Murphy’s sign is a clinical test used to detect gallbladder inflammation, specifically acute cholecystitis. Here’s how it’s performed and interpreted:
Murphy’s sign test – How to Perform
- Patient Position: The patient lies down (supine position) with their knees slightly bent.
- Palpation: The healthcare provider places their hand on the right upper quadrant of the patient’s abdomen, just below the rib cage.
- Inspiration: The patient is asked to take a deep breath.
- Observation: As the patient inhales, the gallbladder moves downwards due to the diaphragm pushing it. The provider applies gentle pressure at this point.
Murphy’s Sign Positive
- Pain and Arrested Breathing: If the patient suddenly experiences sharp pain and stops inhaling (due to the discomfort), this is considered a positive Murphy’s sign. It suggests the presence of gallbladder inflammation, often due to acute cholecystitis.
Negative Murphy’s Sign
- No Pain/Discomfort: If the patient can continue to inhale without pain or significant discomfort, the sign is considered negative, making acute cholecystitis less likely.
This sign is commonly used in the clinical setting as part of the physical examination to assess for gallbladder disease.
Murphy’s sign location
Murphy’s sign is located in the right upper quadrant (RUQ) of the abdomen, just beneath the ribcage. To elicit Murphy’s sign, a healthcare provider presses down in this area while the patient takes a deep breath. If the patient experiences pain and stops inhaling due to tenderness in the gallbladder region, this indicates a positive Murphy’s sign. It is often associated with acute cholecystitis (inflammation of the gallbladder).
Murphy’s sign cholecystitis
Murphy’s sign is a clinical test used to assess for acute cholecystitis, which is the inflammation of the gallbladder, often due to gallstones blocking the cystic duct.
How to Perform Murphy’s Sign Test:
- Patient position: The patient lies supine (on their back).
- Examiner’s hand: The examiner places their hand just below the right costal margin (the edge of the rib cage) at the midclavicular line, over the location of the gallbladder.
- Deep inspiration: The patient is asked to take a deep breath while the examiner applies pressure in this area.
- Positive Murphy’s Sign: If the patient suddenly stops inhaling due to sharp pain upon the gallbladder being palpated, this is considered a positive Murphy’s sign. The patient may experience tenderness and involuntarily “catch” their breath due to the pain.
Interpretation:
- Positive Murphy’s sign suggests acute cholecystitis, often caused by a gallstone obstructing the gallbladder’s outflow.
- Negative Murphy’s sign may indicate that the condition could be another issue, such as chronic cholecystitis, peptic ulcer disease, or other abdominal pathology.
It’s commonly used in clinical practice along with imaging studies, like an ultrasound, to confirm the diagnosis of acute cholecystitis.
Murphy’s sign appendicitis
Murphy’s sign is actually associated with acute cholecystitis (gallbladder inflammation), not appendicitis. It is elicited by asking the patient to take a deep breath while the examiner palpates the right upper quadrant of the abdomen. A positive Murphy’s sign occurs when the patient feels pain and abruptly stops inhaling due to discomfort, which indicates potential gallbladder inflammation.
In contrast, appendicitis typically presents with McBurney’s point tenderness (pain in the lower right quadrant of the abdomen), Rovsing’s sign (pain in the right lower quadrant when the left lower quadrant is palpated), and sometimes a psoas sign or obturator sign, which indicate irritation of the surrounding abdominal muscles or organs.
Positive Murphy’s sign pancreatitis
Murphy’s sign is a clinical test used primarily to detect cholecystitis, which is the inflammation of the gallbladder. A positive Murphy’s sign is when the patient experiences pain upon palpation of the right upper quadrant of the abdomen, particularly when the examiner applies pressure during inhalation. The sudden stopping of breath due to pain is considered a positive sign, often indicating gallbladder inflammation.
In the context of pancreatitis, a positive Murphy’s sign is not typically associated with this condition. Pancreatitis involves inflammation of the pancreas, which is located in the upper abdomen but more centrally or to the left rather than in the right upper quadrant where Murphy’s sign is tested.
However, in some cases of acute pancreatitis, particularly when it is complicated by gallstone disease (biliary pancreatitis), a positive Murphy’s sign might be present due to concurrent cholecystitis or biliary tract involvement. In such cases, the positive Murphy’s sign could suggest that gallstones are contributing to the pancreatitis by causing an obstruction in the biliary system.
So, while a positive Murphy’s sign is not directly indicative of pancreatitis, it can be relevant if the pancreatitis is related to gallstone disease.
FAQ
- The healthcare provider asks the patient to take a deep breath while palpating the right upper quadrant of the abdomen, specifically over the gallbladder area.
- If the patient suddenly stops breathing in and experiences sharp pain during the palpation, the Murphy’s sign is considered positive.
This response suggests that the gallbladder may be inflamed, likely due to gallstones blocking the cystic duct.
Yes, cholecystitis can be a medical emergency. It is the inflammation of the gallbladder, often caused by a blockage from a gallstone. If left untreated, it can lead to complications such as gallbladder rupture, infection, or the spread of inflammation to other parts of the body (sepsis). Signs that it may be an emergency include:
- Intense, ongoing pain in the upper right part of the abdomen
- Fever and chills
- Nausea and vomiting
- Jaundice (yellowing of the skin and eyes)
If cholecystitis is suspected, it’s important to seek medical attention promptly. In many cases, hospitalization and treatment, including antibiotics or surgery, may be necessary.
To check for gallbladder tenderness, a healthcare provider usually presses on the upper right part of the abdomen, just below the ribcage. This area is known as Murphy’s point.
During a physical examination, the provider will ask the patient to take a deep breath while gently pressing on this spot. If there is pain or a sudden halt in the deep breath due to discomfort, this is referred to as Murphy’s sign and may indicate gallbladder inflammation, such as in cholecystitis.
what is negative sonographic murphy’s sign
A negative sonographic Murphy’s sign means that, during an ultrasound examination, the patient does not experience pain or tenderness when the ultrasound probe is pressed over the gallbladder.
In contrast, a positive sonographic Murphy’s sign occurs when there is significant tenderness during this maneuver, which can indicate gallbladder inflammation, such as acute cholecystitis. A negative sign suggests that acute cholecystitis is less likely, but it doesn’t rule out other gallbladder or abdominal conditions.