A 32-year-old woman presents to the emergency department with acute onset right upper quadrant pain and tenderness. On examination, the clinician notes tenderness at a point located at the intersection of the lateral border of the rectus abdominis muscle and the costal margin. The patient reports the pain began after a fatty meal. Ultrasound confirms acute cholecystitis. Which anatomical landmark was being palpated during the clinical examination?

Explanation

## Anatomical Landmark Identification **Key Point:** Murphy's point (also called the gallbladder point) is located at the intersection of the lateral border of the rectus abdominis muscle and the costal margin, typically at the level of the 9th costal cartilage. This is the surface projection of the gallbladder fundus and is the classic site of tenderness in acute cholecystitis. ### Surface Anatomy Correlation The gallbladder fundus lies deep to this point, making it an ideal landmark for clinical palpation. When the patient takes a deep breath during Murphy's sign examination, the descending liver pushes the inflamed gallbladder fundus against the examiner's hand, eliciting pain and arrest of inspiration (positive Murphy's sign). ### Clinical Pearl **Clinical Pearl:** Murphy's point tenderness combined with a positive Murphy's sign (inspiratory arrest during deep palpation of the RUQ) is highly specific for acute cholecystitis. The anatomical basis is the superficial location of the gallbladder fundus relative to the abdominal wall at this landmark. ### Related Landmarks | Landmark | Location | Clinical Significance | |----------|----------|----------------------| | McBurney's point | Lateral 1/3 of line from ASIS to umbilicus | Appendicitis tenderness | | Murphy's point | Lateral border of rectus × costal margin | Cholecystitis tenderness | | Lanz's point | Medial 1/3 of line from ASIS to umbilicus | Alternative appendicitis point | | Traube's space | Left anterior axillary line, 6th–10th ribs | Splenic dullness | **High-Yield:** McBurney's point is for appendicitis; Murphy's point is for cholecystitis. This distinction is tested frequently in NEET PG.