From the Guidelines
Murphy's sign, also known as Murphy's maneuver, is a physical examination finding used to diagnose acute cholecystitis, characterized by focal tenderness corresponding to a sonographically localized gallbladder, which is elicited by pressing down on the right upper quadrant of the abdomen as the patient inhales, causing the inflamed gallbladder to touch the examiner's fingers and resulting in abrupt cessation of inhalation due to pain. The Murphy sign is an important diagnostic tool in the clinical assessment of patients with suspected biliary disease, particularly those presenting with right upper quadrant pain 1. To perform the Murphy sign, the examiner places their fingers or hand below the right costal margin at the level of the gallbladder while the patient takes a deep breath, and the test is considered positive if the patient experiences pain and stops inhaling when the inflamed gallbladder touches the examiner's fingers 1. Some key points to consider when interpreting the Murphy sign include:
- The sensitivity of the Murphy sign can range from 50-97%, and its specificity is around 79-96% 1.
- A positive Murphy sign is highly suggestive of acute cholecystitis, but it is not always present in all cases 1.
- The Murphy sign is particularly useful in the initial clinical assessment of patients with right upper quadrant pain, especially when combined with other findings such as fever, leukocytosis, and right upper quadrant tenderness 1.
- Additional imaging studies like ultrasound are typically needed to confirm the diagnosis of acute cholecystitis 1.
From the Research
Definition of Murphy's Sign
- Murphy's sign, also known as Murphy's maneuver, is a clinical sign used to diagnose acute cholecystitis, which is an inflammation of the gallbladder 2, 3, 4, 5, 6.
- It is defined as the presence of maximal tenderness elicited over a sonographically localized gallbladder, or the presence of tenderness in the right upper quadrant of the abdomen when the patient inhales deeply and the examiner applies pressure over the gallbladder area 4, 5.
Clinical Significance
- A positive Murphy's sign is indicative of acute cholecystitis, but it is not always present in patients with the condition 2, 4.
- The sensitivity of Murphy's sign is around 63%, while the specificity is around 93.6% 4.
- The predictive value of a positive Murphy's sign is around 72.5%, while the predictive value of a negative sign is around 90.5% 4.
- The sonographic Murphy sign, which is performed using ultrasound, has a positive predictive value of 92.2% for acute cholecystitis when combined with acute pain and gallstones 5.
Diagnostic Criteria
- Murphy's sign is one of the diagnostic criteria for acute cholecystitis, along with local inflammatory findings, fever, and systemic inflammatory reaction findings detected by blood tests 6.
- Definite diagnosis of acute cholecystitis can only be made on the basis of imaging studies such as ultrasonography, computed tomography, or scintigraphy (HIDA scan) 6.