Scribd
Upload
2K views25 pages

Percussion of The Abdomen: Prof. R. Sukumar MD Institute of Internal Medicine MMC & GGH

This document provides an overview of percussion techniques used to examine the abdomen. It describes how to percuss the liver, spleen, kidneys, urinary bladder, and detect free fluid. For the liver, techniques are described to locate the upper border and measure the span. For the spleen, Nixon's method, Castell's method, and Traube's space percussion are outlined. Signs of organ enlargement or other abnormalities are also noted. Detection of free fluid discusses fluid thrill, shifting dullness, and Puddle's sign. The document emphasizes the importance of physical examination in medical diagnosis.

Uploaded by

Vignesh Kumar Chandiraseharan
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
2K views25 pages

Percussion of The Abdomen: Prof. R. Sukumar MD Institute of Internal Medicine MMC & GGH

This document provides an overview of percussion techniques used to examine the abdomen. It describes how to percuss the liver, spleen, kidneys, urinary bladder, and detect free fluid. For the liver, techniques are described to locate the upper border and measure the span. For the spleen, Nixon's method, Castell's method, and Traube's space percussion are outlined. Signs of organ enlargement or other abnormalities are also noted. Detection of free fluid discusses fluid thrill, shifting dullness, and Puddle's sign. The document emphasizes the importance of physical examination in medical diagnosis.

Uploaded by

Vignesh Kumar Chandiraseharan
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 25

PERCUSSION OF THE

ABDOMEN

Prof. R. Sukumar MD
Institute of Internal
Medicine
MMC & GGH
A MUSICAL INTERLUDE
 Dr. Leopold Auenbrugger was the inventor of
percussion
 He got the idea by observing a wine
merchant percussing out a half-full barrel
 Later, he began to practice this technique on
his patients
 History tells us that he percussed immediately
with one hand, using all four fingertips
PERCUSSION OF THE
ABDOMEN
 Liver
 Spleen
 Kidneys
 Urinary bladder
 Free fluid
PERCUSSION OF LIVER
 Percuss downwards from the right 5th
intercostal space in the midclavicular line to
locate the upper border of the liver
 Patient's breath held in full expiration
 Measure the distance from the upper border
of dullness to the palpable liver edge in the
midclavicular , midaxillary and midscapular
line
LIVER SPAN

Normal span is 12-15 cm at midclavicular line


Loss of normal Liver Dullness
 Emphysema
 Large right pneumothorax
 Hollow viscus perforation
 Post Laparotomy/ Laparoscopy
 Massive hepatic necrosis.
 Interposition of the transverse colon
between the liver and the diaphragm
(Chilaiditi's sign)
PERCUSSION OF SPLEEN
 Nixon’s method

 Castell’s method

 Traube’s space percussion


NIXON’S METHOD
 The patient is placed on the right side so that the
spleen lies above the colon and stomach
 Percussion begins at the lower level of pulmonary
resonance in the posterior axillary line
 Proceeds diagonally along a perpendicular line
toward the lower midanterior costal margin
 The upper border of dullness is normally 6–8 cm
above the costal margin
 Dullness >8 cm in an adult is presumed to indicate
splenic enlargement
CASTELL’S METHOD
 Patient is poitioned supine
 Percuss in the lowest intercostal space in the
anterior axillary line (8th or 9th)
 Resonant note is produced if the spleen is
normal in size
 This is true during expiration or full
inspiration
 Dull percussion note on full inspiration
suggests splenomegaly
CASTELL’S METHOD
TRAUBE’S SPACE
TRAUBE’S SPACE
 Described by Ludwig Traube
 It is a semilunar space over the fundus of stomach
 Bounded medially by the left lobe of the liver,
laterally by the spleen, superiorly by the left lung
resonance and inferiorly by left costal margin
 On the surface, it can be mapped by dropping
perpendicular lines from the sixth rib at the
costochondral junction and the ninth rib at the
anterior axillary line to the costal margin
 Tympanic on percussion
 Percussed in sitting or supine posture
Obliteration of Traube’s Space
 Left sided Pleural Effusion
 Massive Splenomegaly
 Enlarged Left lobe of Liver
 Full Stomach
 Fundal Growth
 Massive Pericardial effusion
KIDNEYS
 Percussion over a right or left subcostal
mass
 To distinguish hepatic or splenic from
renal masses
 Resonant area is percussed over renal
mass because of overlying bowel
 Sometimes a very large renal mass may
displace overlying bowel
URINARY BLADDER
 Percussion in the suprapubic region

 Helpful in determining whether an


ill-defined mass is an enlarged bladder
(dull) or distended bowel (resonant)
ABDOMINAL DISTENTION
DEMONSTRATION OF
FREE-FLUID
 Fluid thrill

 Shifting dullness

 Puddle’s sign
FLUID THRILL
 An assistant (or the patient) to place the
medial edge of palm firmly on the centre of
the abdomen
 The examiner flicks the side of the abdominal
wall
 Pulsation (thrill) is felt by the hand placed on
the other abdominal wall
 Positive in massive ascites (>2L), massive
ovarian cyst or a pregnancy with hydramnios.
FLUID THRILL
SHIFTING DULLNESS
 The percussion note over most of the
abdomen is resonant, due to air in the
intestines
 When ascites collects, the influence of gravity
causes this to accumulate first in the flanks in
a supine patient
 When at least 1 litre of fluid have
accumulated, a dull percussion note in the
flanks
 Even with gross ascites an area of central
resonance will always persist
SHIFTING DULLNESS
 Percuss centrally and laterally until dullness is
detected
 Keep your finger pressed there
 Ask the patient to roll onto the opposite side
 Ask the patient to hold the new position for about
half a minute.
 Repeat percussion moving laterally to central over
your mark
 The fluid(dull note) will now be moved by gravity
away from the marked spot and the previously dull
area will be resonant
SHIFTING DULLNESS
PUDDLE’S SIGN
 Ausculto percussion method
 Have the patient lie prone for 5 minutes and then
raise himself up to a knee elbow position
 Place the diaphragm of the stethoscope over the
most dependent portion of the abdomen.
 Flick with your finger, gradually moving it from the
periphery toward the stethoscope
 A positive sign consists of an abrupt perceived
increase in the intensity and clarity of the note just
as the flicking finger moves beyond the edge of the
pool of fluid
 Detects as little as 120 mL of ascites
PUDDLE’S SIGN
 Medicine is learned by the bedside
and not in the classroom.
Sir William Osler (1849-1919)

THANK YOU

You might also like