CYSTIC POINT: WHAT IS IT, IMPORTANCE, ANATOMY OF THE GALLBLADDER - ANATOMY AND PHYSIOLOGY - 2025

The cystic point, or Murphy's point, is an abdominal landmark that indicates the topographic location of the gallbladder. The point is located below the right costal ridge where the midclavicular line meets the costal ridge.

This is where the gallbladder is normally located within the abdomen. Locating this point is important when the doctor suspects inflammation of the gallbladder, a condition known as acute cholecystitis.

By BruceBlaus - Own work, CC BY-SA 4.0, The gallbladder is an intra-abdominal organ that is located below the liver. It is part of the digestive system and serves as a reservoir for bile. In turn, bile is a liquid produced by the liver that plays an important role in the digestion and absorption of fats. Contains salts, proteins, cholesterol and water.

The most common disease of the gallbladder is gallstones, which is nothing more than the formation of stones or lithiasis within that organ. The presence of these stones causes pain and sometimes obstructs the flow of bile.

By George Chernilevsky - Own work, CC BY-SA 4.0, In any case, inflammation of the walls of the gallbladder can occur, causing acute cholecystitis. When the cystic point is painful there is a high probability that the patient is suffering from cholecystitis.

Cystic point and Murphy's sign

The cystic point is the reflection of the location of the gallbladder on the abdominal wall of a person. It is used as a reference to know where the gallbladder is located and thus be able to examine it.

The point is in the right upper quadrant of the abdomen. It is the intersection between the midclavicular line and the rib margin. The midclavicular line is an imaginary line that runs from the middle of the clavicle and extends downward.

This image is the projection of the location of the gallbladder on the abdominal wall.

From Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below) Bartleby.com: Gray's Anatomy, Plate 1220, Public Domain, https://commons.wikimedia.org/w/index. php? curid = 564836

To demonstrate the Murphy sign, the physician should locate the cystic point and press gently while asking the patient to take a strong, sustained inspiration. This respiratory movement causes the liver to descend and the gallbladder, which is located below the liver, to touch the doctor's hand.

When the inflamed gallbladder meets the examiner's hands, the patient feels severe pain that causes the need to interrupt inspiration. When that happens, Murphy's sign is considered positive. It is a specific sign for acute cholecystitis.

The sign was described by the eminent surgeon John Benjamin Murphy (1857-1916) who made great contributions to the field of abdominal surgery and whom Dr. William Mayo described as the surgical genius of that generation.

When the Murphy sign is positive, you have a percentage of certainty for the diagnosis of acute cholecystitis of 79%. Confirmation of the disease is provided by abdominal ultrasound, which is the recommended examination for evaluation of the gallbladder.

Clinical significance of the cystic point

The cystic point is a topographic landmark that tells the doctor where the gallbladder is located. The importance of knowing its location is that the symptoms and signs of gallbladder disease are very specific. As they have this high specificity, it is important to highlight them to advance in the diagnosis of biliary disease.

The doctor must know the anatomy of the abdominal cavity and the topographic location of the organs to be able to carry out the necessary maneuvers that bring him closer to the diagnosis of biliary pathology.

Although acute cholecystitis is the most common disease of the gallbladder, other types of conditions can also be found including malignant gallbladder tumors.

When palpating a large, firm, non-painful mass at the cystic point, a malignant tumor should be suspected and appropriate tests performed promptly for prompt diagnosis and treatment.

Gallbladder: Anatomy

The gallbladder is an organ of the digestive system that belongs to the biliary system. The biliary system is a complex structure of ducts that originate in the liver and are responsible for forming bile.

There is an intra-hepatic and an extra-hepatic biliary system. The gallbladder is part of the extra-hepatic system.

It is located below the liver and is attached to it by fibrous tissue and fat.

From Biliary_system_new.svg: * Biliary_system.svg: Vishnu2011derivative work: Vishnu2011 (talk) derivative work: Ortisa (talk) - Biliary_system_new.svg, Public Domain, https://commons.wikimedia.org/w/index.php?curid= 10811487

The function of the gallbladder is to store and release bile, which is the yellowish-green liquid produced by the liver for the digestion of fats.

The gallbladder is activated by a reflex mechanism when the stomach empties into the duodenum. The activation consists of its contraction for the expulsion of bile, which binds to the fats in food and helps in its absorption and digestion.

By Unknown Illustrator - This image was released by the National Cancer Institute, an agency part of the National Institutes of Health, with the ID 1772 (image) (next)., Public Domain, https://commons.wikimedia.org/w /index.php?curid=24055052

When the bile is heavily loaded with cholesterol salts or when the gallbladder's movements are very slow, gallstones or gallstones can form. These formations remain within the cavity of the gallbladder and are an obstacle at the time of contraction.

When the gallbladder contracts and there are stones inside it, the patient presents a sharp pain of very strong intensity called biliary colic.

The presence of gallstones in the gallbladder, as well as the slow contraction response of the gallbladder are two of the causes that generate, in the medium term, gallbladder inflammation or acute cholecystitis.

Acute cholecystitis

Acute cholecystitis is inflammation of the gallbladder. The most common cause of cholecystitis is the presence of stones inside the gallbladder and the obstruction of its outlet duct, known as the cystic duct.

By BruceBlaus - Own work, CC BY-SA 4.0, Cholecystitis pain is one of the main reasons for acute abdominal pain in young and middle-aged women. This disease occurs more often in women than in men.

Cholecystitis is characterized by colicky pain located in the right upper quadrant, below the costal margin. A colicky pain is one that appears suddenly, reaching a peak in which the pain becomes very strong and subsequently calms down until it improves completely. It is not continuous pain.

This pain occurs with the ingestion of fatty or high carbohydrate foods since they are what stimulate the activity of the gallbladder.

By Unknown - This image was released by the National Cancer Institute, an agency part of the National Institutes of Health, with the ID 2400 (image) (next)., Public Domain, https://commons.wikimedia.org/w/ index.php? curid = 10531779

When this disease is diagnosed, it must be treated immediately through the administration of antibiotics and the performance of a surgical procedure called a cholecystectomy. Cholecystectomy is an abdominal operation that involves removing the diseased gallbladder.

It is important to diagnose and treat the patient with cholecystitis as soon as possible since when the disease progresses it can have serious complications that endanger the life of the person suffering from it.

Diagnosis

The diagnostic approach to acute cholecystitis begins with the questioning and analysis of the symptoms that the patient has presented in recent months.

These are usually women who complain of digestive disorders such as gas, bloating, and nausea after eating large or high-fat meals.

Junge schlanke Frau hat Bauchschmerzen Young slim female has abdominal pain

Biliary colic is a specific pain of this disease that is triggered with the ingestion of food. The pain that begins mild, reaches a point of very strong intensity within a few minutes. This can improve with the administration of antispasmodic medications. These medications are those that relax the muscles of the gallbladder.

If medication is not administered, the pain decreases after a few minutes and may occur several times during the day.

The diagnosis of acute cholecystitis is established through physical examination and abdominal ultrasound, which is the most specific test for the diagnosis of gallstones and acute cholecystitis.

By James Heilman, MD - Own work, CC BY-SA 3.0, Within the physical examination, the cystic point of Murphy should be located and the patient must be forced to inhale to reveal the Murphy sign.

References

1. Musana, K; Yale, SH (2005). John Benjamin Murphy (1857 - 1916). Clinical medicine & research. Taken from: ncbi.nlm.nih.gov
2. Jones, MW; Deppen, JG. (2019). Physiology, Gallbladder. Treasure Island (FL). Taken from: ncbi.nlm.nih.gov
3. Njeze GE (2013). Gallstones. Nigerian journal of surgery: official publication of the Nigerian Surgical Research Society. Taken from: ncbi.nlm.nih.gov
4. Sanders, G; Kingsnorth, AN (2007). Gallstones. Taken from: ncbi.nlm.nih.gov
5. Tanaja J, Meer JM. Cholelithiasis. Treasure Island (FL). Taken from: ncbi.nlm.nih.gov