Expansion
Arrest of inspiration on palpating the right upper quadrant, from an inflamed gallbladder meeting the examining hand
Expansion
The technique: place fingers at the right costal margin in the mid-clavicular line and ask the patient to breathe in. The diaphragm pushes the liver and gallbladder down onto the examining hand. If the gallbladder is inflamed, the patient catches their breath, a positive sign.
The anatomy explains the specificity: the sign requires the inflamed gallbladder to contact the parietal peritoneum of the anterior abdominal wall, which is somatically innervated and therefore precisely localising.
The same manoeuvre performed on the left should be painless, checking this improves specificity.
Related signs:
- Boas’ sign - hyperaesthesia below the right scapula, from referred pain
- Sonographic Murphy’s sign - maximal tenderness directly over the ultrasound-visualised gallbladder, more reliable than the clinical sign