Murphy's sign

Murphy's sign is a clinical maneuver used in the physical examination of a patient's abdomen, specifically to assess gallbladder disease. Named after the American surgeon John Benjamin Murphy, it is often indicative of acute cholecystitis, a condition characterized by inflammation of the gallbladder.

Procedure

Murphy's sign is elicited by asking the patient to take a deep breath while the examiner palpates the right subcostal area of the abdomen, at the location of the gallbladder. If the patient abruptly stops inhaling due to sharp pain or discomfort, this constitutes a positive Murphy's sign.

Clinical Significance

The pain or discomfort arises when the inflamed gallbladder comes into contact with the examiner's fingers during inspiration. This reaction is suggestive of acute cholecystitis, as the gallbladder inflammation is commonly associated with this condition. It's important to note that a negative Murphy's sign does not entirely rule out gallbladder disease.

Limitations and Differential Diagnosis

• While Murphy's sign is helpful, it is not definitive. The sign can sometimes be positive in other conditions, such as lower lobe pneumonia, pleurisy, or even subphrenic abscess. Similarly, not all patients with acute cholecystitis will exhibit a positive Murphy's sign.
• Hence, further investigations are usually needed to confirm a diagnosis. These may include laboratory tests, such as complete blood count and liver function tests, as well as imaging studies like abdominal ultrasound, HIDA scan, or CT scan.

See Also

• Physical examination
• Cholecystitis
• Gallbladder disease

References

• American Family Physician. (2023). Right Upper Quadrant Pain. Retrieved from https://www.aafp.org/afp/2014/0301/p306.html
• Stanford Medicine 25. (2023). Murphy's Sign. Retrieved from http://stanfordmedicine25.stanford.edu/the25/murphy.html
• Mayo Clinic. (2023). Gallstones. Retrieved from https://www.mayoclinic.org/diseases-conditions/gallstones/symptoms-causes/syc-20354214
• BMJ Best Practice. (2023). Acute Cholecystitis. Retrieved from https://bestpractice.bmj.com/topics/en-us/66