Murphy is a medical term for an examination sign that can indicate irritation or inflammation of the gallbladder. It is checked during a physical examination, known as palpation.
What is behind the term?
The term comes from the American surgeon John Benjamin Murphy. It refers to the Murphy sign, a simple but important tool used to find out whether the gallbladder is inflamed. To check it, the examining person gently presses with their fingers just below the right rib margin while the patient breathes in deeply. If the gallbladder is irritated, this pressure can cause a sudden pain strong enough to make the patient stop breathing in. This stopping of the breath due to pain is called a "positive Murphy sign". It is considered a sign of acute inflammation of the gallbladder, known in medical terms as cholecystitis.
When is the Murphy sign checked?
The Murphy sign is used whenever there are complaints in the upper right abdomen. Typical symptoms include pain, a feeling of pressure, or digestive problems, sometimes also fever or nausea. The examination is straightforward to carry out and gives early clues as to whether inflammation of the gallbladder might be present. It is a standard part of the physical examination, particularly in accident and emergency departments and in GP surgeries.
What does a positive Murphy sign mean?
If the Murphy sign is described as positive, this points towards acute inflammation of the gallbladder. The cause is usually a gallstone that is blocking the flow of bile and thereby triggering inflammation. This situation is not without risk, as the inflammation can spread and even lead to complications such as peritonitis. A positive Murphy sign is therefore a warning signal that leads to further investigations and usually also to prompt treatment.
How does the diagnosis continue?
After a notable Murphy sign, an ultrasound scan of the abdomen usually follows. This can show whether the gallbladder wall is thickened or surrounded by fluid, and whether gallstones are visible. Blood tests are also carried out to detect signs of inflammation. Only the combination of these findings allows a reliable diagnosis to be made. The Murphy sign on its own is therefore an important indicator, but it does not replace further investigations.
What happens with a negative Murphy sign?
If the Murphy sign is negative, that is a good sign. It speaks against acute gallbladder inflammation. However, other causes for the symptoms may still be possible, for example problems with the liver, stomach, or bowel. The doctor will then arrange further investigations to find the exact cause.
Are there any risks or pain during the examination?
Checking the Murphy sign is generally safe. It can, however, be uncomfortable or painful, especially if inflammation is actually present. The pressure is only applied for as long as it takes to establish whether pain occurs or not. After the examination, any pain usually settles quickly.
Different meanings of Murphy in medicine
In the vast majority of cases, Murphy refers to the Murphy sign. Occasionally, the name Murphy may appear in other contexts, for example as the namesake of surgical instruments or procedures. In everyday medical practice, however, it almost always refers to the gallbladder examination sign described above. Which meaning is intended always depends on the context in the doctor's letter or report. It is therefore important to consider the term in the context of the relevant examination.
Why the Murphy sign matters
The Murphy sign helps to identify a dangerous inflammation of the gallbladder at an early stage. It is a simple but very useful tool in diagnosis. Particularly when there are symptoms in the upper right abdomen, it provides valuable clues and can help to prevent serious complications. Anyone who reads a corresponding finding in a doctor's letter will find in it an early indication of the cause of the symptoms. The precise diagnosis and the next steps are then always determined on an individual basis.
