From the Research
Murphy's sign is present in approximately 50-70% of patients with acute cholecystitis, as reported in the most recent and highest quality study 1. This physical examination finding, characterized by pain and respiratory arrest during deep palpation of the right upper quadrant of the abdomen during inspiration, is a helpful but imperfect indicator of gallbladder inflammation. The sensitivity of Murphy's sign varies across studies, with some reporting it as low as 50% and others as high as 97%, though most reliable estimates fall in the 65-70% range, as seen in studies such as 2 and 3. Some key points to consider when evaluating Murphy's sign include:
- The sign is more reliable in younger patients and may be less sensitive in elderly patients, diabetics, or those with altered mental status who may have diminished pain responses.
- Other clinical findings such as right upper quadrant pain, fever, leukocytosis, and imaging studies (particularly ultrasound showing gallstones, gallbladder wall thickening, or pericholecystic fluid) are necessary to establish a definitive diagnosis of acute cholecystitis, as noted in 4 and 5. It's essential to combine Murphy's sign with other clinical parameters, such as patient age, sex, and white blood cell count, to effectively stratify patients into risk groups for acute cholecystitis, as demonstrated in 1. By considering these factors and using the most recent and highest quality evidence, clinicians can make more accurate diagnoses and develop effective treatment plans for patients with suspected acute cholecystitis.