In
medicine, Murphy's sign (also known as Sweeney’s sign) is a maneuver during a
physical examination as part of the
abdominal examination.
It is useful for
differentiating pain
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
in the
right upper quadrant. Typically, it is positive in
cholecystitis, but negative in
choledocholithiasis,
pyelonephritis, and
ascending cholangitis
Ascending cholangitis, also known as acute cholangitis or simply cholangitis, is inflammation of the bile duct, usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). It tends to occur if th ...
.
During physical examination
Classically, Murphy's sign is tested for during an
abdominal examination in supine position; 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 breathe in. Normally, during inspiration, the
abdominal contents are pushed downward as the
diaphragm
Diaphragm may refer to:
Anatomy
* Thoracic diaphragm, a thin sheet of muscle between the thorax and the abdomen
* Pelvic diaphragm or pelvic floor, a pelvic structure
* Urogenital diaphragm or triangular ligament, a pelvic structure
Other
* Diap ...
moves down (and
lung
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
s expand). If the patient stops breathing in (as the gallbladder is
tender
Tender may refer to:
Entertainment Film
* ''Illegal Tender'' (2007), a film directed by Franc. Reyes
* ''Tender'' (2012), a short film by Liz Tomkins
* ''Tender'' (2019), a short film by Darryl Jones and Anthony Lucido
* ''Tender'' (2019), a sh ...
and, in moving downward, comes in contact with the examiner's fingers) and winces with a "catch" in breath, the test is considered positive. In order for the test to be considered positive, the same maneuver must not elicit pain when performed on the left side.
Predictive value
Murphy's sign has a high
sensitivity
Sensitivity may refer to:
Science and technology Natural sciences
* Sensitivity (physiology), the ability of an organism or organ to respond to external stimuli
** Sensory processing sensitivity in humans
* Sensitivity and specificity, statisti ...
and
negative predictive value
The positive and negative predictive values (PPV and NPV respectively) are the proportions of positive and negative results in statistics and diagnostic tests that are true positive and true negative results, respectively. The PPV and NPV descr ...
, although the
specificity is not high.
However, in the elderly the sensitivity is markedly lower; a negative Murphy's sign in an elderly person is not useful for ruling out cholecystitis if other tests and the clinical history suggest the diagnosis.
History
The sign is named after American
physician John Benjamin Murphy (1857–1916), a Chicago surgeon from the 1880s to the early 1900s, who first described the hypersensitivity to deep palpation in the subcostal area when a patient with gallbladder disease takes a deep breath.
See also
*
Courvoisier's law – when the gallbladder is palpable, painless
jaundice
Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme meta ...
is unlikely to be related to
gallstones.
*
Murphy's triad
References
External links
*
{{Digestive system and abdomen symptoms and signs
Medical signs
Hepatology