The usefulness of Murphy's sign and ultrasonography to diagnose acute cholecystitis: a case study

Acute cholecystitis (AC) is a common cause of right upper quadrant abdominal pain and requires prompt diagnosis to prevent complications. This case study highlights the role of Advanced Clinical Practitioners (ACPs) in the diagnostic process of AC, focusing on the use of Murphy's sign and ultrasonography (US). The study follows a systematic approach to patient assessment, including comprehensive history-taking, clinical examination, and the formulation of differential diagnoses, guided by national and international guidelines such as NICE and the Tokyo Guidelines. The case study critically evaluates the effectiveness of Murphy's sign and US in diagnosing AC, noting the limitations of each diagnostic tool. While Murphy's sign remains valuable, its sensitivity and specificity can vary, emphasising the need for a holistic diagnostic approach. In addition, US, though the first-line imaging modality, must be used in conjunction with other clinical findings. This case study advocates for an integrated diagnostic approach, combining clinical examination, laboratory tests, and imaging to improve diagnostic accuracy. The application of Borton's reflective model (‘What? So What? Now What?’) highlights the role of reflective practice in enhancing clinical decision-making and professional development. The case study illustrates the critical contribution of ACPs in managing both differentiated and undifferentiated presentations, while demonstrating the importance of evidence-based practice in supporting safe and effective patient outcomes.