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.
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
- 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. 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.