ASCITES - how to assess if you have it?

To detect ascites and differentiate it from other causes of abdominal distention, check for shifting dullness, fluid wave, and puddle sign.


Shifting Dullness

Step 1. With the patient in a supine position, percuss from the umbilicus outward to the flank. Draw a line on the patient's skin to mark the change from tympany to dullness

Step 2. Turn the patient onto his side (note that this positioning causes ascitic fluid to shift). Percuss again and mark the change from tymphany to dullness. A difference between these lines can indicate ascites.

Fluid Wave
- Have another person press deeply into the patient's midline to prevent vibration from travel along the abdominal wall. Place one of your palms on one of the patient's flanks. Strike the opposite flank with your other hand. If you fell the blow in the opposite palm, ascitic fluid is present.

Puddle Sign
- Position the patient on his elbows and knees, which causes ascitic fluid to pool in the most dependent part of the abdomen. Percuss the abdomen from the flank to the midline. The percussion note becomes louder at the edge of the puddle, or the ascitic pool.

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