The
puddle sign is a physical examination test that can be used in gastroenterology to identify ascites. Ascites can be detected in as little as 120 mL, whereas bulging flanks and shifting dullness often require 500 mL.
The following are the steps:-
1. For five minutes, the patient is on their back.
2. The patient then gets to her knees and elbows.
3. Apply the stethoscope diaphragm to the area of the abdomen that is most vulnerable.
4. The examiner repeatedly flicks his finger in the vicinity of the flank. Keep flicking at the same area of the abdomen.
5. Away from the examiner, move the stethoscope across the abdomen.
6. The farther the edge of the puddle, the louder the sound.
7. When the patient is seated, sound transmission remains constant.
The puddle indication is less sensitive than auscultatory percussion but more specific.
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