The Abdominal Exam


LSU Physician Champions - Dr. Daniel Raines and Dr. Kellen Jex


Assessment of Ascites

Assessment of Ascites


Begin with visual inspection of the abdomen with the patient in the supine position and the abdomen exposed. A distended abdomen with “bulging flanks” is suspicious for ascites. Percuss the entire abdomen, beginning at the apex of the abdomen which is typically tympanic. Move to either flank until dullness to percussion is noted. Ask your patient shift their position to a lateral decubitus position, placing the percussed flank up. Repeat percussion of the abdomen taking note of any change in areas of tympani and dullness.



If ascites is present, the areas of dullness to percussion will shift down to the dependent side, with tympani being noted in the most superior area. This is known as “shifting dullness”.