Murphy’s Sign is a classic technique used during the physical assessment of the abdomen. A medical sign is an objective physical finding observed by a clinician, indicating a possible disease or condition. This maneuver focuses on the right upper quadrant, where several organs are located, to help differentiate the cause of a patient’s pain. The sign itself is a physical response suggesting inflammation in one of the organs beneath the rib cage.
Eliciting the Sign: The Examination Procedure
The procedure begins with the patient lying supine, which helps relax the abdominal muscles. The healthcare provider places their fingers beneath the patient’s right costal margin (the lower edge of the rib cage). This placement aims to position the fingers directly over the projected location of the gallbladder.
Once the fingers are in place, the patient is instructed to take a slow, deep breath. The test is considered positive if the patient experiences a sudden, sharp pain that causes them to abruptly stop inhaling, known as inspiratory arrest. If the patient completes the deep breath without this sudden cessation, the sign is considered negative.
What a Positive Result Indicates
A positive Murphy’s Sign is highly suggestive of acute cholecystitis, which is the sudden inflammation of the gallbladder. This inflammation is most commonly caused by a gallstone blocking the cystic duct, the tube allowing bile to flow out. The obstruction causes bile to back up, leading to irritation, swelling, and pain in the gallbladder wall.
While a positive sign is a strong indicator, it does not provide a definitive diagnosis on its own. Clinicians combine Murphy’s Sign with other evidence, such as laboratory blood tests showing elevated inflammatory markers and imaging like an abdominal ultrasound. The sign’s presence helps distinguish gallbladder inflammation from other potential causes of upper abdominal discomfort.
The Underlying Cause of the Pain Reaction
The mechanism behind the pain reaction is directly related to the movement of internal organs during breathing. The gallbladder is located in the upper right abdomen, tucked beneath the liver. When a person takes a deep breath, the diaphragm muscle contracts and moves downward.
This downward movement of the diaphragm pushes the liver and, consequently, the gallbladder lower into the abdominal cavity. If the gallbladder is acutely inflamed and tender, the descent causes it to be pressed directly against the examiner’s fingers. This mechanical contact with the tender, swollen organ elicits the characteristic sharp pain that involuntarily causes the patient to stop breathing mid-inspiration.
Variations and Related Diagnostic Tools
The traditional physical maneuver has a recognized variant known as the Sonographic Murphy’s Sign, which is performed under ultrasound guidance. In this procedure, the pain is elicited not by the clinician’s fingers, but by the ultrasound probe itself when pressure is applied directly over the visualized gallbladder. This variant is often considered more accurate because it confirms that pressure is applied precisely to the organ in question.
There are also clinical situations where the sign may be less reliable, referred to as an Atypical Murphy’s Sign. This can occur in elderly patients or those with conditions like diabetes, where the body’s pain response may be blunted. This blunting can lead to a false-negative result even when acute cholecystitis is present.