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Puddle Sign - Wikipedia

The puddle sign is a physical examination maneuver used to detect small amounts of ascites, as little as 120mL. It involves having the patient lie prone for 5 minutes then rise to elbows and knees. The examiner places a stethoscope on the lowest part of the abdomen and repeatedly flicks the flank with a finger. Sound transmission increases as the stethoscope is moved away, indicating fluid has pooled on the dependent side. The puddle sign is more specific than auscultatory percussion for detecting ascites but less sensitive.

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1K views5 pages

Puddle Sign - Wikipedia

The puddle sign is a physical examination maneuver used to detect small amounts of ascites, as little as 120mL. It involves having the patient lie prone for 5 minutes then rise to elbows and knees. The examiner places a stethoscope on the lowest part of the abdomen and repeatedly flicks the flank with a finger. Sound transmission increases as the stethoscope is moved away, indicating fluid has pooled on the dependent side. The puddle sign is more specific than auscultatory percussion for detecting ascites but less sensitive.

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MudoogoEdgar
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© © All Rights Reserved
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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.[1]

Puddle sign
Differential diagnosis ascites
The steps are outlined as follows:[2]

1. Patient lies prone for 5 minutes


2. Patient then rises onto elbows and
knees
3. Apply stethoscope diaphragm to
most dependent part of the abdomen
4. Examiner repeatedly flicks near flank
with finger. Continue to flick at same
spot on abdomen
5. Move stethoscope across abdomen
away from examiner
6. Sound loudness increases at farther
edge of puddle
7. Sound transmission does not change
when patient sits

In relation to auscultatory percussion, the


puddle sign is more specific, but less
sensitive.[3]

See also
Abdominal examination
Fluid wave test
Bulging flanks

References
1. Shah R. Ascites. eMedicine.com. URL:
http://www.emedicine.com/med/topic
173.htm . Accessed on: September 17,
2007.
2. FamilyPracticeNotebook.com URL:
http://www.fpnotebook.com/GI41.ht
m Archived 2007-09-16 at the
Wayback Machine. Accessed on:
March 14, 2008.
3. 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 .

External links
Gill, Christopher J.; Sabin, Lora; Schmid,
Christopher H. (2005). "Why clinicians
are natural bayesians" . BMJ. 330
(7499): 1080–1083.
doi:10.1136/bmj.330.7499.1080 .
PMC 557240 . PMID 15879401 .

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title=Puddle_sign&oldid=913195185"

Last edited 1 month ago by Ozzie10aaaa

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