Murphy’s Sign is a clinical technique healthcare professionals use to assess abdominal discomfort. This maneuver helps identify the source of pain, especially in the upper right abdomen. It serves as a tool in evaluating various conditions, guiding medical professionals toward potential diagnoses.
Performing the Test
To perform the Murphy’s Sign test, the patient lies on their back. The healthcare professional asks the patient to exhale completely. The examiner then gently places their hand or fingers below the right costal margin, the lower edge of the rib cage on the right side, near where the gallbladder is typically located.
The patient then takes a slow, deep breath. As the patient inhales, the diaphragm moves downward, pushing the liver and gallbladder lower into the abdominal cavity. If the gallbladder is inflamed, this movement causes it to contact the examiner’s fingers. The practitioner observes the patient’s reaction for pain or a sudden cessation of breath.
Interpreting a Positive Result
A “positive Murphy’s Sign” is a sudden, sharp pain that causes the patient to abruptly stop inhaling, often called an “inspiratory arrest.” This reaction occurs as the inflamed gallbladder descends with the diaphragm and presses against the examiner’s fingers. The pain is typically localized to the upper-right quadrant of the abdomen.
A positive Murphy’s Sign is associated with acute cholecystitis, inflammation of the gallbladder. In this condition, the gallbladder becomes distended and sensitive, often due to an obstruction like gallstones blocking its duct. Contact between the tender, inflamed gallbladder and the examiner’s hand during the deep breath elicits the characteristic pain.
Importance in Diagnosis
Murphy’s Sign is a clinical indicator, particularly when a patient presents with upper right abdominal pain. It helps healthcare providers differentiate causes of abdominal pain, guiding diagnosis. While a positive sign suggests acute cholecystitis, it is one piece of a larger diagnostic puzzle.
The sign’s reliability is discussed in terms of sensitivity and specificity. Sensitivity is how often the test correctly identifies individuals with the condition, while specificity is how often it correctly identifies those without it. For Murphy’s Sign, its ability to identify acute cholecystitis can be high, but a negative result does not definitively rule out the condition, especially in older patients. Healthcare professionals combine Murphy’s Sign findings with other clinical assessments, laboratory tests, and imaging studies, like ultrasound, to reach a definitive diagnosis and determine treatment.