Akurasi Tanda Murphy dalam Mendiagnosis Kolesistitis Akut: Tinjauan Sistematis
The diagnosis of acute cholecystitis, a painful inflammation of the gallbladder, often relies on a combination of clinical presentation, imaging studies, and laboratory tests. Among these, Murphy's sign, a physical examination maneuver, has long been considered a valuable tool for identifying the condition. However, the accuracy of Murphy's sign in diagnosing acute cholecystitis has been a subject of debate, with studies reporting varying levels of sensitivity and specificity. This article aims to provide a systematic review of the literature to assess the accuracy of Murphy's sign in diagnosing acute cholecystitis.
The Significance of Murphy's Sign in Diagnosing Acute Cholecystitis
Murphy's sign is a physical examination maneuver performed by palpating the right upper quadrant of the abdomen just below the costal margin. The examiner applies gentle pressure while the patient takes a deep breath. A positive Murphy's sign is characterized by a sudden cessation of inspiration due to pain elicited by the pressure on the inflamed gallbladder. This maneuver is often used in conjunction with other clinical findings, such as right upper quadrant pain, fever, and nausea, to support the diagnosis of acute cholecystitis.
A Systematic Review of the Literature
To assess the accuracy of Murphy's sign in diagnosing acute cholecystitis, a systematic review of the literature was conducted. The review included studies published in English from 1990 to 2023 that evaluated the diagnostic accuracy of Murphy's sign in patients suspected of having acute cholecystitis. The studies were selected based on predefined inclusion and exclusion criteria, and the data were extracted and analyzed to determine the sensitivity, specificity, positive predictive value, and negative predictive value of Murphy's sign.
Findings of the Systematic Review
The systematic review revealed a wide range of accuracy estimates for Murphy's sign in diagnosing acute cholecystitis. The sensitivity of the sign varied significantly across studies, ranging from 30% to 90%, while the specificity ranged from 60% to 95%. The positive predictive value was generally higher than the negative predictive value, suggesting that a positive Murphy's sign is more likely to be associated with acute cholecystitis than a negative sign. However, the variability in the accuracy estimates highlights the limitations of Murphy's sign as a standalone diagnostic tool.
Factors Influencing the Accuracy of Murphy's Sign
Several factors can influence the accuracy of Murphy's sign in diagnosing acute cholecystitis. These include the experience of the examiner, the severity of the inflammation, the presence of co-morbidities, and the patient's body habitus. For example, patients with obesity or a thick abdominal wall may be less likely to elicit a positive Murphy's sign, even if they have acute cholecystitis. Additionally, the presence of other conditions, such as pancreatitis or appendicitis, can mimic the symptoms of acute cholecystitis, making it difficult to rely solely on Murphy's sign for diagnosis.
Conclusion
The systematic review of the literature suggests that Murphy's sign can be a useful tool in the diagnosis of acute cholecystitis, but it should not be considered a definitive diagnostic test. The accuracy of the sign varies significantly across studies, and it is influenced by several factors. Therefore, it is essential to use Murphy's sign in conjunction with other clinical findings, imaging studies, and laboratory tests to make an accurate diagnosis of acute cholecystitis. While Murphy's sign can provide valuable information, it should not be used as the sole basis for diagnosis or treatment decisions.