Exam

Murphy Sign

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Murphy Sign

  • Indications
  1. Acute Cholecystitis
  • Technique
  1. Examiner palpates the abdominal RUQ (deep subcostal palpation)
  2. Patient takes a deep breath
  • Interpretation
  1. Positive test if the patient has increased pain or suddenly halts their inspiration due to pain (inspiratory arrest)
  2. Suggests Acute Cholecystitis when present
  • Efficacy
  1. General patients
    1. Positive Likelihood Ratio: 5.0
    2. Negative Likelihood Ratio: 0.4
    3. Test Sensitivity: 65%
    4. Test Specificity: 87%
  2. Older patients
    1. Positive Likelihood Ratio: 2.3
    2. Negative Likelihood Ratio: 0.66
    3. Test Sensitivity: 48%
    4. Test Specificity: 79%
  • References
  1. Trowbridge (2003) JAMA 289(1): 80-6 [PubMed]