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What Is the Utility of the Murphy’s Sign and Does It Change with Pain Medication?

  • Yiju Teresa LiuEmail author
Chapter

Abstract

Murphy’s sign occurs when a patient feels pain as the right upper quadrant is palpated under the costal margin during inspiration, resulting in inspiratory arrest. This maneuver is supposed to compress the gallbladder, and, thus, pain would suggest acute inflammation of the gallbladder. A positive Murphy’s sign increases the likelihood that the patient has cholecystitis, and a negative Murphy’s sign makes it less likely, but the finding lacks the sensitivity and specificity to rule in or rule out acute cholecystitis. The sonographic Murphy’s sign occurs when pain is caused by compression of the gallbladder under sonographic visualization. It is more accurate than a simple Murphy’s sign for diagnosing cholecystitis. Neither Murphy’s sign is affected by analgesic administration.

Keywords

Acute cholecystitis Sonographic Murphy’s sign Murphy’s sign Physical examination 

References

  1. 1.
    Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003;289(1):80–6.CrossRefGoogle Scholar
  2. 2.
    Avegno J, Carlisle M. Evaluating the patient with right upper quadrant abdominal pain. Emerg Med Clin. 2016;34(2):211–28.CrossRefGoogle Scholar
  3. 3.
    Ralls PW, Colletti PM, Lapin SA, Chandrasoma PA, Boswell WD Jr, Ngo C, Radin DR, Halls JM. Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs. Radiology. 1985;155(3):767–71.CrossRefGoogle Scholar
  4. 4.
    Singer AJ, McCracken G, Henry MC, Thode HC, Cabahug CJ. Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis. Ann Emerg Med. 1996;28(3):267–72.CrossRefGoogle Scholar
  5. 5.
    Jain A, Mehta N, Secko M, Schechter J, Papanagnou D, Pandya S, Sinert R. History, physical examination, laboratory testing, and emergency department ultrasonography for the diagnosis of acute cholecystitis. Acad Emerg Med. 2017;24(3):281–97.CrossRefGoogle Scholar
  6. 6.
    Adedeji OA, McAdam WA. Murphy’s sign, acute cholecystitis and elderly people. J R Coll Surg Edinb. 1996;41(2):88–9.PubMedGoogle Scholar
  7. 7.
    Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):35–46.CrossRefGoogle Scholar
  8. 8.
    Bennett GL. Evaluating patients with right upper quadrant pain. Radiol Clin N Am. 2015;53(6):1093–130.CrossRefGoogle Scholar
  9. 9.
    Bree RL. Further observations on the usefulness of the sonographic Murphy sign in the evaluation of suspected acute cholecystitis. J Clin Ultrasound. 1995;23(3):169–72.CrossRefGoogle Scholar
  10. 10.
    Ralls PW, Halls J, Lapin SA, Quinn MF, Morris UL, Boswell W. Prospective evaluation of the sonographic Murphy sign in suspected acute cholecystitis. J Clin Ultrasound. 1982;10(3):113–5.CrossRefGoogle Scholar
  11. 11.
    Attard AR, Corlett MJ, Kidner NJ, Leslie AP, Fraser IA. Safety of early pain relief for acute abdominal pain. BMJ. 1992;305(6853):554–6.CrossRefGoogle Scholar
  12. 12.
    Thomas SH, Silen W, Cheema F, Reisner A, Aman S, Goldstein JN, Kumar AM, Stair TO. Effects of morphine analgesia on diagnostic accuracy in emergency department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg. 2003;196(1):18–31.CrossRefGoogle Scholar
  13. 13.
    Nelson BP, Senecal EL, Hong C, Ptak T, Thomas SH. Opioid analgesia and assessment of the sonographic Murphy sign. J Emerg Med. 2005;28(4):409–13.CrossRefGoogle Scholar
  14. 14.
    Noble VE, Liteplo AS, Nelson BP, Thomas SH. The impact of analgesia on the diagnostic accuracy of the sonographic Murphy’s sign. Eur J Emerg Med. 2010;17(2):80–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLATorranceUSA

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