Clinical diagnosis of gall-bladder disease.

An investigation into the diagnosis of gall-bladder disease in general practice by simple clinical methods was carried out over seven years; 916 patients were seen in 1018 episodes of illness. These patients were examined particularly for oedema in the skin and subcutaneous tissue of the right hypochondrium, Murphy's sign, clinical jaundice and bilirubinuria.Oedema was found in 89% of the episodes of confirmed gall-bladder disease and in 74% of the suspected cases, but in only 4% of the other abdominal and thoracic conditions studied. Clinical jaundice or bilirubinuria or both occurred in 28% of the confirmed episodes of gall-bladder disease and in 12% of the suspected ones.If oedema, Murphy's sign and jaundice were all present there was a 72% probability of the condition being gall-bladder disease.During the study, there was a 45% increase in the number of new cases of gall-bladder disease correctly diagnosed each year compared with the previous three and a half years, and an 89% decrease in the number of cases missed.