From the Research
Yes, pancreas pathology can cause a positive Murphy's sign, though this is not the classic association. Murphy's sign, characterized by pain and breath-holding when pressing on the right upper quadrant during inspiration, is typically associated with gallbladder inflammation (acute cholecystitis) [ 1 ]. However, pancreatic conditions, particularly acute pancreatitis or pancreatic inflammation that extends to involve nearby structures, can sometimes produce a positive Murphy's sign. This occurs because the inflamed pancreas, especially the head of the pancreas which sits near the gallbladder, can create localized tenderness in the right upper quadrant.
Key Points to Consider
- The anatomical proximity of the pancreas to the gallbladder and liver means that pancreatic inflammation can irritate surrounding tissues and peritoneum, mimicking gallbladder disease.
- Clinicians should consider pancreatic pathology in the differential diagnosis when encountering a positive Murphy's sign, especially if other symptoms suggest pancreatic involvement such as epigastric pain radiating to the back, elevated lipase or amylase levels, or risk factors for pancreatitis like alcohol use or gallstones [ 2 ].
- Ultrasonography alone has a high rate of false-negative studies for acute cholecystitis, but a higher rate of accurate diagnosis can be achieved using a triad of positive Murphy sign, elevated neutrophil count, and an ultrasound showing cholelithiasis or cholecystitis [ 2 ].
- It is essential to note that while the provided studies 1, 3, 2](2014) ] focus on the diagnosis of acute cholecystitis, the clinical presentation of pancreatic pathology can sometimes overlap with that of gallbladder disease, highlighting the need for a comprehensive diagnostic approach.