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-clavicle, clavicular line (the approximate location of the gallbladder). The patient is then instructed to breathe in. Normally, during inspiration, the abdomen, abdominal contents are pushed downward as the diaphragm (anatomy), diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is Pain, 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 (tests), sensitivity and negative predictive value, although the Specificity (tests), 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 is unlikely to be related to gallstones. * Murphy's triadReferences
External links
* {{Digestive system and abdomen symptoms and signs Medical signs Hepatology