In
medicine
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
, Murphy's sign (also known as Sweeney’s sign) is a maneuver during a
physical examination
In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the pati ...
as part of the
abdominal examination
An abdominal examination is a portion of the physical examination which a physician or nurse uses to clinically observe the abdomen of a patient for signs of disease. The physical examination typically occurs after a thorough medical history i ...
.
It is useful for
differentiating pain in the
right upper quadrant
The human abdomen is divided into quadrants and regions by anatomists and physicians for the purposes of study, diagnosis, and treatment. The division into four quadrants allows the localisation of pain and tenderness, scars, lumps, and other ...
. Typically, it is positive in
cholecystitis
Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede acute cholecystitis. The pai ...
, but negative in
choledocholithiasis
Common bile duct stone, also known as choledocholithiasis, is the presence of gallstones in the common bile duct (CBD) (thus '' choledocho-'' + ''lithiasis''). This condition can cause jaundice and liver cell damage. Treatments include choledocholi ...
,
pyelonephritis
Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may ...
, and
ascending cholangitis.
During physical examination
Classically, Murphy's sign is tested for during an
abdominal examination
An abdominal examination is a portion of the physical examination which a physician or nurse uses to clinically observe the abdomen of a patient for signs of disease. The physical examination typically occurs after a thorough medical history i ...
in supine position; it is performed by asking the patient to breathe out and then gently placing the hand below the
costal margin
The costal margin, also known as the costal arch, is the lower edge of the chest (thorax) formed by the bottom edge of the rib cage.
Structure
The costal margin is the medial margin formed by the cartilages of the seventh to tenth ribs. It attac ...
on the right side at the mid-
clavicular
The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the rig ...
line (the approximate location of the
gallbladder
In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although ...
). The patient is then instructed to breathe in. Normally, during inspiration, the
abdominal
The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso ...
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) 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 and
negative predictive value, 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
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
John Benjamin Murphy
John Benjamin Murphy, born John Murphy (December 21, 1857 – August 11, 1916) was an American physician and abdominal surgeon noted for advocating early surgical intervention in appendicitis appendectomy, and several eponyms: Murphy’s button, ...
(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 is unlikely to be related to
gallstones
A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of mi ...
.
*
Murphy's triad
References
External links
*
{{Digestive system and abdomen symptoms and signs
Medical signs
Hepatology