In medicine, Murphy’s sign is a test used during an abdominal assessment which may be used to differentiate between a diagnosis of cholycystitis, pyelonephritis, and ascending cholangitis.
To assess the abdomen for Murphy’s sign:
- Lie the patient supine (as you would during any other abdominal assessment);
- Instruct the patient to breath out;
- Place your palpating hand just below the costal margin, approximately mid-clavicularly (this is just above the gallbladder);
-Then instruct the patient to slowly breath in;
A positive Murphy’s sign is identified when the patient stops breathing in due to pain -- this is caused by the move of the diaphragm pushing the inflamed gallbladder into the palpating hand.
A negative Murphy’s sign is identified when the patient comfortable breaths all the way in without any pain -- in this case, the diaphragm pushes the non-inflamed gallbladder into the palpating hand with nil changes in the patient’s level of comfort.
A positive Murphy’s sign often indicates Cholycystitis, where as a negative Murphy’s sign may suggest pyelonephritis, and ascending cholangitis.
Here is a video of someone assessing for a Murphy’s Sign:
Some confusions when performing a Murphy’s Test of the Abdominal Region may include:
- The patient may have pain on inspiration to both L and R sides of the Costal Margin. Always test bilaterally!
- If the examiner’s fingers are incorrectly placed the Murphy’s Test will not accurately indicate anything.