Commonly taken to describe tenderness over the gall bladder shown by palpation under right rib cage when the patient is asked to inspire. The original description apparently described cessation of inspiration on palpation rather than pain per se.
While it can of course develop in the time between one examination and another consultants are unlikely to believe that this was the case when:
- Inital assessment was only a few minutes before
- The patient had a few of the 'F's (fever, female, fertile, fat)
- Its presence or absence was not documented on initial assessment.
- The first mention of acute cholecystitis as a possible differential diagnosis in a patient with fever and jaundice is after the CT scan showing the diagnosis.