Interpretasi Tanda Murphy Positif dalam Diagnosis Kolesistitis Akut

The diagnosis of acute cholecystitis, an inflammation of the gallbladder, often relies on a combination of clinical presentation, imaging studies, and laboratory tests. Among these, the Murphy's sign, a physical examination maneuver, plays a crucial role in supporting the diagnosis. This sign, characterized by a sharp pain elicited upon palpation of the right upper quadrant of the abdomen, is considered a highly suggestive indicator of acute cholecystitis. However, it's important to understand that a positive Murphy's sign is not always indicative of the condition, and other factors must be considered for a definitive diagnosis. This article delves into the interpretation of a positive Murphy's sign in the context of acute cholecystitis, exploring its significance, limitations, and the need for a comprehensive approach to diagnosis.

The Significance of a Positive Murphy's Sign

A positive Murphy's sign, characterized by the patient experiencing sharp pain upon palpation of the right upper quadrant of the abdomen, is a strong indicator of acute cholecystitis. This pain arises from the inflamed gallbladder being compressed during palpation, triggering a sharp, localized pain response. The presence of this sign, when combined with other clinical symptoms like fever, nausea, and vomiting, significantly increases the likelihood of acute cholecystitis. The sensitivity of Murphy's sign in diagnosing acute cholecystitis is reported to be around 70%, meaning that it is present in approximately 70% of patients with the condition. This high sensitivity makes it a valuable tool for initial assessment and suspicion of acute cholecystitis.

Limitations of Murphy's Sign

While a positive Murphy's sign is a strong indicator of acute cholecystitis, it's crucial to acknowledge its limitations. The sign is not specific to acute cholecystitis, and other conditions can also elicit a similar response. For instance, patients with right upper quadrant pain due to other causes, such as hepatitis, pancreatitis, or even a perforated peptic ulcer, may also exhibit a positive Murphy's sign. Additionally, some patients with acute cholecystitis may not exhibit a positive Murphy's sign, particularly those with less severe inflammation or those who are unable to tolerate palpation due to pain.

The Need for a Comprehensive Approach

The interpretation of a positive Murphy's sign in the context of acute cholecystitis requires a comprehensive approach that considers other clinical factors and diagnostic tools. A thorough medical history, including the patient's symptoms, duration of pain, and any previous episodes of similar pain, is essential. A physical examination, including assessment of vital signs, abdominal tenderness, and other signs of inflammation, provides further insights. Imaging studies, such as ultrasound or CT scan, are crucial for visualizing the gallbladder and identifying any signs of inflammation, stones, or other abnormalities. Laboratory tests, including blood tests to assess liver function and inflammatory markers, can further support the diagnosis.

Conclusion

A positive Murphy's sign is a valuable tool in the initial assessment of acute cholecystitis, but it should not be considered a definitive diagnosis. The interpretation of this sign requires a comprehensive approach that considers other clinical factors, imaging studies, and laboratory tests. A thorough evaluation, including a detailed medical history, physical examination, and appropriate diagnostic investigations, is essential for accurate diagnosis and management of acute cholecystitis.