Murphy’s sign is a physical examination technique used by healthcare professionals to evaluate abdominal pain, particularly in the upper right side. This maneuver helps clinicians assess the possibility of gallbladder inflammation. Understanding the outcome of this test provides insights into potential underlying conditions.
What is Murphy’s Sign
To perform Murphy’s sign, a medical professional asks the patient to lie flat. The examiner then places their fingers or thumb along the patient’s right subcostal margin, which is the edge of the rib cage on the right side, directly over the approximate location of the gallbladder. The patient is then instructed to take a deep breath.
A positive Murphy’s sign occurs if the patient experiences a sudden, sharp increase in pain and an abrupt cessation of inspiration as the inflamed gallbladder descends and comes into contact with the examiner’s fingers. This inspiratory arrest indicates acute cholecystitis, which is sudden inflammation of the gallbladder. The gallbladder is a small organ beneath the liver that stores bile.
Meaning of a Negative Result
A negative Murphy’s sign indicates the patient does not experience the characteristic sharp pain or inspiratory arrest during the deep breath maneuver. This absence of reaction provides diagnostic information.
While a positive Murphy’s sign suggests acute cholecystitis, a negative result helps rule out this condition as the primary cause of symptoms. It indicates the gallbladder is likely not acutely inflamed. However, a negative Murphy’s sign does not rule out other gallbladder issues, such as chronic cholecystitis, gallstones without inflammation, or other non-gallbladder related abdominal problems.
When Murphy’s Sign is Negative
Even when Murphy’s sign is negative, medical professionals often pursue further investigations if a patient presents with right upper quadrant pain or other concerning symptoms. A negative result simply means that acute inflammation of the gallbladder is less likely. Other conditions can cause similar pain that would not elicit a positive Murphy’s sign.
A negative Murphy’s sign does not exclude conditions like peptic ulcer disease, hepatitis, pancreatitis, kidney issues, or musculoskeletal strain in the abdominal wall. Therefore, a comprehensive medical evaluation is necessary. This typically involves a detailed patient history, other physical examination findings, laboratory tests such as blood work, and imaging studies like an abdominal ultrasound to identify the source of discomfort.