Percussion

• define the size and nature of organs and masses
• detect fluid in the peritoneal cavity
• elicit tenderness in patients with peritonitis

Note - shifting dullness, present in ascites, should be demonstrated by percussing from the midline to the flank till the note changes from dull to resonant and then having the patient roll over on their side towards the examiner and wait for 10 seconds. This manoeuvre allows any fluid, if present, to move downwards. The percussion should then be repeated, moving in the same direction. If the percussion note changes to resonant, shifting dullness is positive. (1)

Reference

1. Schipper HG, Godfried MH. [Physical diagnosis--ascites]. Ned Tijdschr Geneeskd. 2001 Feb 10;145(6):260-4