Shifting Dullness

by Noor Sash, PhD

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    00:00 Back to ascites, shifting dullness, is it alright to do that or do you have to do the fluid thrill thing as well? You can do the fluid thrill. Shall we? Do you want to demonstrate how? I can’t remember how to do that.

    00:15 Okay. So, what I’m going to ask you to do is I’m just going to have to tap on your tummy. But if I can borrow your hand, just get you to place that across your tummy, what I’m going to do is I’m going to flick on one side of your tummy and I’m going to put a hand on the other side. So, what am I doing? That’s fine.

    00:32 You can get the patients to do that. Exactly. Sit up for me. So, what you’re doing is essentially when you’re tapping one side, you are just stopping any skin conduction by putting that hand there and you’re checking to see whether or not that pulse is being transmitted through the underlying fluid. But again, take it in the context. If someone has obviously got ascites, that somebody has got a massive amount of tense ascites.

    00:55 So you might have a small ascites that you might necessarily be able to demonstrate a fluid thrill on, but you might be able to demonstrate shifting dullness on.

    01:03 I have a quick question about hepatomegaly. I’ve read different things in different books. Some people would say that it’s better to feel in for the liver when they’re breathe in. Yeah. And then some people say that when you breathe out, your lungs fill with air so they push the liver down. So, that means you should do it when they breathe out because then you’ll feel the liver hitting your hand. So I wasn’t too sure which one – When you breathe in your lungs fill with air.

    01:30 Oh yeah. But I’ve read two different things in the book.

    01:37 No. I can see why you’re confused. I thought you want to be in there when they take a breath. As they’re taking a breath in and you’re pushing in and you’re supposed to be putting your hand a third down so you can feel that long-edge passing as they’re taking a breath in. Does that make sense? So not when they’re breathing out? When they’re breathing out, that liver is just moving about. So you might potentially catch the edge of it but it’s much easy to feel something going in that direction. Yeah, breathing in pushes it down. Okay.

    02:05 That’s fine. I think you meant like in the book, like you push in and keep your hands still while they breathe out and then you might feel it hitting your hand. Yeah. Maybe that’s probably it. So, wait for them to breathe out and then leave your hand-- And then when they breathe in, yeah. But you’re trying to like meet it.

    02:25 In clinical practice, I don’t really do that because I don’t find it very accurate.

    02:29 So, what I tend to do is, have you heard of a scratch test, which I don’t know what

    About the Lecture

    The lecture Shifting Dullness by Noor Sash, PhD is from the course The Physical Exam.

    Author of lecture Shifting Dullness

     Noor Sash, PhD

    Noor Sash, PhD

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