A positive Murphy test indicates inflammation of the gallbladder, often due to cholecystitis.
Understanding Murphy's Sign
Murphy's sign is a clinical test used to assess for gallbladder inflammation. It is performed during a physical examination by a healthcare provider. The provider places their hand under the patient's right rib cage, in the area of the gallbladder.
How to Perform the Murphy's Sign Test
- The patient is instructed to take a deep breath.
- The examiner palpates the subcostal area (below the ribs on the right side).
- The examiner asks the patient to inhale.
Defining a Positive Murphy's Test
According to the provided reference, a positive Murphy’s sign occurs "if pain occurs when the inflamed gallbladder comes into contact with the examiner's hand". The patient will typically abruptly halt their inspiration because of the sharp pain they feel when the inflamed gallbladder is pressed during breathing. This sudden stop in breathing, due to pain, is a key indicator of a positive result.
Here's a breakdown in a table:
| Feature | Positive Murphy's Sign | Negative Murphy's Sign |
|---|---|---|
| Palpation during Inspiration | Pain elicited by palpation under the ribs | No pain or mild discomfort |
| Inspiratory Effort | Sudden stop in inspiration due to pain | Continues to breathe smoothly |
| Gallbladder Condition | Suggests acute inflammation, likely cholecystitis | Suggests gallbladder is not significantly inflamed |
Clinical Significance of a Positive Murphy's Sign
A positive Murphy’s test suggests a high likelihood of:
- Acute Cholecystitis: Inflammation of the gallbladder, most often caused by gallstones blocking the bile duct.
- Other Biliary Tract Issues: While most commonly associated with cholecystitis, it could also indicate other issues in the biliary tract.
Example
- Imagine a patient experiencing right upper abdominal pain.
- During the Murphy’s test, when the examiner palpates the area and the patient tries to breathe in, the patient stops their breath sharply, due to sudden pain. This would indicate a positive Murphy's sign, suggesting gallbladder inflammation.
A negative test, where the patient breathes comfortably during palpation, does not rule out gallbladder disease but makes cholecystitis less likely.
It's important to note that Murphy’s sign is just one element of a comprehensive diagnosis. Healthcare professionals consider other tests and symptoms for a proper diagnosis.
