Question: Gastrointestinal System
A 45-year-old woman comes to the emergency department because of a 1-day history of fever and constant right upper quadrant abdominal pain. She has had several previous episodes of similar pain after eating fatty meals that resolved on their own. Her temperature is 38.4°C (101.1°F). When the examiner presses on the right upper quadrant and asks her to take a deep breath, she stops inspiration abruptly because of pain. Which of the following physical examination findings is being described?
| Temperature | 38.4 °C |
|---|---|
| WBC | 14,000 /mm3 |
Choose one answer.
Explanation
Correct answer: C. Murphy sign
Arrest of inspiration during deep palpation of the right upper quadrant is a positive Murphy sign, seen in acute cholecystitis when the inflamed gallbladder descends and contacts the examiner's hand. The history of recurrent post-fatty-meal pain reflects biliary colic from gallstones. Cullen sign is periumbilical bruising; McBurney point tenderness and the psoas and Rovsing signs point to appendicitis.
Learning objective: Identify Murphy sign and associate it with acute cholecystitis.
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