In
gastroenterology
Gastroenterology (from the Greek gastḗr- “belly”, -énteron “intestine”, and -logía "study of") is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract ...
, the puddle
sign
A sign is an object, quality, event, or entity whose presence or occurrence indicates the probable presence or occurrence of something else. A natural sign bears a causal relation to its object—for instance, thunder is a sign of storm, or me ...
is a
physical examination
In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patien ...
maneuver that can be used to detect the presence of
ascites
Ascites is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdominal size, increased weight, ab ...
. It is useful for detecting small amounts of ascites—as small as 120
mL;
shifting dullness
In medicine, shifting dullness refers to a sign elicited on physical examination for ascites (fluid in the peritoneal cavity).Murray Longmore, Ian B. Wilinson, Edward H. Dawvidson, Alexander Foulkes and Ahmad R. Mafi ''Oxford Handbook of Clinical M ...
and
bulging flanks typically require 500 mL.
The steps are outlined as follows:
# 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
A percussion instrument is a musical instrument that is sounded by being struck or scraped by a beater including attached or enclosed beaters or rattles struck, scraped or rubbed by hand or struck against another similar instrument. Exc ...
, the puddle sign is more
specific
Specific may refer to:
* Specificity (disambiguation)
* Specific, a cure or therapy for a specific illness
Law
* Specific deterrence, focussed on an individual
* Specific finding, intermediate verdict used by a jury in determining the fina ...
, but less
sensitive.
See also
*
Abdominal examination
An abdominal examination is a portion of the physical examination which a physician or nurse uses to clinically observe the abdomen of a patient for signs of disease. The physical examination typically occurs after a thorough medical history i ...
*
Fluid wave test
*
Bulging flanks
References
External links
*
{{Digestive system and abdomen symptoms and signs
Medical signs