Murphy sign

[ManUtdForever]

How could I distinguish whether patient is having cholescystitis and other liver diseases eg cirrhosis of Murphy's sign is postive? Isnt the technique to perform Murphy's sign similar to liver palpation?

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[willen101383]

How could I distinguish whether patient is having cholescystitis and other liver diseases eg cirrhosis of Murphy's sign is postive? Isnt the technique to perform Murphy's sign similar to liver palpation?

I doubt any premeds would know.

Yes its similar. Murphys sign shouldnt be positive in cirrhosis.

 

[ManUtdForever]

I doubt any premeds would know.

Yes its similar. Murphys sign shouldnt be positive in cirrhosis.

But well i think nowadays doctors can depend on various ways of examinations eg CT scan to confirm any pathologies

 

[QuizzicalApe]

How could I distinguish whether patient is having cholescystitis and other liver diseases eg cirrhosis of Murphy's sign is postive? Isnt the technique to perform Murphy's sign similar to liver palpation?

By getting an ultrasound.

Physical will be mildly helpful, history will be pretty helpful, but the money will be in the visualization on this one.

 

[SLC]

But well i think nowadays doctors can depend on various ways of examinations eg CT scan to confirm any pathologies

Obviously

But don't you think it would be wise to do a competent physical exam before ordering radiological studies? A Murphy's sign to me provides evidence that a CT or ultrasound of the gallbladder is warranted. No ressone ti put somenos through The radiation exposure, and the cost of a CT unless you strongly suspect something, your physical exam helps validate, or refute your suspicions.

 

[QuizzicalApe]

Obviously

But don't you think it would be wise to do a competent physical exam before ordering radiological studies? A Murphy's sign to me provides evidence that a CT or ultrasound of the gallbladder is warranted. No ressone ti put somenos through The radiation exposure, and the cost of a CT unless you strongly suspect something, your physical exam helps validate, or refute your suspicions.

why is everyone trying to get a CT for this

 

[Bacchus]

Agreed, suspicion of gall bladder disease is 1st tested with ultrasound as is choledocholithiasis. If there's an issue if its ascending cholangitis then a CT can be ordered.

 

[HipChick]

why is everyone trying to get a CT for this

CTs are all the new rage for this. almost every doc I've seen orders one instead of an US.

 

[QuizzicalApe]

CTs are all the new rage for this. almost every doc I've seen orders one instead of an US.

as an initial test or when the US is unhelpful? as an initial test it is pretty irresponsible unless the US folks at the hospital are known to be actively trying to sabotage patient care

 

[HipChick]

as an initial test or when the US is unhelpful? as an initial test it is pretty irresponsible unless the US folks at the hospital are known to be actively trying to sabotage patient care

Initial... yeah I know... I've only seen it for acute cholescystitis cases. Haven't really figured out why the difference. Man-power? IDK... I never really asked. But I will if i see it again. I know I was sent right for a CT also.

 

[SpecterGT260]

im just gunna throw in that I love Murphy's sign. You just know some salty old attending named murphy was watching a resident do an ultrasound while looking for something that might cause pain and the guy just says "You dont know if that hurts? well... jab it in there!".
similar to the bed bump for peritonitis

 

[willen101383]

im just gunna throw in that I love Murphy's sign. You just know some salty old attending named murphy was watching a resident do an ultrasound while looking for something that might cause pain and the guy just says "You dont know if that hurts? well... jab it in there!".
similar to the bed bump for peritonitis

Or the dreaded chandelier sigh

 

[Bacchus]

"She hits the ceiling!"

 

[SpecterGT260]

ew

 

[willen101383]

"She hits the ceiling!"

 

[HipChick]

im just gunna throw in that I love Murphy's sign. You just know some salty old attending named murphy was watching a resident do an ultrasound while looking for something that might cause pain and the guy just says "You dont know if that hurts? well... jab it in there!".
similar to the bed bump for peritonitis

Giggle, snort

 

[ManUtdForever]

Well...after checking various videos and wiki...this is my conclusion
" Murphy's sign is positive when the pain is only in the right side and the patient stops suddenly to inspire due to the pain. Pain in both sides possibly points to disorders in abdominal muscles. In Bates is stated the below: liver tenderness may be also increased by this maneuver, but usually is less well localised." So in a conclusion, i think if we got a positive Murphy's sign, we should suspect cholecystitis but not confirming the diagnosis until an ultrasound is done. Plus patient's clinical signs may also tell us whether this patient has possibly liver disease or cholecystitis like spider angioma, dilated abdominal veins and etc