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Shifting dullness
This is an essential sign in cases of moderate or severe ascites, and it is elicited in the physical exam. The first step to check for shifting dullness is to tap on the midline of the abdomen with the patient laying down facing upwards in order to check if there is abdominal gas. If there is, the examiner would change the position of the patient and continue tapping to evaluate how the tapping sounds. The air level has a different sound than the area full of liquid, and as the patient moves and the liquid does the same following the gravity, the position of air sounds and liquid sounds start shifting. That’s what we call shifting dullness, and it is a way to diagnose ascites in patients with severe cases.
