Murphy’s Sign is a clinical examination technique healthcare professionals use to assess for inflammation of the gallbladder. This physical maneuver helps in evaluating patients experiencing discomfort in the upper right abdomen. It serves as an indicator during initial assessments to guide further diagnostic steps.
Understanding the Test
A positive Murphy’s Sign is elicited when a healthcare professional gently presses beneath the right rib cage, near the liver, and asks the patient to take a deep breath. If the patient experiences a sudden, sharp pain and abruptly stops inhaling as the inflamed gallbladder descends and contacts the examiner’s hand, the sign is considered positive. This inspiratory arrest is a characteristic response indicating the gallbladder’s hypersensitivity due to inflammation. This finding is commonly associated with acute cholecystitis, a condition where the gallbladder becomes inflamed, often due to gallstones obstructing its duct.
Interpreting a Negative Result
A negative Murphy’s Sign means the patient can complete a deep breath without significant pain or inspiratory arrest. While a negative result makes acute cholecystitis less likely, it does not definitively rule out the condition. This is particularly true in older adults, where the sign’s sensitivity can be lower.
Additionally, pain medication before examination might lead to a false negative result. Other abdominal conditions can cause similar symptoms to gallbladder issues but typically yield a negative Murphy’s Sign.
These include inflammation of the pancreas, kidney stones, or appendicitis, which manifest with pain in different areas or distinct characteristics. Conditions like choledocholithiasis (stones in the bile duct) or ascending cholangitis (a bile duct infection) may also present with right upper quadrant pain but often result in a negative Murphy’s Sign.
Beyond the Murphy’s Sign
Murphy’s Sign is a tool but should not be considered a standalone diagnostic test. Its diagnostic accuracy can vary, and a negative result does not completely exclude all gallbladder issues or other abdominal pathologies. For a definitive diagnosis, healthcare professionals often rely on a combination of clinical findings, laboratory tests, and imaging studies.
Additional investigations, such as abdominal ultrasound, blood tests (like complete blood count or liver function tests), or more specialized imaging like a HIDA scan, are often necessary. These tests provide a more comprehensive picture, helping confirm or rule out acute cholecystitis and identify other abdominal pain causes.
What Is a Negative Murphy’s Sign and What Does It Mean?
A positive Murphy’s Sign is elicited when a healthcare professional gently places their hand below the right costal margin, in the right upper quadrant of the abdomen, and asks the patient to take a deep breath. If the patient experiences a sudden, sharp pain and abruptly stops inhaling as the inflamed gallbladder descends and contacts the examiner’s hand, the sign is considered positive. This inspiratory arrest is a characteristic response indicating the gallbladder’s hypersensitivity due to inflammation. This finding is commonly associated with acute cholecystitis, a condition where the gallbladder becomes inflamed, often due to gallstones obstructing its cystic duct.
Interpreting a Negative Result
A negative Murphy’s Sign means the patient can complete a deep breath without significant pain or inspiratory arrest. While a negative result makes acute cholecystitis less likely, it does not definitively rule out the condition. This is particularly true in older adults, where the sign’s sensitivity can be lower. In elderly patients, diagnostic accuracy can drop significantly when the sign is negative.
Additionally, pain medication before examination might lead to a false negative result, as analgesia can affect accuracy. Other abdominal conditions can cause similar symptoms to gallbladder issues but typically yield a negative Murphy’s Sign.
These include inflammation of the pancreas, kidney stones, or appendicitis, which often present with pain in different areas or distinct characteristics. Conditions like choledocholithiasis (stones in the common bile duct) or ascending cholangitis (a severe infection of the bile ducts) may also present with right upper quadrant pain but commonly result in a negative Murphy’s Sign. A negative sign may also suggest chronic cholecystitis or peptic ulcer disease.
Beyond the Murphy’s Sign
Murphy’s Sign is a tool but should not be considered a standalone diagnostic test. Its diagnostic accuracy can vary, and a negative result does not completely exclude all gallbladder issues or other abdominal pathologies. For a definitive diagnosis, healthcare professionals often rely on a combination of clinical findings, laboratory tests, and imaging studies.
Additional investigations, such as abdominal ultrasound, are frequently used as a first-line imaging technique to detect gallstones, assess inflammation, and evaluate the gallbladder’s size and shape. Blood tests, including a complete blood count to check for infection or inflammation, and liver function tests to assess bile flow, also contribute to the diagnostic process. More specialized imaging tests like a HIDA scan, measuring gallbladder emptying function, or magnetic resonance cholangiopancreatography (MRCP), providing detailed images of the bile ducts, may also be necessary.