How is the presence of ascites detected during an abdominal exam?

Updated: Dec 02, 2020
  • Author: Simon S Rabinowitz, MD, PhD, FAAP; Chief Editor: Kurt E Roberts, MD  more...
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Dullness along the flanks while in the supine position may indicate the presence of ascites. Various maneuvers can confirm this finding. [14] The examiner should percuss from the midline laterally and if ascites is present, a change from the tympany of bowel gas to the dullness of fluids should exist. The patient should then be positioned in a lateral position and the same sequence should be performed. If free-flowing ascitic fluid exists, the gravity will reposition it to the dependent side and a “shifting dullness” will be present.

The older, cooperative child or the parent can put the sides of their hands by the umbilicus, perpendicular to the abdomen, and apply gentle pressure. The examiner then gently pushes on one flank and determines if the “fluid wave” can be palpated on the opposite side. The “puddle sign” may also be used in children by first percussing the umbilicus while supine. As the child is moved to a prone position the ascitic fluid pools anteriorly, and the acoustic quality of percussion changes. The child may be placed in this position either by holding a very small child prone or by having them support themselves on their hands and knees.

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