiovascular System
• Normal S1 and S2
Respiratory System
• B/l air entry present, no added sounds
Gall Bladder Lump Examination Summary
The patient is conscious and oriented to time, place and person. He/She is examined in a well-lit room, adequately exposed, in supine position, after taking verbal consent.
General physical examination revealed pulse ___/min, blood pressure _ mmHg, respiratory rate ___/min, temperature ___°F and BMI ___kg/m². The patient is moderately built and nourished. Pallor/Icterus/Cyanosis/Clubbing/Lymphadenopathy/Pedal edema are present or absent accordingly.
On inspection of the abdomen, the abdomen is symmetrical/asymmetrical and moved normally with respiration. Fullness is noted over the right hypochondrium and/or epigastrium. The overlying skin is normal with no scars, dilated veins, sinuses or visible peristalsis. The umbilicus is central and inverted.
On palpation, a solitary lump is palpable in the right hypochondrium extending into the epigastrium, measuring approximately __ × __ cm. The lump is smooth/nodular, oval/globular in shape, with well-defined/ill-defined margins and a smooth/irregular surface. The overlying skin is normal and pinchable.
The lump is soft/firm/hard in consistency and is non-tender/tender. It moved with respiration and could be moved slightly from side to side but not vertically. Its lower border is palpable/not palpable, while the upper border could not be reached as it disappeared beneath the right costal margin. Fingers could be insinuated between the swelling and the right iliac fossa. The mass is bimanually palpable/not palpable and is ballotable/not ballotable.
The swelling is dull on percussion and continuous with liver dullness. There is no fluid thrill or shifting dullness suggestive of ascites.
On auscultation, no bruit or venous hum is heard over the swelling.
Examination for associated features revealed icterus present/absent. Scratch marks, palpable lymph nodes, hepatomegaly, ascites or a palpable abdominal mass elsewhere are present/absent. There is no pedal edema or other evidence of chronic liver disease.
Examination of the abdomen revealed no tenderness elsewhere and no evidence of peritonitis. Examination of the external genitalia and hernial orifices is unremarkable.
Systemic examination revealed normal cardiovascular and respiratory findings. Examination of other systems is unremarkable.
Summary
This is a case of a gall bladder lump presenting as a smooth, globular swelling in the right hypochondrium extending into the epigastrium, moving with respiration, with its upper border disappearing beneath the right costal margin and fingers insinuable between the swelling and the right iliac fossa, associated/not associated with jaundice and other features of biliary obstruction.
One-line Case Presentation
This is a case of gall bladder enlargement presenting as a smooth, non-tender, globular lump in the right hypochondrium moving with respiration and associated/not associated with jaundice, suggestive of a distended gall bladder secondary to ______ (carcinoma head of pancreas/periampullary carcinoma/distal common bile duct obstruction/mucocele of gall bladder/carcinoma gall bladder).
