Examination: Murphy’s Sign

The patient may be flushed, jaundiced, dehydrated, tachycardic and hypotensive, all depending on the stage of gall stone disease continuum. They may have epigastric and/or RUQ tenderness, or diffuse abdominal tenderness (more likely to be gall stone pancreatitis).

Murphy’s sign is demonstrated by asking the patient to inspire while the examiner palpates deeply in the right subcostal region. A sharp increase in pain is felt as the inflamed gall bladder touches the examiner’s hand: this can cause inspiratory arrest.

Isolated rebound tenderness in the RUQ reflects localised peritoneal irritation secondary to leakage of inflammatory fluid (acute cholecystitis) or gall bladder contents (gall bladder perforation contained locally within the omentum). Generalised rigidity and peritonism is rare and reflects leakage of gall bladder contents from a gall bladder rupture into the peritoneal cavity.

There may be a reduction in bowel sounds and distension due to a secondary ileus.

Learning Bite

Murphy’s sign is about 97% sensitive for acute cholecystitis.