Which of the following symptoms best describes Murphy’s sign?
A. Periumbilical ecchymosis exists.
B. On deep palpation and release, pain elicited.
C. On deep inspiration, pain is elicited and breathing stops.
D. Abdominal muscles are tightened in anticipation of palpation.
Correct Answer: C. On deep inspiration, pain is elicited and breathing stops.
Murphy’s sign is elicited when the client reacts to pain and stops breathing. It’s a common finding in clients with cholecystitis. Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
Option A: Periumbilical ecchymosis, Cullen’s sign, is present in peritonitis. Cullen sign manifests as superficial edema with bruising in the subcutaneous fatty tissue around the periumbilical region. Originally described in association with ectopic pregnancy.
Option B: Pain on deep palpation and release is rebound tenderness. Blumberg’s sign (also referred to as rebound tenderness or the Shyotkin-Blumberg sign) is a clinical sign in which there is pain upon removal of pressure rather than the application of pressure to the abdomen. (The latter is referred to simply as abdominal tenderness.) It is indicative of peritonitis.
Option D: Tightening up abdominal muscles in anticipation of palpation is guarding. Investigations of relationships of specific pain behaviors with pain intensity and fear of movement are rare. Guarding, defined as “behavior that is aimed at preventing or alleviating pain” and which includes stiffness, hesitation, and bracing, has been shown to predict work loss over 3 months in injured workers.
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