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Puddle sign

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Medical condition

Puddle sign
Differential diagnosis	ascites

Ingastroenterology, thepuddlesign is aphysical examination maneuver that can be used to detect the presence ofascites. It is useful for detecting small amounts of ascites—as small as 120mL;shifting dullness andbulging flanks typically require 500 mL.^[1]

The steps are outlined as follows:^[2]

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 further edge of puddle
Sound transmission does not change when patient sits

In relation toauscultatory percussion, the puddle sign is morespecific, but lesssensitive.^[3]

^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 Archived 2007-09-16 at theWayback Machine. 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.

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.

Accessory

Abdomen

Pain	Abdominal pain Acute abdomen Colic Baby colic Abdominal guarding Blumberg's sign
Distension	Abdominal distension Bloating Ascites Tympany Shifting dullness Fluid wave test
Masses	Abdominal mass Hepatosplenomegaly Hepatomegaly Splenomegaly
Other	Jaundice Mallet-Guy's sign Puddle sign Ballance's sign Aortic insufficiency Castell's sign Kehr's sign Cullen's sign Grey Turner's sign