Murphy's sign

A physical examination maneuver involving deep palpation of the right subcostal region at the midclavicular line during inspiration; sudden interruption of inspiratory effort due to pain when the inflamed gallbladder contacts the examiner’s hand indicates irritation of the gallbladder and is suggestive of acute cholecystitis.

Causes

• Gallbladder-related causes

  • Acute cholecystitis

  • Chronic cholecystitis with acute exacerbation

  • Cholecystolithiasis

  • Acalculous cholecystitis

• Hepatobiliary causes

  • Hepatitis

  • Cholangitis

  • Biliary obstruction

  • Gallbladder empyema

  • Gallbladder perforation or inflammation

• Other causes

  • Right upper quadrant peritoneal inflammation

  • Subhepatic abscess

  • Peptic ulcer disease with adjacent inflammation

  • Right lower lung pathology causing referred abdominal tenderness