Murphy's sign

In medicine, Murphy's sign refers to a maneuver during a physical examination as part of the abdominal examination and a finding elicited in ultrasonography. It is useful for differentiating pain in the right upper quadrant. Typically, it is positive in cholecystitis or choledocholithiasis, but negative in pyelonephritis and ascending cholangitis.

During physical examination

Classically Murphy's sign is tested for during an abdominal examination; it is performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder). The patient is then instructed to inspire (breathe in). Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner's fingers) and winces with a 'catch' in breath, the test is considered positive. A positive test also requires no pain on performing the maneuver on the patient's left hand side. Ultrasound imaging can be used to ensure the hand is properly positioned over the gallbladder

Predictive value

Murphy's sign has a high sensitivity and negative predictive value; however, the specificity is not high.^[1] In the elderly the sensitivity is markedly lower; a negative Murphy's sign in an elderly person is not useful for ruling out cholecystitis if other tests and the clinical history suggest the diagnosis.^[2]

History

The sign is named for American physician John Benjamin Murphy (1857–1916), a prominent Chicago surgeon from the 1880s through the early 1900s, who first described the hypersensitivity to deep palpation in the subcostal area when a patient with gallbladder disease takes a deep breath.

See Also

• Courvoisier's law - when the gallbladder is palpable, painless jaundice is unlikely to be related to gallstones.
• Sonographic Murphy sign

References

1. ^ Singer AJ, McCracken G, Henry MC, Thode HC, Cabahug CJ (September 1996). "Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis". Ann Emerg Med 28 (3): 267–72. doi:10.1016/S0196-0644(96)70024-0. PMID 8780468. http://linkinghub.elsevier.com/retrieve/pii/S0196-0644(96)70024-0. Retrieved 2008-05-22. 
2. ^ Adedeji OA, McAdam WA (April 1996). "Murphy's sign, acute cholecystitis and elderly people". J R Coll Surg Edinb 41 (2): 88–9. PMID 8632396. 

External links

• iv_1/c/cholecystitis_acute article at GE's Medcyclopaedia