304: Murphy’s Sign

Well, this doctor was the patient this week for a wee bit of knee surgery and recovering nicely (but where is Claire and her medicinal whisky when I need her?).  I’m squeezing in a quick post about episode 304 just before the next episode is available on streaming in about a half hour!

What was this pressing surgery that Joe called Claire about?

murphy calcifications.png

Harry Greenbaum has abdominal pain, a positive Murphy’s sign, and calcifications on his x-ray.  Hmmm.  What’s going on?

What is Murphy’s sign? 

Murphy’s sign is a test performed during physical exam of the abdomen that may indicate the presence of inflammation of the gall bladder.  The examiner palpates the abdomen just under the rib cage on the right side as the patient inspires.  During inspiration, the abdominal contents (including the gallbladder) move downward because the lungs are expanding.  If the patient halts inspiration due to pain while the area is palpated, this is considered a positive Murphy’s sign.  See below the location of the gallbladder in the right upper part of the abdomen just under the ribcage:

 

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Image Source: Wikimedia Commons

What about those calcifications?

Could they be gall stones?  The could, though most gall stones are made up of cholesterol and are not visible on x-ray.  In fact, only 15-20% of gallstones are visible on x-ray.  Today, these are most commonly diagnosed on ultrasound.

The calcifications on Harry’s x-ray could also be a porcelain gall bladder, or a condition when the gall bladder wall becomes calcified due to chronic inflammation, generally associated with gall stones and occasionally associated with cancer of the gall bladder.  This type of calcification is easily seen on x-ray.

Either way, it is time for Harry’s gall bladder to be removed.  Because Joe made it a point to call Claire in Scotland to discuss this, my guess is that Harry is a long time patient of Claire’s and Joe wanted to give her the chance to perform the surgery herself if she would be back in time.  Cholecystectomy, or surgical removal of the gall bladder, is a routine surgery and certainly not anything Joe would need Claire to return for, if there were not other circumstances surrounding this case.

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Whew!  Done with a few minutes to spare!  On to episode 305 as this patient continues to enjoy a little bit of downtime recovering from surgery herself!

Cheers!

Outlander images property of STARZ

 

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