Percussing the Abdomen

Estimating size of liver (normal span = 6-12 cm)

  • At Right mid-clavicular line, find normal resonance / tympany in lower abdomen
  • Percuss upward seeking change to dullness (can’t go past rib margin)
  • Then percuss upper chest for normal resonance (at RMCL), and continue downward in each intercostal space seeking change to dullness
  • Measure distance between both change points (I measure by width of PIPs of my middle 3 fingers, = 2 cm each)

Percussing a distended bladder

  • Find normal resonance / tympany at umbilicus, & percuss downward in midline to symphysis pubis
  • Any change to dullness = distended bladder (or pregnant uterus)

Percussion for subtle Splenomegaly

  • Roll patient onto right side, knees bent
  • Percuss the abdomen just below the lower left rib margin — should sound like typical abdominal resonnance
  • Have the patient take a deep breath & percuss again — an enlarged spleen will now sound dull