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What Is Murphy's Sign?

By L. Baran
Updated Mar 03, 2024
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Murphy's sign is a medical term used to describe a patient's specific reaction when an abdominal examination is performed. It occurs when the person stops breathing for a period of time in response to pain caused by palpation of a swollen gallbladder. Assessing for a positive Murphy's sign is performed by doctors and other medical professionals to determine whether a patient is suffering from cholecystitis, an inflamed gallbladder, rather than another intestinal condition that would not produce a positive reaction. This term may also refer to a finding during a sonogram examination in which a patient experiences pain when the sonographic device is pressed over the gallbladder.

In order to test for a positive Murphy's sign, the affected patient first lies down on his or her back either with clothing removed or raised above the chest area. The patient breathes out while the doctor places his or her hand on the lower ribs, between the 7th and 10th ribs, at the midpoint of the chest. As the doctor continues to feel the area, he or she will ask the patient to breathe slowly. If the patient reacts by holding his or her breath, or has difficulty breathing in, the test is positive. Breathing difficulty is caused by acute pain when the diaphragm pushes down on the affected gallbladder.

Cholecystitis is indicated by a positive sign. A negative sign requires further medical investigation and may indicate other conditions, such as ascending cholangitis or pyelonephritis. Ascending cholangitis is a bacterial infection of the bile duct, while pyelonephritis is a type of kidney infection. It is very important that the examiner's hand is placed accurately on the patient's body, or an inaccurate diagnosis may result. The test is only positive if the pain is on the left side of the body and not the right, so both sides must be tested for accuracy.

Using ultrasound technology, technicians can accurately locate a patient's gallbladder with high resolution imagery. The term Murphy's sign is also used in ultrasonography but is distinct from the result of the physical examination. For a positive sign to occur during an ultrasound exam, the patient must demonstrate pain when the sonogram wand is placed directly over the site of the organ, but not in any other area. This may also indicate cholecystitis and is often used in conjunction with the physical examination in diagnostic testing. A sonographic Murphy's sign tends to be more accurate when the presence of gallstones exists.

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Discussion Comments
By Ana1234 — On May 05, 2013

Gallstones are supposed to be so incredibly painful. There are some pictures you can see online of gallbladders that are full of gallstones which really make me cringe. I'm not surprised the pain is so great that it can make a person stop breathing when a doctor is examining them.

Although it seems like the kind of thing that is kind of non-specific, as I would imagine any pain in the stomach would make someone hold their breath in the same way.

By indigomoth — On May 04, 2013

@irontoenail - If they have specifically diagnosed that it is her gallbladder giving her trouble, then I'm sure they have either seen Murphy's sign, or they've given her a scan and seen evidence of other problems.

And it is definitely an option to remove the gallbladder, but, like most major surgeries, it should be considered a last resort. You can live without a gallbladder of course, but it means you have to go on a special diet and I believe some people have to take medication as well. I personally would prefer to have every other option explored before someone removed one of my organs, particularly when it will have long term consequences.

By irontoenail — On May 03, 2013

I have a friend who has had problems with her gallbladder and it is not a very pleasant condition to have. She's had all kinds of pain and trouble with rashes and other symptoms and she's had a lot of difficulty getting a diagnosis as well, since it seems like the symptoms come and go.

I don't know if she's ever been checked for this sign or not, but I do think that she'd be better off if they'd just remove her gallbladder already.

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