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. 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. Source
