This article is about the clinical sign observed in physical examinations. For the sonographic sign, see Sonographic Murphy sign. For the condition sometimes known as "Murphy's punch sign", see costovertebral angle tenderness.
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-clavicular line (the approximate location of the gallbladder). The patient is then instructed to breathe in. Normally, during inspiration, the abdominal 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.[citation needed]
Predictive valueedit
Murphy's sign has a high sensitivity and negative predictive value, although the specificity is not high.[2] 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.[3]
Historyedit
The sign is named after American physicianJohn 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.[citation needed]
^Bree, RL (March–April 1995). "Further observations on the usefulness of the sonographic Murphy sign in the evaluation of suspected acute cholecystitis" (PDF). Journal of Clinical Ultrasound. 23 (3): 169–72. doi:10.1002/jcu.1870230304. hdl:2027.42/38197. PMID 7730462. S2CID 16882278.
^Singer AJ, McCracken G, Henry MC, Thode HC, Cabahug CJ (September 1996). "Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis". Ann Emerg Med. 28 (3): 267–72. doi:10.1016/S0196-0644(96)70024-0. PMID 8780468.
^Adedeji OA, McAdam WA (April 1996). "Murphy's sign, acute cholecystitis and elderly people". J R Coll Surg Edinb. 41 (2): 88–9. PMID 8632396.
External linksedit
. Medcyclopaedia. GE. Archived from the original on 2012-02-05.
April 26, 2024
murphy, sign, this, article, about, clinical, sign, observed, physical, examinations, sonographic, sign, sonographic, murphy, sign, condition, sometimes, known, murphy, punch, sign, costovertebral, angle, tenderness, medicine, also, known, sweeney, sign, maneu. This article is about the clinical sign observed in physical examinations For the sonographic sign see Sonographic Murphy sign For the condition sometimes known as Murphy s punch sign see costovertebral angle tenderness In medicine Murphy s sign also known as Sweeney s sign is a maneuver during a physical examination as part of the abdominal examination 1 It is useful for differentiating pain in the right upper quadrant Typically it is positive in cholecystitis but negative in choledocholithiasis pyelonephritis and ascending cholangitis Murphy s signPurposeDifferentiating upper right quadrant pain Contents 1 During physical examination 2 Predictive value 3 History 4 See also 5 References 6 External linksDuring physical examination editClassically 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 clavicular line the approximate location of the gallbladder The patient is then instructed to breathe in Normally during inspiration the abdominal 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 citation needed Predictive value editMurphy s sign has a high sensitivity and negative predictive value although the specificity is not high 2 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 3 History editThe 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 citation needed See also editCourvoisier s law when the gallbladder is palpable painless jaundice is unlikely to be related to gallstones Murphy s triadReferences edit Bree RL March April 1995 Further observations on the usefulness of the sonographic Murphy sign in the evaluation of suspected acute cholecystitis PDF Journal of Clinical Ultrasound 23 3 169 72 doi 10 1002 jcu 1870230304 hdl 2027 42 38197 PMID 7730462 S2CID 16882278 Singer AJ McCracken G Henry MC Thode HC Cabahug CJ September 1996 Correlation among clinical laboratory and hepatobiliary scanning findings in patients with suspected acute cholecystitis Ann Emerg Med 28 3 267 72 doi 10 1016 S0196 0644 96 70024 0 PMID 8780468 Adedeji OA McAdam WA April 1996 Murphy s sign acute cholecystitis and elderly people J R Coll Surg Edinb 41 2 88 9 PMID 8632396 External links edit Cholecystitis acute Medcyclopaedia GE Archived from the original on 2012 02 05 Retrieved from https en wikipedia org w index php title Murphy 27s sign amp oldid 1076335549, wikipedia, wiki, book, books, library,
