Murphy's sign

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In medicine, Murphy's sign refers to a physical examination manoeuvre that is part of the abdominal examination and a finding elicited in ultrasonography. It is useful for differentiating right upper quadrant abdominal pain. Typically, it is positive in cholecystitis, but negative in choledocholithiasis and ascending cholangitis.

Murphy's sign has a high sensitivity and specificity;^[1] however, should be interpreted with more caution in the eldery.^[2]

1 Murphy's sign in the physical examination
2 Sonographic Murphy's sign
3 Eponym
4 References
5 See also
6 External links

[edit] Murphy's sign in the physical examination

Classically, it is performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder). The patient is then instructed to inspire (breathe in). Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner's fingers) the test is considered positive. A positive test also requires no pain on performing the manoeuvre on the patient's left hand side.

[edit] Sonographic Murphy's sign

The sonographic Murphy's sign is similar to the physical examination manoeuvre, but performed with ultrasound guidance and ensures proper positioning over the gallbladder.

[edit] Eponym

The sign is named for the American surgeon John Benjamin Murphy (1857-1916) who described it.

[edit] References

^ Singer AJ, McCracken G, Henry MC, Thode HC Jr, Cabahug CJ. Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis. Ann Emerg Med. 1996 Sep;28(3):267-72. PMID 8780468.
^ Adedeji OA, McAdam WA. Murphy's sign, acute cholecystitis and elderly people. J R Coll Surg Edinb. 1996 Apr;41(2):88-9. PMID 8632396.