The Murphy Sign is a clinical test used to diagnose conditions causing abdominal pain. This physical examination technique provides valuable information to healthcare professionals, guiding further diagnostic steps.
What is the Murphy Sign?
Performing the Murphy Sign involves a specific physical examination. The patient lies on their back. A healthcare professional gently places their hand or fingers below the costal margin on the right side of the patient’s upper abdomen, near the mid-clavicular line, which is the approximate location of the gallbladder.
The patient is then instructed to take a deep breath. As they inhale, the diaphragm moves downward, pushing the liver and gallbladder lower into the abdominal cavity. The examiner maintains firm pressure in the right upper quadrant, observing the patient’s breathing and any signs of discomfort.
What a Positive Result Indicates
A “positive Murphy Sign” occurs when the patient experiences sudden, sharp pain and inspiratory arrest as the examiner presses on the right upper quadrant during inspiration. This abrupt cessation of breath happens when the inflamed gallbladder comes into contact with the examiner’s fingers.
A positive Murphy Sign is suggestive of acute cholecystitis, an inflammation of the gallbladder. This inflammation often results from a gallstone blocking the cystic duct, the main opening of the gallbladder. When obstructed, bile builds up, increasing pressure and causing inflammation. Acute cholecystitis commonly presents with severe pain in the upper right abdomen, which can sometimes spread to the right shoulder or back, along with symptoms like nausea, vomiting, and fever.
Diagnosing and Treating the Underlying Condition
While a positive Murphy Sign strongly points towards acute cholecystitis, it is not the only diagnostic tool. Healthcare professionals typically order additional tests to confirm the diagnosis and rule out other conditions. Imaging tests, such as an abdominal ultrasound, are often the initial choice. An ultrasound can reveal gallstones, thickening of the gallbladder wall, or fluid around the gallbladder.
Another imaging test, a hepatobiliary iminodiacetic acid (HIDA) scan, tracks the flow of bile from the liver through the bile ducts and into the small intestine. A HIDA scan can confirm acute cholecystitis by showing a blockage in the cystic duct, preventing the radioactive tracer from entering the gallbladder. Blood tests, including a complete blood count (to check for infection) and liver function tests, provide important information.
Treatment for acute cholecystitis often involves initial medical management, including resting the bowel, intravenous fluids, and pain medication. Antibiotics are typically given to address any associated infection. The definitive treatment is usually surgical removal of the gallbladder, a procedure called a cholecystectomy. This surgery is commonly performed using minimally invasive laparoscopic techniques, which involve small incisions.