When sudden or persistent pain strikes the upper right side of the abdomen, known as the right upper quadrant (RUQ), medical professionals often suspect gallbladder issues. The RUQ houses several organs, including the liver, the right kidney, and the gallbladder itself. To determine the precise cause of discomfort, especially if gallbladder inflammation is suspected, diagnostic imaging is used. An ultrasound, or sonogram, is typically the first step. During this examination, the sonographic Murphy’s sign is performed to help pinpoint the source of the patient’s pain. Interpreting the result of this sign is a major factor in determining the next steps of care.
Defining the Sonographic Murphy’s Sign
The sonographic Murphy’s sign is a refinement of a traditional physical examination technique designed to test for acute cholecystitis, which is inflammation of the gallbladder. Unlike the clinical version, which relies on blind palpation, the sonographic test uses an ultrasound probe to visualize the gallbladder in real-time. The procedure involves the technician or physician first locating the gallbladder precisely on the screen.
Once the gallbladder is visualized, the examiner presses directly over it with the ultrasound probe. The patient is asked to take a deep breath, which causes the diaphragm to push the abdominal organs downward, bringing the gallbladder closer to the abdominal wall. A positive result occurs if the patient experiences a sudden, sharp intake of breath or pain when the probe presses directly on the gallbladder. This accuracy of localization ensures the tenderness is specifically over the gallbladder. The test is primarily designed to detect acute cholecystitis, a condition typically caused by a gallstone blocking the cystic duct.
Interpreting a Negative Finding
A negative sonographic Murphy’s sign strongly suggests that the patient does not have acute cholecystitis. A negative finding means the patient does not feel a sharp increase in pain or stop breathing abruptly when the ultrasound probe is pressed directly over the visualized gallbladder. This absence of localized tenderness helps to rule out the acute inflammation targeted by the test.
The sign has a high negative predictive value, meaning that when the test is negative, there is a high degree of confidence that acute cholecystitis is not the cause of the patient’s symptoms. A positive sign, by contrast, suggests the presence of acute gallbladder inflammation, often in conjunction with other findings like gallstones or gallbladder wall thickening.
The result is not an absolute guarantee, as the test is not 100% accurate. For example, the sign may be falsely negative in patients who have received strong pain medication before the exam. A negative result can also occur in cases of gangrenous cholecystitis, a severe complication where the nerve endings in the gallbladder wall have been destroyed, leading to a lack of pain. Despite these exceptions, a negative result offers significant reassurance by making the most common serious gallbladder issue highly unlikely.
Other Causes of Right Upper Quadrant Pain
While a negative sonographic Murphy’s sign is reassuring regarding the gallbladder, it confirms only that acute cholecystitis is unlikely. The right upper quadrant contains several other organs and tissues that can be the source of discomfort. If a patient still has pain despite the negative gallbladder finding, the clinical investigation must pivot to explore these other possibilities.
One common cause of RUQ pain is peptic ulcer disease, where sores in the lining of the stomach or the duodenum can cause a burning sensation that radiates to the right side. Pancreatitis, or inflammation of the pancreas, can also cause severe pain in the upper abdomen that may be felt in the RUQ or radiate to the back.
The liver, which takes up a large portion of the RUQ, can be the source of pain if it is inflamed from conditions like hepatitis or if it is significantly enlarged. Furthermore, kidney issues, such as kidney stones or a kidney infection, can cause intense pain that may also present in the RUQ. Given the variety of potential causes, persistent pain requires continued medical follow-up to arrive at a definitive diagnosis and appropriate treatment.