A common abdominal examination manoeuvre, but a common understanding is elusive
Most of us think that Murphy’s sign consists of the abrupt interruption of deep inspiration when palpating in the right upper quadrant of the abdomen. Its relevance would seem to be its presence in a non-tender abdomen, but is that so? Canvass your colleagues and you will find that a common understanding is as elusive as the Scarlet Pimpernel. The radiological community’s development of a “sonographic” Murphy’s sign has only added to the confusion.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Murphy JB. The diagnosis of gall-stones. Medical News 1903; 82: 825-833.
- 2. Dowdall GG. Five diagnostic methods of John B. Murphy of Chicago. Arch Diagnosis 1910; 3: 18-21 (reprinted in Surg Clin John B. Murphy 1912; 1: 459-466).
- 3. Aldea PA, Meehan JP, Sternbach G. The acute abdomen and Murphy’s signs. J Emerg Med 1986; 4: 57-63.
- 4. Murphy JB. Cholelithiasis; pericholecystitis; stones in the cystic duct; cholecystectomy. Surg Clin John B. Murphy 1914; 3: 237-245.
- 5. Maingot R. Types of cholecystitis: the management of acute and chronic calculous cholecystitis. In: Maingot R, editor. Abdominal operations. 7th ed. New York: Appleton-Century-Crofts, 1980.
- 6. Strasberg SM. Acute calculous cholecystitis. N Engl J Med 2008; 358: 2804-2811.
- 7. Singer AJ, McCracken G, Henry MC, et al. Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis. Ann Emerg Med 1996; 28: 267-272.
- 8. Adedeji OA, McAdam WA. Murphy’s sign, acute cholecystitis and elderly people. J R Coll Surg Edinb 1996; 41: 88-89.
- 9. Sherman M, Ralls PW, Quinn M, et al. Intravenous cholangiography and sonography in acute cholecystitis: prospective evaluation. AJR 1980; 135: 311-313.
- 10. Ralls PW, Halls J, Lapin SA, et al. Prospective evaluation of the sonographic Murphy sign in suspected acute cholecystitis. J Clin Ultrasound 1982; 10: 113-115.
I thank my colleagues Roy Hopkins and Joel McVey for the demonstration shown in the Box.
No relevant disclosures.
Series editors
Balakrishnan (Kichu) Nair
Simon O’Connor