American Board of Pathology (ABPath) Practice Test 2025 - Free Pathology Exam Practice Questions and Study Guide

A negative Murphy's sign in the context of gangrenous cholecystitis can occur due to nerve damage caused by the necrotic tissue surrounding the gallbladder. In gangrenous cholecystitis, the gallbladder wall can become severely inflamed and necrotic. This destruction of tissue and nerves can lead to the impairment of the sensory pathways that relay the pain sensation. Consequently, even when pressure is applied to the gallbladder during a physical exam, the patient may not experience the expected sharp pain which would normally cause a positive Murphy's sign.

This scenario draws attention to how damage to the nerve fibers involved in pain transmission can diminish the patient's ability to register tenderness, thus resulting in a negative Murphy's sign despite the underlying pathology. This phenomenon can mislead clinicians regarding the extent of the disease since pain perception is a critical element in the diagnosis of acute cholecystitis.