Which physical examination finding is most indicative of cholecystitis?

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Murphy's sign reveals gallbladder inflammation. When you press along the right upper quadrant under the liver margin and the patient takes a deep breath, an inflamed gallbladder is irritated and the patient often winces or abruptly stops inhaling. That inspiratory arrest on palpation is the hallmark of acute cholecystitis because the gallbladder is tender and irritated there.

The other signs point to different problems: Rovsing’s sign is rebound tenderness in the left lower quadrant and is more associated with appendicitis; Psoas sign involves pain with hip extension, suggesting retrocecal appendicitis or psoas irritation; Obturator sign involves internal rotation of a flexed hip, pointing to pelvic involvement. They don’t specifically reflect gallbladder inflammation, so they’re not as indicative of cholecystitis.

A positive Murphy’s sign is a helpful clinical clue for cholecystitis and is typically followed by imaging, like ultrasound, to confirm gallbladder inflammation and assess for stones.