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Puddle sign
This sign is elicited in the physical exam, similar to shifting dullness, but this time the patient does not need to have an extensive collection of liquid. Even smaller accumulations and mild cases of ascites can be detected with this method. After lying down for 5 minutes, the patient is asked to stand on all fours. The doctor places the stethoscope on the lower part of the abdomen, flicking the flanks repeatedly as they do and then moving the stethoscope to evidence changes in loudness of the flick sound. This changes the transmission of sound as opposed to sitting.
