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In elderly patients, a positive Murphy's sign is useful, but a negative sign should be treated with caution and other diagnostic tests and promptly. Murphy sign: Sensitivity and Specificity. Postcholecystectomy complications such as leak, abscess, and wound infection are also more common and reflect the underlying multisystemic problems. Login or Sign up to edit.
I have never found, this sign absent in a calculous or infectious case of gall-bladder, or duct disease.I have found the simplest method of eliciting the pressure signs to be this: While the surgeon sits on the edge of the couch, to the right of the patient, the left hand is laid over the lower part of the right side of the patient’s chest, so that the thumb lies along the rib-margin; as a deep breath is taken the thumb is pressed upwards towards the under surface of the liver.The presence of Murphy’s sign has been shown to be both sensitive (97.2%) and highly predictive (93.3%) of a positive hepatobiliary scintigraphy in patients with suspected acute cholecystitis: Murphy’s Sign should be used with caution in elderly patients. The classic physical exam finding is that of No one piece of clinical, physical, or laboratory finding is sufficient to make a diagnosis of acute cholecystitis.Patients with acute cholecystitis typically have epigastric or right upper quadrant abdominal pain lasting longer than 3 hours. Diffuse gallbladder wall thickening in patients without primary gallbladder wall disease occurs in a variety of systemic processes, such as hypoalbuminemia, congestive heart failure, hepatitis, and pancreatitis (We use cookies to help provide and enhance our service and tailor content and ads.
However, in the elderly the sensitivity is markedly lower; a negative Murphy's sign in an elderly person is not useful for ruling out cholecystitis if other tests and the clinical history suggest the diagnosis. In patients with right upper quadrant pain and suspected cholecystitis, the findings that increase the probability of cholecystitis (see The Murphy sign may be less accurate in elderly patients because up to 25% of patients over 60 years of age with cholecystitis lack any abdominal tenderness whatsoever.In patients with a pyogenic liver abscess, the presence of the Murphy sign increases the probability of associated biliary tract sepsis (sensitivity 32%, specificity 88%, positive LR = 2.8, negative LR not significant).In emphysematous cholecystitis, echogenic air bubbles in the gallbladder wall produce reverberation artifact. The signs and symptoms of an acute abdomen in older patients are not as classic or specific (which may explain the differences in sensitivity and specificity).
In elderly patients, a positive Murphy's sign is useful, but a negative sign should be treated with caution and other diagnostic tests and promptly. Murphy sign: Sensitivity and Specificity. Postcholecystectomy complications such as leak, abscess, and wound infection are also more common and reflect the underlying multisystemic problems. Login or Sign up to edit.
I have never found, this sign absent in a calculous or infectious case of gall-bladder, or duct disease.I have found the simplest method of eliciting the pressure signs to be this: While the surgeon sits on the edge of the couch, to the right of the patient, the left hand is laid over the lower part of the right side of the patient’s chest, so that the thumb lies along the rib-margin; as a deep breath is taken the thumb is pressed upwards towards the under surface of the liver.The presence of Murphy’s sign has been shown to be both sensitive (97.2%) and highly predictive (93.3%) of a positive hepatobiliary scintigraphy in patients with suspected acute cholecystitis: Murphy’s Sign should be used with caution in elderly patients. The classic physical exam finding is that of No one piece of clinical, physical, or laboratory finding is sufficient to make a diagnosis of acute cholecystitis.Patients with acute cholecystitis typically have epigastric or right upper quadrant abdominal pain lasting longer than 3 hours. Diffuse gallbladder wall thickening in patients without primary gallbladder wall disease occurs in a variety of systemic processes, such as hypoalbuminemia, congestive heart failure, hepatitis, and pancreatitis (We use cookies to help provide and enhance our service and tailor content and ads.
However, in the elderly the sensitivity is markedly lower; a negative Murphy's sign in an elderly person is not useful for ruling out cholecystitis if other tests and the clinical history suggest the diagnosis. In patients with right upper quadrant pain and suspected cholecystitis, the findings that increase the probability of cholecystitis (see The Murphy sign may be less accurate in elderly patients because up to 25% of patients over 60 years of age with cholecystitis lack any abdominal tenderness whatsoever.In patients with a pyogenic liver abscess, the presence of the Murphy sign increases the probability of associated biliary tract sepsis (sensitivity 32%, specificity 88%, positive LR = 2.8, negative LR not significant).In emphysematous cholecystitis, echogenic air bubbles in the gallbladder wall produce reverberation artifact. The signs and symptoms of an acute abdomen in older patients are not as classic or specific (which may explain the differences in sensitivity and specificity).