Murphy sign !

Sign

Pressing below the right ribs while the patient breathes in deeply makes the pain cut the breath short: it suggests an inflamed gallbladder.

Updated 2026-11-01

See it in 3D: Gallbladder · Liver · Diaphragm · Rectus abdominis · Costal cartilages

What it is

Murphy sign is the sudden halt of inspiration from pain when the examiner keeps the fingers under the right costal margin at the midclavicular line and the patient takes a deep breath. It happens because the diaphragm pushes the inflamed gallbladder down onto the hand. It is the classic sign of acute cholecystitis: very sensitive in younger adults, but not very specific and less reliable in older adults.

The anatomy it tests

The gallbladder fundus projects onto the front wall where the lateral border of the right rectus crosses the costal margin (tip of the ninth costal cartilage), at the midclavicular line.
On inspiration the diaphragm descends and pushes the liver and gallbladder down onto the examiner's fingers.
The inflamed gallbladder irritates the peritoneum over it; the sudden contact causes somatic pain and the reflex stops inspiration.

How to elicit it

Patient supine with knees flexed to relax the wall; the examiner on the right.
Find the gallbladder point: where the lateral border of the right rectus crosses the costal margin, at the midclavicular line.
Ask the patient to breathe all the way out.
Place the fingertips of the right hand under the costal margin at that point, pressing firmly and steadily up and in.
Keep the pressure and ask the patient to breathe in deeply and slowly.
Watch whether inspiration stops suddenly with pain, and watch the face.
Repeat on the left as a control: it should be painless.

What a positive result means

Positive: an abrupt halt of inspiration with pain in the right hypochondrium.
Suggests acute cholecystitis, nearly always from gallstones; it can also occur in cholangitis and in hepatitis or liver abscess with capsular pain.
Sonographic Murphy sign: maximal pain when the probe presses over the visualized gallbladder; strongly supports cholecystitis.
A negative sign does not rule out cholecystitis, especially in older adults, people with diabetes or after strong analgesia, nor in gangrenous cholecystitis with a necrotic wall.

Usefulness and limits

In words: high sensitivity and low specificity; it is more useful together with fever, a raised white count and ultrasound.
Lower sensitivity in older adults: do not use it alone to rule out the diagnosis.
Abdominal ultrasound is the first test when cholecystitis is suspected.

Test yourself

Think of the answer, then tap the question to see it.

Where do you place your fingers to test for Murphy sign?

Under the right costal margin at the midclavicular line, where the lateral border of the rectus crosses the costal margin.

What defines a positive Murphy sign?

An abrupt halt of deep inspiration from pain while pressure is kept under the right costal margin.

Why does a negative Murphy sign not rule out cholecystitis in an older adult?

Its sensitivity falls with age; pain may be milder, so diagnosis relies on ultrasound and the overall picture.

What is the sonographic Murphy sign?

Maximal tenderness when the ultrasound probe presses directly over the visualized gallbladder; it supports acute cholecystitis.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Acute Cholecystitis - Hepatology - Merck Manual Professional Edition (Merck & Co., Inc., 2025); Murphy's sign (Wikipedia, 2026).

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Representative model, for educational purposes only.