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
In relation to auscultatory percussion, the puddle sign is more specific, but less sensitive.
Read more about Puddle Sign: See Also
Famous quotes containing the words puddle and/or sign:
“An oblong puddle inset in the coarse asphalt; like a fancy footprint filled to the brim with quicksilver; like a spatulate hole through which you can see the nether sky. Surrounded, I note, by a diffuse tentacled black dampness where some dull dun dead leaves have stuck. Drowned, I should say, before the puddle had shrunk to its present size.”
—Vladimir Nabokov (1899–1977)
“A good businessman never makes a contract unless he’s sure he can carry it through, yet every fool on earth is perfectly willing to sign a marriage contract without considering whether he can live up to it or not.”
—Dalton Trumbo (1905–1976)