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Abdominal
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
To elicit shifting dullness, start percussion in the midline of the abdomen (where the percussion note should be resonant) and percuss down towards the right flank. When the percussion note becomes dull, percuss accurately to determine where the interface between resonant and dull is. Mark this point with your middle finger. Invite the patient to turn away from you, onto their side, keeping your finger where the difference in percussion note was heard. Keep them on their side for longer than 30 seconds, and then percuss again. The percussion note of the point at which you marked may have become resonant. With the patient still on their side, percuss down towards the midline of the abdomen until the percussion note becomes dull again, i.e. a shift in the ‘dullness’ Demonstration of this sign is consistent with a finding of intra-abdominal fluid.
The peritoneum, omentum, mesentery and retroperitoneal space
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Ascites can usually be recognised clinically only when the amount of fluid present exceeds 1.5 L depending on body habitus: in obese individuals a greater quantity than this is necessary before there is clear evidence. The abdomen is distended evenly with fullness of the flanks, which are dull to percussion. Usually, shifting dullness is present but, when there is a very large accumulation of fluid, this sign is absent. In such cases, on flicking the abdominal wall, a characteristic fluid thrill is transmitted from one side to the other. In women, ascites must be differentiated from an enormous ovarian cyst.
Case 30: An abnormal ECG
Published in Eamon Shamil, Praful Ravi, Dipak Mistry, Janice Rymer, 100 Cases in Emergency Medicine and Critical Care, 2018
Eamon Shamil, Praful Ravi, Dipak Mistry
General examination reveals an unkempt individual with evidence of asterixis and stigmata of chronic liver disease. Heart sounds are present with no murmurs, but the rhythm is irregular. Abdominal examination reveals a distended abdomen, and shifting dullness and a fluid thrill are noted. Abbreviated Mental Test Score is 6/10.
Spontaneous vaginal cuff dehiscence with evisceration in a woman with vaginal vault prolapse long after hysterectomy: a case report
Published in Journal of Obstetrics and Gynaecology, 2023
Lu Jiang, Peng Jia, Baofeng Duan, Zixuan Yang, Yan Zhang
Two hours after the protrusion, she underwent a physical examination. Her vital signs were normal, and she measured 162 cm and weighed 57 kg. Cardiopulmonary examination revealed no abnormalities, and the abdomen was soft with slight tenderness and negative shifting dullness. The hypoactive bowel sounds were two times per minute by auscultation, accompanied by the absence of anal exhaust. The gynaecologic examination revealed 30 cm of small bowel emerging from the vagina. The eviscerated bowel was intact, 20 cm of which was dilatated and oedematous, with a dark red hyperaemia appearance but no signs of necrosis (Figure 1(A)). Laboratory results were in the range of normal except for a neutrophil ratio of 82.5%. Abdominal and pelvic computed tomography (CT) plain scans suggested vaginal cuff, the 5th group of small intestine and mesentery prolapse (Figure 1(B)).
Strangulated internal hernia following severe ovarian hyperstimulation syndrome: a case report
Published in Gynecological Endocrinology, 2021
Likun Wei, Yanfang Zhang, Xueru Song
Her height was 165 cm and she weighed 70 kg. On admission, her temperature was 36.6 °C, blood pressure was 120/65 mmHg, heart rate was 110 beats/min, and oxygen saturation was 99%. Her abdomen was distended (abdominal girth, 91 cm), and shifting dullness was positive. A slight abdominal tenderness in the right upper abdomen was reported. Blood laboratory tests showed hemoconcentration (hematocrit, 42%; hemoglobin, 146 g/L), leukocytosis (white blood cells [WBC], 14.44 × 109/L; neutrophils, 79.6%), and hypoalbuminemia (serum albumin, 28 g/L). Her serum β-hCG level was 1378 IU/L and D-Dimer level was 1443 ng/ml, and renal function was normal. Pelvic ultrasound revealed a normal-sized uterus, bilateral ovarian enlargement (right ovary: 7.1 cm × 8.9 cm × 10.0 cm; left ovary: 6.6 cm × 4.0 cm × 7.0 cm) and large free fluid in the abdominal cavity (The depth of the right iliac fossa fluid was 8.6 cm, and the left was 5.4 cm. The depth of the Douglas pouch fluid was 2.3 cm, and a great quantity of fluid accumulated around the liver, spleen, and hepatorenal recess). Moreover, small amounts of left pleural effusion measuring 5.8 mm was detected in the patient. She was diagnosed with severe OHSS in early pregnancy, and was admitted to a hospital.
Large pancreatic mass with chylous ascites
Published in Baylor University Medical Center Proceedings, 2020
Madhuri Badrinath, Ajay Tambe, Rachana Mandru, Sheikh Saleem, David Heisig
A 69-year-old man presented with a 2-month history of reduced appetite, abdominal pain, and distension in the absence of fever, chills, weight loss, or change in bowel habits. He was a nonsmoker, denied alcohol use, and had a noncontributory past medical history as well as no family history of cancer. A farmer, he reported exposure to Agent Orange many years earlier. His abdomen was soft, distended, and nontender with fluid thrill and positive shifting dullness. The only abnormal laboratory test was a mildly elevated lactate dehydrogenase of 254 U/L (normal range 122–225 U/L). Abdominal computed tomography (CT) showed a 20 × 10 × 17 cm soft tissue mass impinging the distal duodenum, replacing the proximal pancreatic parenchyma, and encasing the celiac and superior mesenteric arteries; ascites, lymphadenopathy, and multiple omental nodules were seen (Figure 1). No cirrhosis or hepatomegaly was noted.