The Murphy’s Sign is a specific physical examination maneuver healthcare providers use to help diagnose the source of pain in the upper right side of the abdomen. This non-invasive test involves breathing and palpation designed to reveal inflammation in organs located in that region. The sign is a valuable tool in the initial assessment of a patient presenting with abdominal discomfort. This article focuses on the meaning of a negative finding and its implications within a broader medical evaluation.
Understanding the Murphy’s Sign Test
The procedure for eliciting the Murphy’s Sign relies on the anatomical movement of internal organs during respiration. The patient lies flat while the examiner gently places a hand beneath the right costal margin (the edge of the rib cage), corresponding to the approximate location of the gallbladder beneath the liver.
The patient is instructed to take a slow, deep breath, causing the diaphragm to move downward. This descent pushes the liver and the gallbladder lower into the abdominal cavity. If the gallbladder is severely inflamed, this movement causes the tender organ to forcefully press against the examiner’s fingers. A positive sign occurs when the patient suddenly stops inhaling—called inspiratory arrest—because the pain is too sharp to continue the breath.
Interpreting a Negative Result
A negative Murphy’s Sign means the patient completes the deep inspiratory maneuver without experiencing a sharp increase in pain or stopping their breath. Despite the pressure applied in the right upper quadrant, the patient exhibits no sudden wincing severe enough to halt the diaphragm’s descent. This outcome suggests that inflamed tissue is not being physically compressed against the sensitive parietal peritoneum.
This result holds significant diagnostic weight, strongly indicating the patient is likely not suffering from acute cholecystitis (acute inflammation of the gallbladder). The high negative predictive value means a negative finding reliably rules out cholecystitis in most adult patients. The lack of an inspiratory catch suggests that any pain present is not due to the characteristic mechanism of an acutely inflamed gallbladder moving against the abdominal wall.
However, a negative result is not absolute. Certain patient groups can present with an unreliable response, such as older adults or individuals who are immunocompromised. These patients may exhibit a blunted pain response due to changes in their nervous system or immune function. In these specific populations, the absence of the typical pain reaction does not entirely exclude cholecystitis, prompting the need for further investigation.
Clinical Context and Differential Diagnosis
The primary purpose of the Murphy’s Sign is to help narrow down the cause of pain specifically in the right upper quadrant (RUQ) of the abdomen. A negative result effectively eliminates acute cholecystitis as the most likely diagnosis. This immediately shifts the diagnostic focus to other conditions that cause similar RUQ pain but do not involve the characteristic localized inflammation of the gallbladder wall.
Several other conditions can mimic the discomfort of cholecystitis yet result in a negative Murphy’s Sign. These include hepatitis (inflammation of the liver) or kidney infections such as pyelonephritis, which typically produce pain felt higher or in the back. Other possibilities include choledocholithiasis (gallstones within the bile duct) or referred pain from a lower lobe pneumonia.
A negative Murphy’s Sign is one piece of a larger diagnostic puzzle, and a definitive diagnosis is rarely made based on this physical maneuver alone. Regardless of the result, healthcare providers typically order confirmatory tests, such as laboratory blood work and abdominal imaging. An abdominal ultrasound is the standard imaging modality used to visualize the gallbladder and bile ducts, providing a final confirmation or exclusion of the underlying cause of the patient’s symptoms.