Clinical signs represent observable indicators used by healthcare providers to help diagnose medical conditions through physical examination. Murphy’s Sign is a well-established examination technique focusing on the upper right quadrant of the abdomen, an area associated with several digestive organs. This test is a quick, initial screening tool used to differentiate between various sources of abdominal discomfort.
The Purpose of Murphy’s Sign
A positive Murphy’s Sign is used primarily to suggest the presence of acute cholecystitis, a condition involving inflammation of the gallbladder. The physical response that defines a positive result is a sudden, sharp pain felt by the patient, which causes an abrupt cessation of their deep breath, known as inspiratory arrest. This reaction occurs due to the anatomical movement of organs during the respiratory cycle.
When the patient inhales deeply, the diaphragm moves downward, pushing the liver and the attached, inflamed gallbladder along with it. The tender, swollen gallbladder then makes forceful contact with the examiner’s fingers, which are pressing into the area just beneath the rib cage. This unexpected contact causes such intense visceral pain that the patient cannot continue their inhalation, providing a strong indication of gallbladder inflammation.
Interpreting a Negative Result
A negative Murphy’s Sign occurs when the patient is able to complete a full, deep breath without experiencing a sudden spike of pain or inspiratory arrest, even while the examiner maintains pressure on the upper right quadrant. The absence of this specific, painful reaction suggests that the patient’s abdominal pain is very likely not caused by acute cholecystitis. This negative finding is valuable because it helps the clinician narrow the focus of the diagnosis away from primary gallbladder inflammation.
While a negative result is highly suggestive that acute cholecystitis is not present, it does not rule out all possible gallbladder issues. Other conditions affecting the biliary system, such as a gallstone lodged in the common bile duct (choledocholithiasis) or an infection of the bile ducts (ascending cholangitis), may still be present despite the negative sign. Furthermore, a negative Murphy’s Sign does not exclude other causes of upper right quadrant pain, such as kidney infection, appendicitis, or liver pathology. The test is specific to the inflammation of the gallbladder wall itself.
The Physical Examination Procedure
To perform the test, the patient is asked to lie on their back in a relaxed position. The healthcare provider then places their fingers or hand on the patient’s abdomen, specifically beneath the right costal margin at the mid-clavicular line, which is the approximate location of the gallbladder. The patient is instructed to exhale completely before the fingers are gently but firmly pressed into the abdominal tissue.
Following this placement, the patient is asked to take a slow, deep breath. As the patient inhales, the examiner observes their breathing pattern closely for any sudden interruption or wincing. Repeating the maneuver on the left side of the abdomen is sometimes done as a control to ensure the pain is specific to the right side.
When the Sign May Be Misleading
Despite its utility, the Murphy’s Sign is a clinical finding that can sometimes be misleading, particularly leading to false negative results. One common factor that can mask a true positive response is the prior administration of strong pain medication, such as opioid analgesics. These medications can dull the patient’s pain perception, preventing the characteristic inspiratory arrest even when the gallbladder is inflamed.
Another population where the sign is less reliable is the elderly, who often exhibit a blunted pain response compared to younger patients. In older individuals, the sensitivity of the test can be significantly lower, meaning a negative result may not effectively rule out acute cholecystitis. A similar false negative can occur if the gallbladder has become gangrenous or perforated, altering the typical inflammatory pain response. Clinicians may also use the “Sonographic Murphy’s Sign,” which involves using an ultrasound probe to apply pressure directly over the visualized gallbladder, offering a more precise diagnostic tool.