Shifting dullness
Encyclopedia
In medicine
, shifting dullness refers to a sign, elicited on physical examination
, for ascites
.
To perform the test, first the midline is percussed
eliciting a resonant note due to gas in the bowel. If there is no area of resonance then the test cannot be performed. Percussion is then moved progressively more lateral (away from the examiner) - this is depicted as the red section in the diagram on the right - until the note becomes dull, as depicted by the green section. The examiner's index finger is left on the resonant side, and the middle finger is left on the dull side; thus straddling a fluid-air level. The patient is then asked to lean on their right lateral side (assuming the examiner used the traditional right sided approach). This sandwiches the patient between the examiner's hands and body, stabilising the patient. It is imperative that the finger positions aren't lost. After waiting sufficient time for any fluid to shift (up to 30 seconds), the dull position is then percussed. It may now be resonant. The percussion may now be performed down the anterior side until a new dullness is found. To confirm a positive result it is recommended that the now resonant area become dull again when the patient is back in the supine position.
If the borders between tympanic (resonant) and dullness remain the same, the person probably does not have ascites, or has less than 2 litres of free fluid present. If the fluid causing the dullness was not free, then the air-fluid level would not move. Shifting dullness is usually present if the volume of ascitic fluid is greater than 1500 ml. If low volume ascites is suspected, then an attempt to elicit the puddle sign
may be performed.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, shifting dullness refers to a sign, elicited on physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
, for ascites
Ascites
Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity.The medical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy. Although most commonly due to cirrhosis and severe liver...
.
To perform the test, first the midline is percussed
Percussion (medicine)
Percussion is a method of tapping on a surface to determine the underlying structure, and is used in clinical examinations to assess the condition of the thorax or abdomen. It is one of the four methods of clinical examination, together with inspection, palpation and auscultation...
eliciting a resonant note due to gas in the bowel. If there is no area of resonance then the test cannot be performed. Percussion is then moved progressively more lateral (away from the examiner) - this is depicted as the red section in the diagram on the right - until the note becomes dull, as depicted by the green section. The examiner's index finger is left on the resonant side, and the middle finger is left on the dull side; thus straddling a fluid-air level. The patient is then asked to lean on their right lateral side (assuming the examiner used the traditional right sided approach). This sandwiches the patient between the examiner's hands and body, stabilising the patient. It is imperative that the finger positions aren't lost. After waiting sufficient time for any fluid to shift (up to 30 seconds), the dull position is then percussed. It may now be resonant. The percussion may now be performed down the anterior side until a new dullness is found. To confirm a positive result it is recommended that the now resonant area become dull again when the patient is back in the supine position.
If the borders between tympanic (resonant) and dullness remain the same, the person probably does not have ascites, or has less than 2 litres of free fluid present. If the fluid causing the dullness was not free, then the air-fluid level would not move. Shifting dullness is usually present if the volume of ascitic fluid is greater than 1500 ml. If low volume ascites is suspected, then an attempt to elicit the puddle sign
Puddle sign
In gastroenterology, the puddle sign is a physical examination maneuver that can be used to detect the presence of ascites. It is useful for detecting small amounts of ascites -- as small as 120 mL; shifting dullness and bulging flanks typically require 500 mL....
may be performed.
See also
- Abdominal examinationAbdominal examinationThe abdominal exam, in medicine, is performed as part of a physical examination, or when a patient presents with abdominal pain or a history that suggests an abdominal pathology.The exam includes several parts:* Setting and preparation...
- Fluid wave testFluid wave testIn medicine, the fluid wave test or fluid thrill test is a test for ascites. It is performed by having the patient push their hands down on the midline of the abdomen. The examiner then taps one flank, while feeling on the other flank for the tap...
- Bulging flanksBulging flanksIn medicine, bulging flanks refers to a sign for ascites. If, on inspection , the sides of the abdomen bulge outward in an unusual fashion on a patient, they likely have fluid in the abdomen...
- Puddle signPuddle signIn gastroenterology, the puddle sign is a physical examination maneuver that can be used to detect the presence of ascites. It is useful for detecting small amounts of ascites -- as small as 120 mL; shifting dullness and bulging flanks typically require 500 mL....