What is a positive Murphy's sign

A positive Murphy's sign is a common method used by doctors to examine cholecystitis. When a patient has a positive Murphy's sign, it means that the patient may have acute cholecystitis. At this time, the doctor can put the patient's right rib with the palm of his left hand, and then put the thumb of his left hand on the gallbladder. Use the thumb to press the intestinal wall with moderate force. The patient then takes a deep breath. When taking a deep breath, the inflamed gallbladder often causes increased pain. The patient will suddenly hold his breath because of the pain. This is gallbladder pain, which is the manifestation of a positive Murphy's sign. This is also a common method for diagnosing cholecystitis. It can be said to be very simple and easy to operate, and it also reflects the patient's symptoms more intuitively.

reason

Generally speaking, a positive Murphy's sign indicates a problem with the gallbladder, especially acute cholecystitis (stones and non-stones), because the inflammation spreads to the area around the gallbladder and peritoneum. There are local peritoneal irritation signs, weakened and limited abdominal breathing, tenderness in the right upper abdomen or under the xiphoid process, tense abdominal muscles, or rebound pain, which is more obvious in the gallbladder area.

Sometimes, about 1/3 to 1/2 of the patients can feel an enlarged and tender gallbladder, and Murphy's sign is positive. That is, when palpating the gallbladder area under the right costal margin, the patient is asked to take a deep breath until the gallbladder is touched and the patient stops breathing because of pain. Those with a history of recurrent attacks may not be able to feel the gallbladder, but often have an enlarged liver and occasionally an enlarged spleen. If gallbladder perforation occurs, there may be signs of diffuse peritonitis. One-third of patients developed mild jaundice.

Clinical manifestations

About 85% of patients with acute cholecystitis experience paroxysmal colic in the middle and right upper abdomen and radiating pain in the right subscapular area in the early stages of the disease. It is often accompanied by nausea and vomiting, and a positive Murphy's sign.

The fever is generally between 38 and 39 degrees Celsius, without chills. 10 to 15 patients may have mild jaundice. Physical examination revealed tenderness and muscle tension in the right upper abdomen. Murphy's sign was positive. In about 40% of patients, an enlarged and tender gallbladder can be felt in the middle and right upper abdomen.

The white blood cell count is often slightly elevated, generally between 10,000 and 15,000/mm3. If the lesion develops into gallbladder gangrene and perforation and leads to bile peritonitis, the systemic infection symptoms may be significantly aggravated, and chills, high fever, increased pulse and a significant increase in white blood cell count (generally exceeding 20,000/mm3) may occur. At this time, local signs include right upper abdominal tenderness and muscle tension, which expands in range and becomes more severe.

Generally, acute cholecystitis rarely affects liver function, or only shows mild symptoms of liver damage, such as slightly increased serum bilirubin and alanine aminotransferase levels. The clinical manifestations of acalculous cholecystitis are similar to those of calculous cholecystitis but are often atypical.