Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area.
If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
The presence of Murphy’s sign has been shown to be both sensitive (97.2%) and highly predictive (93.3%) of a positive hepatobiliary scintigraphy in patients with suspected acute cholecystitis: Singer AJ. Ann Emerg Med. 1996
Murphy’s Sign should be used with caution in elderly patients. A positive sign is useful, however a negative sign is not reliable to rule out acute cholecystitis and further diagnostic tests should be instigated.
- The diagnostic accuracy for acute cholecystitis was 80% dropping to 34% when the sign was negative.
- The positive predictive value of the test in elderly people was 0.58, with a sensitivity of 0.48 and a specificity of 0.79: Adedeji OA. J R Coll Surg Edinb. 1996
- John Benjamin Murphy (1857 – 1916)
- Murphy’s Sign
- Schmitz, RL. Oh, TT. The Remarkable Surgical Practice of John Benjamin Murphy. University of Illinois Press; 1st edition (February 1, 1993)
- Musana, K. John Benjamin Murphy (1857 – 1916). Clin Med Res. 2005 May; 3(2): 110–112. [PMC 1183442]
- Singer AJ, McCracken G, Henry MC, Thode HC Jr, Cabahug CJ. Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis. Ann Emerg Med. 1996 Sep;28(3):267-72. [PMID 8780468]
- Adedeji OA, McAdam WA. Murphy’s sign, acute cholecystitis and elderly people. J R Coll Surg Edinb. 1996;41(2):88. [PMID 8632396]
- Murphy, JB. Early treatment of perityphlitis. West Med Rep 1889;11:282–291
- Murphy, JB. Operative surgery of the gall tracts with original report of twenty successful cholecystenterostomies by means of the anastomosis button. 1894
- Murphy, JB. Appendicitis : with original report and analysis of one hundred and forty-one histories and laparotomies for that disease under personal observation. 1895
- Murphy, JB. Surgical clinic and demonstration. 1895
- Murphy, JB. Cholelithiasis. The Surgical Clinics of John B. Murphy, 1912; i(3) 417-428