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Likelihood Ratio (LR) in Emergency Medicine

4/15/2012

Does Murphy’s sign and sonographic Murphy sign have the same clinical utility?

A 40 yo woman presented to the ED with upper quadrant pain since three hours after eating a tasty pizza. She is overweight, she presents feverish (38°C) her skin is nonicteric. The abdomen is soft, there is tenderness on the upper right quadrant, you perform a deep palpation in the subcostal area, and the patient stops breathing for pain. 




Is Murphy’s sign useful to make diagnosis of cholecystitis? What about the sonographic Murphy’s sign?









Conclusion 

Sonographic Murphy sign is positive when you elicit pain pushing the trasnducer just over the gallbladder; despite this has more accuracy than clinical Murphy’s sign, cholecystitis remains a clinical diagnosis and not a sonographic one, it is achieved through a combination of history, physical examination, laboratory and radiologic testing. Murphy’s sign as any other single clinical finding has not sufficient weight to rule in or rule out this condition alone, the presence of Murphy US sign, dilatation, wall tickness and perycholecistic fluid can give a great contribute.


Bibliography 

ED ultrasound in hepatobiliary disease
J Emerg Med vol 30 n1 pag 69-74 2006
AH Miller et al.

Acute calculous cholecystitis
N Engl J Med June 26, 2008
SM Strasberg et al. 

Does this patient have acute cholecystitis?
Jama Vol 289 N 1 2003
RL Trowbridge et al. 

Ciro Paolillo




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