Murphys Sign: Difference between revisions
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Revision as of 12:52, 2 February 2024
Purpose
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Murphy's sign is a physical examination technique used to diagnose acute cholecystitis, which is inflammation of the gallbladder.[1] One of the most common and recognizable signs of gallbladder hypersensitivity is the inability of the patient to take a complete, deep breath while the physician's fingers are placed deep beneath the right costal arch, below the hepatic margin. The diaphragm pushes the liver down until the sensitive gallbladder meets the fingers during examination, at which point the patient's ability to inhale suddenly stops as though it has been cut off.[2]
Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area(right upper quadrant) of the abdomen.[3]Murphy described two signs for cholecystitis. He called the first one that bears his name 'deep-grip palpation' and the second one 'hammer-stroke percussion', which he considered even better.
Technique
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Murphy’s sign is performed by palpating the subcostal region during inspiration. If pain is elicited and the patient suddenly stops their inspiratory effort. If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
Evidence[edit | edit source]
Several studies have shown that the presence of Murphy's sign is highly sensitive (97.2%) and predictive (93.3%) of a positive diagnosis of acute cholecystitis in most patients. However, this sign may not be as reliable in elderly patients as found by Adedeji and McAdam in their retrospective investigation. They discovered that the diagnostic accuracy for acute cholecystitis dropped to 34% when Murphy's sign was negative in patients over 70 years old, compared to 80% when it was present. The test's positive predictive value in the same patients was 58%, with a sensitivity of 48% and a specificity of 79%.[1]
Resources[edit | edit source]
add any relevant resources here
References[edit | edit source]
- ↑ 1.0 1.1 Musana K, Yale SH. John Benjamin Murphy (1857 - 1916). Clinical Medicine & Research. 2005 May 1;3(2):110–2.
- ↑ Jeans PL. Murphy’s sign. Medical Journal of Australia. 2017 Feb;206(3):115–6.
- ↑ Musana KA, Yale SH. Murphy’s Sign. Clinical Medicine & Research. 2005 Aug 1;3(3):132–2.
- ↑ Doctor O'Donovan. Murphys sign. Available from: http://www.youtube.com/watch?v=kRXScm2UIc4 [last accessed 1/2/2024]
- ↑ Surgical Teaching. Murphy's sign | What is this Classic Examination Finding?. Available from: http://www.youtube.com/watch?v=ZxMps5NeoXo [last accessed 1/2/2024]
