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
DiagnosisDude 