Pain typically occurs suddenly and radiates to the right shoulder and back, depending on several factors, including specific diseases.

This maneuver requires the physician to grab the lower part of the right ribs and curl their fingers under them.

The sign also has over a 90% positive and negative predictive value for acute cholecystitis[2][7] Gallstones may develop in the gallbladder as well as elsewhere in the biliary tract.

[8] During pregnancy when female sex hormones are naturally raised, biliary sludge (particulate material derived from bile that is composed of cholesterol, calcium bilirubinate, and mucin) appears in 5% to 30% of women.

The underlying mechanism is female sex hormones; parity, oral contraceptive use and estrogen replacement therapy are established risk factors for cholesterol gallstone formation.

[12] A 2001 comparative study of the IMS LifeLink Health Plan Claims Database interpreted that in a large cohort of women using oral contraceptives, there was found a small, statistically significant increase in the risk of gallbladder disease associated with desogestrel, drospirenone and norethisterone compared with levonorgestrel.

No statistically significant increase in risk was associated with the other formulations of oral contraceptive (etynodiol diacetate, norgestrel and norgestimate).

[13] While some observational studies had suggested that estrogens increase the risk for gallbladder disease by as much as twofold to fourfold, such an association had not been reported consistently.

[14][15] More recent randomized clinical trial data among postmenopausal women now support a causal role for oral menopausal hormone therapy estrogens.

[17] A prospective study in 1994 noted that body mass index remains the strongest predictor of symptomatic gallstones among young women.

[1][2] Ultrasound is the diagnostic imaging of choice to examine for thickening of the gallbladder walls, polyps, pericholecystic fluid, and gallstones.

[2] In patients with an asymptomatic disease where a gallstone or small polyp was found incidentally, no further treatment is undertaken until symptoms arise.

A cholecystectomy is controversial in advanced cancer due to the low 5-year survival rate, especially if regional lymph nodes are involved.