What a positive Murphy's sign indicates: gallbladder inflammation (cholecystitis) during abdominal assessment

Outline:

• Hook and context: Murphy’s sign as a quick clue in abdominal exams

• What Murphy’s sign is and how it’s checked

• Interpreting a positive sign: cholecystitis and gallbladder inflammation

• How this fits with other abdominal conditions

• A quick look at real-world patients’ experiences

• Practical takeaways for students and clinicians

• A brief caveat about limits and other clues

• Closing thought: the value of a careful touch and careful listening

Murphy’s sign: a simple clue in a complex area

Let’s start with a straightforward idea: the abdomen isn’t a blank canvas. It’s a map of the body’s inner workings, and a skilled clinician reads it with hands as much as eyes. One small, powerful cue in that reading is Murphy’s sign. When a clinician suspects gallbladder trouble, this sign often helps steer the way. It’s not a diagnosis on its own, but it’s a classic signal that something in the gallbladder region may be irritated or inflamed.

What exactly is Murphy’s sign, and how is it tested?

Here’s the thing, in plain terms. During an abdominal assessment, the clinician gently presses under the right costal margin—the area just below the right rib cage where the gallbladder tends to sit. Then the patient is asked to take a deep breath. If the gallbladder is inflamed or irritated, pressing there while the patient inhales can trigger pain and cause the patient to stop inhaling mid-breath. That interruption is what we call a “positive Murphy’s sign.”

Why does this happen? The gallbladder sits in a tight space near the liver. If gallstones block the cystic duct or if the gland is inflamed for another reason, touching that area during a deep breath can provoke pain. The breath-hold isn’t dramatic; it’s a simple, real-life reaction your body has when something isn’t happy inside the right upper quadrant.

A positive Murphy’s sign and what it suggests

When Murphy’s sign comes up positive, the most common association is cholecystitis — gallbladder inflammation. It often stems from gallstones getting stuck in the cystic duct, which leads to irritation, swelling, and pain. That chain of events makes the gallbladder cranky and tender, especially when the area is touched during inspiration.

But a positive Murphy’s sign isn’t a one-trick pony. It’s a clue. In the real world, clinicians look at the whole picture: the patient’s pain characteristics, location, and timing; accompanying symptoms like fever, nausea, or vomiting; and other exam findings. A few other abdominal conditions can share some features, so the sign helps along with others, not in isolation. For example:

• Pancreatitis can cause upper abdominal pain and tenderness, but the location and the nature of the pain usually differ, and lab tests help separate it.

• Appendicitis typically starts around the navel and migrates to the lower right quadrant, with specific signs tied to that region.

• Diverticulitis tends to involve the lower left quadrant with localized tenderness and changes in bowel habits.

So, a positive Murphy’s sign tips the clinician toward gallbladder territory, but it isn’t a stand-alone verdict.

What the sign looks like in practice (and what it means to patients)

For patients, the experience behind Murphy’s sign is all about discomfort in a familiar, if not pleasant, spot. If you’ve ever had a “stomach ache” that felt unusually sharp right under the ribs on the right side, you might get a sense of the moment. When a clinician presses gently and asks you to take a deep breath, you’re effectively telling your body, “Let’s see how the gallbladder responds.” If it’s inflamed, the breath becomes less smooth and more of a defensive cue—you wince, you pause, you may shift away from the touch.

From the clinician’s seat, the value lies in how reliably and quickly this sign can be elicited. It’s part of a broader toolkit:

• Observation: looking for color changes, guarding, or rigidity in the abdomen.

• Palpation: assessing superficial tenderness versus deep tenderness.

• Special maneuvers: other signs that point toward gallbladder issues, like right upper quadrant tenderness or referred symptoms.

• History: asking about meals, especially fatty foods that can aggravate gallbladder symptoms.

• Labs and imaging: ultrasound is a go-to test for gallbladder inflammation; labs may show signs of infection or pancreatic involvement if the clinical picture is mixed.

A gentle, practical note about accuracy

No single sign gets you to a diagnosis with 100% certainty. A positive Murphy’s sign has good face validity for cholecystitis, but a thoughtful clinician will consider the whole patient and sometimes order imaging or labs to confirm. And there are caveats. For instance, in patients who are very tense, obese, or who guard the abdomen out of fear or discomfort, the sign can be less reliable. That doesn’t mean the sign is useless; it just means it’s one piece of the puzzle.

A quick tour of the broader context

If you’re studying or working in a setting that uses physical assessment as a first line of evaluation, Murphy’s sign is a neat example of how anatomy and symptom interpretation come together. You’re not just memorizing an effect; you’re learning to connect:

• Anatomy: the gallbladder sits under the liver, tucked near the cystic duct.

• Pathophysiology: gallstones can block drainage, inflaming the gallbladder.

• Clinical reasoning: the sign, in tandem with patient history and other findings, helps narrow down the most likely scenario.

• Patient communication: explaining what you’re doing and why, and listening to the patient’s experience, builds trust.

A few practical takeaways for students and clinicians

• Remember the location and motion: right subcostal area, with the patient encouraged to take a deep breath. Pain that causes an abrupt stop in inspiration signals a positive sign.

• Think “gallbladder” first, but verify with the rest of the clinical picture. Consider pairing Murphy’s sign with other RUQ findings to strengthen your impression.

• Keep a mental list of mimics. Pancreatitis, appendicitis, and diverticulitis each have telltale patterns; the sign helps point in the right direction but doesn’t replace a full assessment.

• Use it as a teaching moment. If you’re guiding someone else through the exam, describe what you’re feeling and why it matters. It makes the learning tangible.

• Tie the finding to patient experience. Acknowledge what the patient is feeling, validate their discomfort, and explain the next steps in plain terms.

Real-world caveats worth knowing

No test is perfect. In some patients, the sign might be less clear due to body habitus, acute pain limiting participation, or concurrent conditions that mask local tenderness. In rare cases, other inflammatory processes in the upper abdomen can produce similar reactions, though the classic right upper quadrant focus narrows the field. That’s why a comprehensive assessment—history, exam, imaging, and labs—tends to paint the clearer picture.

A little context helps: why cholecystitis shows up this way

Cholecystitis isn’t just a random event. It usually starts with gallstones that block the cystic duct. That blockage prevents bile from leaving the gallbladder, causing pressure, irritation, and swelling. The result is a localized, sharp pain that a careful touch can provoke during breathing. If you’ve ever watched someone respond to a sore spot by tensing up your shoulders in sympathy, you’ve felt a hint of what the body is doing here—an instinctive defense mechanism to protect the inflamed organ.

Bringing it all together

Murphy’s sign is a small but meaningful part of the abdominal assessment toolkit. It’s simple to perform, easy to remember, and highly practical in real-world care. When positive, it nudges clinicians toward gallbladder inflammation—most often cholecystitis brought on by gallstones. It’s not a final verdict on its own, but it’s a reliable and teachable cue that helps frame the patient’s story.

If you’re exploring the anatomy and clinical reasoning behind abdominal pain, Murphy’s sign is a helpful anchor. Paired with patient history, careful palpation, and, when needed, imaging and labs, it supports a thoughtful approach to care. And that’s the heart of good clinical practice: listening to the patient, tracing the line from symptom to sign, and using each clue to guide the next step with clarity and care.

A quick recap for easy recall

• Murphy’s sign is tested by palpating under the right rib cage while the patient takes a deep breath.

• A positive sign suggests gallbladder irritation or inflammation, often due to cholecystitis from gallstones blocking the cystic duct.

• It’s most informative when considered alongside other findings and tests.

• Not all patients will show a clear sign; clinical judgment and additional diagnostics remain essential.

• The sign connects anatomy (gallbladder location) with physiology (inflammation and pain during inspiration), a neat demonstration of how the body speaks through symptoms.

If you’re studying topics related to abdominal assessment, keep Murphy’s sign in your mental toolkit. It’s one of those cues that, with a little practice, becomes as natural as greeting a patient and listening for the story their body is telling.