The advanced practice nurse (APRN) is assessing a patient who presents with right upper quadrant pain. On exam the APRN deeply palpates the right upper quadrant and asks the patient to take a deep breath. The patient abruptly stops Inspiration and reports increased pain. The APRN notes that this positive sign likely indicates what disease process?

A. Appendicitis is incorrect because appendicitis usually causes pain localized to the right lower quadrant rather than the right upper quadrant. Classic signs include tenderness at McBurney’s point, rebound tenderness, Rovsing’s sign (pain in the right lower quadrant when the left lower quadrant is palpated), and psoas sign (pain on hip extension). Murphy’s sign is specific to gallbladder irritation, so it would not be positive in appendicitis. B. Pancreatitis is incorrect because pancreatitis typically presents with epigastric or periumbilical pain that may radiate to the back. Additional symptoms include nausea, vomiting, anorexia, and sometimes fever. While patients may have some tenderness in the right upper quadrant if the pancreas head is involved, deep palpation with inspiration does not produce Murphy’s sign, making this maneuver not diagnostic for pancreatitis. C. Cholecystitis is correct because acute cholecystitis is inflammation of the gallbladder, usually due to gallstones obstructing the cystic duct. During the Murphy’s sign test, the examiner palpates the right upper quadrant beneath the costal margin at the mid-clavicular line and asks the patient to inhale deeply. The descending diaphragm pushes the inflamed gallbladder against the examiner’s fingers, causing abrupt pain and halting inspiration. This is a classic and highly suggestive finding for acute cholecystitis. D. Gastroenteritis is incorrect because gastroenteritis causes diffuse abdominal cramping, diarrhea, nausea, and sometimes fever, without localized right upper quadrant inflammation. Deep palpation of the right upper quadrant with inspiration does not produce abrupt pain, so Murphy’s sign would be negative in gastroenteritis.