{"id":1219,"date":"2018-02-08T16:58:09","date_gmt":"2018-02-08T16:58:09","guid":{"rendered":"https:\/\/emedicalupdates.com\/?p=1219"},"modified":"2022-01-12T10:42:38","modified_gmt":"2022-01-12T10:42:38","slug":"murphys-sign","status":"publish","type":"post","link":"https:\/\/emedicalupdates.com\/murphys-sign\/","title":{"rendered":"Murphy’s Sign"},"content":{"rendered":"

What is Murphy\u2019s sign?<\/h2>\n

It is a finding for differentiating the cause, by physical examination of a patient having pain in the right upper quadrant of the abdomen (1<\/strong>)<\/sup>. This test is positive if the patient is having acute cholecystitis (inflammation of the gallbladder) (1<\/strong>)<\/sup>.<\/p>\n

John Benjamin Murphy was the American Surgeon who described the sign first.<\/p>\n

Position of Gallbladder in abdomen<\/h2>\n

Gallbladder is situated under the liver on the right side of abdomen, which is on the right upper quadrant. To see what other organs are situated on the right upper quadrant, click here\u00a0 \u201cAbdominal Pain<\/strong><\/a>\u201d.<\/p>\n

\"gallbladder<\/p>\n

Picture 1: Image showing the position of gallbladder under the liver. The green coloured structure shown is gallbladder.<\/p>\n

\"four<\/p>\n

Picture 2: Image showing the four quadrants of the abdomen with the contents of right upper quadrant (RUQ).<\/p>\n

On a person, it is actually difficult to palpate a gallbladder by palpating the abdomen. If the person is suffering with pain in the right upper quadrant due to acute cholecystitis, then the palpation of the site elicits a painful reaction from him. It is easy to understand where the manoeuvre is done if you can identify a few points on your abdomen.<\/p>\n

    \n
  1. Identify the lower margin of the rib cage on your abdomen (costal margin). It is more like an inverted \u2018V\u2019.<\/li>\n
  2. Now, draw an imaginary line downwards (towards abdomen) from the middle of your right collar bone (clavicle) – Right mid-clavicular line (2<\/strong>)<\/sup>.<\/li>\n
  3. The junction between the lower margin of the right side of the rib cage (right side of the costal margin) and the line described above is the point under which gallbladder can be palpated.<\/li>\n
  4. This is also the tip of right 9th coastal cartilage (3<\/strong>)<\/sup>.<\/li>\n
  5. It is the junction between the lower margin of the right side of the rib cage (right side of the costal margin) and outer border of rectus abdominis muscle (3<\/strong>)<\/sup>.<\/li>\n<\/ol>\n

    \"planes<\/p>\n

    Picture 3: Note the diaphragm, liver, costal margin and gallbladder, in the picture. Remember that abdomen is the area below diaphragm.<\/p>\n

    How is Murphy\u2019s sign elicited?<\/h2>\n

    The test can be done in different ways. The test is usually down with the patient in a lying position. The examiner stands on the right side of the patient and keeps his\/her right palm on the patient\u2019s abdomen. The palm is in fact placed just below the right costal margin near to the right mid-clavicular line. This is the position of gallbladder inside the abdomen(2, 5<\/strong>)<\/sup>.<\/p>\n

    The patient is asked to exhale (breathe out) and then inhale (breathe in) deeply after the placement of the hand. When the patient inhales, the lungs get filled by air and the diaphragm is pulled downward towards the abdomen. We have seen above that diaphragm lies above the liver. See the Liver pain location<\/strong><\/a>.<\/p>\n

    When diaphragm is pulled downwards, the liver and gallbladder is pushed downwards too. If the gallbladder is inflamed as in case of acute cholecystitis, the patient will suddenly catch his\/her breathe (due to sudden pain), when the finger of the examiner touches the gallbladder.<\/p>\n

    \"examination<\/p>\n

    Picture 4: Image showing examination of abdomen of a patient to check for Murphy\u2019s sign.<\/p>\n

    How to test for Murphy\u2019s sign – VIDEO<\/h3>\n