What respiratory maneuver can increase pain in cholelithiasis (gallstones)?

In cholelithiasis, pain is often associated with the presence of gallstones, particularly when they obstruct the cystic duct and cause inflammation of the gallbladder, leading to a condition known as cholecystitis. During inspiration, the diaphragm moves downward, which increases the volume of the thoracic cavity and can create pressure changes in the abdominal area. This action can increase pain in patients with gallbladder inflammation because the gallbladder may be inflamed or distended and more sensitive to pressure changes.

Increased intrathoracic pressure during inspiration can also lead to diaphragm expansion, which can further irritate the inflamed gallbladder. This is not usually the case with expiration, coughing, or sneezing, which may not exert the same level of pressure across the abdominal region or could involve different mechanisms that do not exacerbate the pain associated with gallstone complications. Therefore, inspiration, due to its effect on abdominal pressure and diaphragmatic movement, is the respiratory maneuver most likely to increase pain in patients with cholelithiasis.