Dunphy Sign – Clinical Sign of Appendicitis
The Dunphy sign is a clinical examination finding used to assess suspected appendicitis: coughing worsens pain in the right lower abdomen.
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The Dunphy sign is a clinical examination finding used to assess suspected appendicitis: coughing worsens pain in the right lower abdomen.
What is the Dunphy Sign?
The Dunphy sign is a clinical bedside examination finding used when evaluating patients with suspected appendicitis (inflammation of the appendix). It refers to the observation that asking the patient to cough produces a noticeable increase in pain in the right lower quadrant of the abdomen, particularly around the McBurney point – the classic point of tenderness in appendicitis.
The sign is named after the American surgeon Hanford Dunphy and serves as a simple, non-invasive indicator of peritoneal irritation, which can occur when inflammation spreads from the appendix to the surrounding abdominal lining (peritoneum).
Clinical Significance
The Dunphy sign is one of several clinical signs used to support the diagnosis of appendicitis. Peritoneal irritation develops when inflammation of the vermiform appendix extends to the peritoneum. The act of coughing briefly increases intra-abdominal pressure, provoking the characteristic pain response.
A positive Dunphy sign increases the clinical suspicion of appendicitis but is not diagnostic on its own. It must always be interpreted alongside other clinical findings, laboratory results, and imaging studies.
Related Clinical Signs in Appendicitis
- McBurney sign: Tenderness at the McBurney point (one-third of the distance from the right anterior superior iliac spine to the umbilicus).
- Blumberg sign (rebound tenderness): Pain in the right lower quadrant upon sudden release of pressure applied to the left lower quadrant.
- Rovsing sign: Pain in the right lower quadrant when pressure is applied to the left side of the colon.
- Psoas sign: Increased pain upon extension of the right leg against resistance in a supine patient.
- Obturator sign: Pain elicited by internal rotation of the right hip in a supine patient.
Diagnosis of Appendicitis
The diagnosis of appendicitis relies on a combination of clinical examination, laboratory tests, and imaging:
- Clinical examination: Assessment of multiple appendicitis signs, including the Dunphy sign.
- Laboratory tests: Elevated inflammatory markers such as C-reactive protein (CRP) and elevated white blood cell count (leukocytosis) suggest inflammation.
- Imaging: Abdominal ultrasound is the preferred first-line modality; computed tomography (CT) or magnetic resonance imaging (MRI) may be used for further clarification.
- Alvarado score: A clinical scoring system used to estimate the likelihood of appendicitis.
When to Seek Medical Attention
Severe or worsening pain in the right lower abdomen, especially when accompanied by fever, nausea, vomiting, or a general feeling of illness, requires immediate medical evaluation. Untreated appendicitis can lead to a dangerous perforation of the appendix and potentially life-threatening peritonitis (inflammation of the abdominal cavity).
Treatment of Appendicitis
The standard treatment for acute appendicitis is surgical removal of the appendix, known as an appendectomy. This procedure is most commonly performed as a minimally invasive operation (laparoscopic appendectomy). In selected cases of uncomplicated appendicitis, conservative management with antibiotics may be considered, although the risk of recurrence should be taken into account.
References
- Schwartz's Principles of Surgery, 11th edition – Brunicardi et al., McGraw-Hill Education, 2019.
- Petroianu A. - Diagnosis of acute appendicitis. International Journal of Surgery, 2012; 10(3): 115-119. PubMed PMID: 22349268.
- Stand's Diagnosis and Treatment in Surgery – Wagner et al., Thieme, 2020.
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Related search terms: Dunphy Sign + Dunphy´s Sign + Dunphy-Sign