Shifting Dullness
Shifting Dullness can diagnose 500 ml of fluid. This is seen in moderate ascites.
Procedure
The abdomen is percussed starting from midline. Upper border of fluid in each flank is determined. The pleximeter finger is kept in position on one flank & the patient is turned to other side. After waiting for about 15 seconds, percussion at the same point produces a tympanic note at the intestines float up. The abdomen is then percussed towards the other flank. Shifting dullness is positive when there is an increased width of dullness on the other side due to shift of fluid.
Ascites
Definition
- Ascites is the accumulation of free fluid in the peritoneal cavity.
Diagnosis
1. Generalised distension of the abdomen with more fullness in the flank.
2. Shifting dullness
3. Horseshoe shaped dullness
- It can diagnose 1 litre of fluid.
- This is seen in moderate ascites.
- Procedure: The abdomen is percussed in various directions from the umbilicus outwards. Area of dullness appears horse shoe shaped with a concave upper border.
- Cause: This occurs because fluid accumulates in the dependent parts & the intestines float up.
4. Fluid thrill test
- This is seen in case of tense ascites.
- Procedure: The patient is asked to keep the ulnar edge of one hand in the midline. Examiner put one hand on one flank & then a sharp flick is delivered from the other hand over opposite flank. Fluid thrill is positive when a tap wave is felt on opposite flank. Ii is felt by palpating hand in case of tense ascites.
5. Puddle Sign
- It is elicited in minimal ascites (150 ml).
- Use: Diagnosis of small quantity of fluid.
- Procedure: Patient is asked to go on all four (knee chest position) so that fluid collects in dependent mid abdomen. Stethoscope is placed here. One flank is lightly flicked with one hand & most dependent part is auscultated. Stethoscope is then moved to opposite flank. A change in the intensity of note heard indicate fluid.
6. Laughing or smiling umbilicus (Transversely stretched)
7. Lower ribs pushed outwards & upwards
8. Widened subcostal angle
9. Tense & shiny skin
10. Divarication of recti
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