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.[1]
The steps are outlined as follows:[2]
Patient lies prone for 5 minutes
Patient then rises onto elbows and knees
Apply stethoscope diaphragm to most dependent part of the abdomen
Examiner repeatedly flicks near flank with finger. Continue to flick at same spot on abdomen
Move stethoscope across abdomen away from examiner
Sound loudness increases at farther edge of puddle
Sound transmission does not change when patient sits
In relation to auscultatory percussion, the puddle sign is more specific, but less sensitive.[3]
^Shah R. Ascites. eMedicine.com. URL: http://www.emedicine.com/med/topic173.htm. Accessed on: September 17, 2007.
^FamilyPracticeNotebook.com URL: http://www.fpnotebook.com/GI41.htm Archived 2007-09-16 at the Wayback Machine. Accessed on: March 14, 2008.
^Chongtham DS, Singh MM, Kalantri SP, Pathak S (1997). "A simple bedside manoeuvre to detect ascites". The National Medical Journal of India. 10 (1): 13–4. PMID 9069699.
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