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Clinical Signs
Corresponding Author: Sajad Ahmad Salati, Department of Surgery, College of Medicine, Qassim University, Saudi Arabia. E-mail: docsajad@yahoo.co.in
Abstract
Murphy’s sign is one of the contributions made by a noted American surgeon J B Murphy about a century ago. This sign retains its validity
even today. This article is written with the aim of reviewing Murphy’s sign briefly.
Received: April 17, 2012; Accepted: May 29, 2012; Published online: June 3, 2012
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Murphy’s sign
hammer-like blows (Figure 1). This method is the most inferior rib. The extended left thumb is abducted
uncommonly used nowadays but can be of value in obese and rotated in opposition down and into the patient’s
patients. belly while the patient is requested to take a deep breath.
The thumb is kept where it is, without pressing deeper.
When the inflamed gallbladder presses against your
Deep grip palpation thumb the patient will experience pain or tenderness
Standing behind the patient, provided that the patient is enough to halt inspiration (usually at the end of
well enough to assume an upright posture, the right hand inspiration). If this maneuver is repeated without pressing
of the examiner curls up under the costal margin at the tip in with the thumb and the patient can now complete a full
of the ninth rib and patient is requested to take a deep inspiration then Murphy’s sign is positive for acute
breath (Figure 2). If the gallbladder is inflamed, the cholecystitis.
patient will experience pain and catch the breath as the
gallbladder descends and contacts the palpating hand. If
the patient cannot assume upright posture, the sign can be Negative Murphy’s sign
elicited in supine position. It is identified when the patient comfortably inspires a
deep breath. In this case, the diaphragm pushes the
Alternatively, instead of curling up the fingers of right
non-inflamed gallbladder into the palpating hand without
hand, the extended fingers may be used to apply
moderate pressure and palpate deeply (Figure 3) while causing any discomfort.
the patient is taking deep breath in upright or supine
posture [2].
Significance of Murphy’s sign
A positive Murphy’s sign often indicates cholecystitis,
Moynihan’s modification of eliciting
where as a negative Murphy’s sign may suggest
Murphy’s sign pyelonephritis, and ascending cholangitis.
The left hand is placed on the patient’s lowermost right
anterior rib cage, so that your index finger is resting on
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Murphy’s sign
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Murphy’s sign
Acknowledgements 5. Navarro Fernandez JA, Tarraga Lopez PJ, Rodriguez Montes JA,
Lopez Cara MA. Validity of tests performed to diagnose acute
abdominal pain in patients admitted at an emergency department.
I express my gratitude to the patients (actual/simulated) Rev Esp Enferm Dig. 2009; 101(9):610-618.
who allowed the use of images for academic reasons. 6. Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient
have acute cholecystitis? JAMA. 2003; 289(1):80-86.
7. Ralls PW, Colletti PM, Lapin SA, Chandrasoma P, Boswell WD
Disclosure Jr, Ngo C, Radin DR, Halls JM. Real-time sonography in
suspected acute cholecystitis. Prospective evaluation of primary
There is no conflict of interest. and secondary signs. Radiology 1985; 155:767-771.
8. Bree RL. Further observations on the usefulness of the
sonographic Murphy sign in the evaluation of suspected acute
cholecystitis. J Clin Ultrasound. 1995; 23(3):169-172.
9. Kendall JL, Shimp RJ. Performance and interpretation of focused
References right upper quadrant ultrasound by emergency physicians. J
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3. Singer AJ, McCracken G, Henry MC, Thode HC Jr, Cabahug CJ.
Correlation among clinical, laboratory, and hepatobiliary scanning Copyright: 2012 © Sajad Ahmad Salati, et al. This is an Open
findings in patients with suspected acute cholecystitis. Ann Emerg Access article distributed under the terms of the Creative
Med 1996; 28:267–272. Commons Attribution License, which permits unrestricted use,
4. Adedeji OA, McAdam WA. Murphy’s sign, acute cholecystitis distribution, and reproduction in any medium, provided the
and elderly people. J R Coll Surg Edinb 1996; 41:88–89. original work is properly cited.
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