Begin percussion over the lungs and move from the area of resonant lung sounds to the areas of dullness. Mark the area of change. Repeat the same process from below, moving again from resonance over the bowel to dullness and again mark the area of change. Start in the lower right quadrant so as to not miss a greatly enlarged liver. Measure the vertical distance from the top to the bottom. You can also use palpation to determine the lower border.
Begin palpation over the right lower quadrant, near the anterior iliac spine. Palpate for the liver with one or two hands palm down moving upward cm at a time towards the lower costal margin. Have the patient take a deep breath. The liver will move downward due to the downward movement of the diaphragm.
Feel for the liver to hit the caudal aspect of your palpating hand. Palpate the bottom margin of the liver for the texture of the liver, i. Several different techniques have been described for this exam. One is to place the diaphragm over the area of the liver and then scratch parallel to the costal margin until the sound intensity drops off marking the edge of the liver.
Other techniques involve different patterns of the scratching, for example as in spokes of a wheel and other places for placing the stethoscope such as over the abdomen. There are several physical examination maneuvers described for detection of ascites described below that are at least moderately sensitive and specific. Shifting dullness, bulging flanks and flank dullness are less specific but much more sensitive parameters.
The presence of ascites is very unlikely if the prior probability is low and both the patient's answers and the findings at physical examination are negative. Abdominal ultrasound, the gold standard, is not strictly indicated for diagnosing ascites: if based on the trial tried: pretest probability, clinical history and physical examination, the diagnosis is very likely or very unlikely.
Shifting dullness en Espanol. Shifting dullness en Francais. Shifting dullness in the Marketplace. Patents on Shifting dullness. List of terms related to Shifting dullness. Editor-In-Chief: C. Michael Gibson, M. The shifting dullness refers to a sign , elicited on physical examination , for ascites. If, on percussion , the region of dullness shifts when the patient is turned from supine position to side-lying, they probably have fluid in the abdomen. If the borders between tympanic and dullness remain the same, the person likely does not have ascites.
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Template:WikiDoc Sources. Shifting dullness. Symptoms and signs : circulatory R00—R03 , Template:Navbox subgroup. Symptoms and signs : respiratory system R04—R07 , Epistaxis Hemoptysis. Chest pain Precordial catch syndrome. Symptoms and signs : digestive system and abdomen R10—R19 , ,
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