Shifting Dullness

CLINICAL DIAGNOSTIC MANUAL

Shifting dullness in the abdomen is a clinical sign indicating the presence of free fluid in the peritoneal cavity, known as ascites.

This finding is detected through abdominal percussion, where the dullness shifts when the patient changes position due to the movement of the fluid within the abdomen.

Ascites can be caused by various pathologies, each with distinct pathophysiological mechanisms. Careful clinical evaluation and diagnostic tests are essential to determine the underlying cause and guide appropriate treatment.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Peritoneal Carcinomatosis	Abdominal distension, weight loss, abdominal pain, anorexia	Clinical history, physical examination, weight loss	Abdominal and Pelvic CT scan, paracentesis with ascitic fluid cytology
Cirrhosis	Abdominal distension, jaundice, peripheral edema, bruising, encephalopathy	Clinical history, physical examination, liver function tests	Abdominal ultrasound, Abdominal and Pelvic CT scan, liver biopsy
Congestive Heart Failure	Dyspnea, peripheral edema, abdominal distension, orthopnea, fatigue	Clinical history, physical examination, chest X-ray	Echocardiogram, Abdominal and Pelvic CT scan, blood tests (BNP)
Nephrotic Syndrome	Generalized edema, abdominal distension, foamy urine, weakness, weight gain	Clinical history, physical examination, urinalysis	Blood tests (low albumin, low total proteins), renal biopsy