Murphy's sign

In medicine, Murphy's sign refers to a physical examination maneuver that is part of the abdominal examination and a finding elicited in ultrasonography. It is useful for differentiating right upper quadrant abdominal pain. Typically, it is positive in cholecystitis, but negative in choledocholithiasis and ascending cholangitis.

Murphy's sign has a high sensitivity and Positive Predictive Value. However, specificity is of moderate value. Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis. however, should be interpreted with more caution in the elderly.

Murphy's sign in the physical examination
Classically, 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 inspire (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) the test is considered positive. A positive test also requires no pain on performing the manoeuvre on the patient's left hand side..

Sonographic Murphy's sign
The sonographic Murphy's sign is similar to the physical examination maneuver, but performed with ultrasound guidance and ensures proper positioning over the gallbladder.

History
The sign is named for the American physician John Benjamin Murphy (1857-1916) who described it.