Physical Exam

Abdomen Percussion

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Video coming September 2026

How to Perform

Place the middle finger of your nondominant hand flat against the abdominal wall and strike its distal interphalangeal joint sharply with the tip of your dominant middle finger using a quick wrist motion. Percuss systematically across all four quadrants of the abdomen, comparing the note from area to area. Note where the percussion note is tympanic and where it is dull, map the borders of any dullness, and note any tenderness to percussion.

How to Interpret

Ascites

Flank dullness

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Strong

Hepatomegaly

Liver span enlarged on percussion (>10 cm in the midclavicular line)

Rule in

Not helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Limited

References

Joshi R, Singh A, Jajoo N, Pai M, Kalantri SP. Accuracy and reliability of palpation and percussion for detecting hepatomegaly: a rural hospital-based study. Indian J Gastroenterol. 2004 Sep-Oct;23(5):171-174. PMID: 15598999.
Weatherall M, Harwood M. The accuracy of clinical assessment of bladder volume. Arch Phys Med Rehabil. 2002;83(9):1300-1302. PMID: 12235612.
Tarasconi A, Coccolini F, Biffl WL, et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg. 2020 Jan 7;15:3. doi:10.1186/s13017-019-0283-9. PMID: 31921329.
Golledge J, Toms AP, Franklin IJ, Scriven MW, Galland RB. Assessment of peritonism in appendicitis. Ann R Coll Surg Engl. 1996;78(1):11-14. PMID: 8659965; PMCID: PMC2502643.
Williams JW Jr, Simel DL. The rational clinical examination. Does this patient have ascites? How to divine fluid in the abdomen. JAMA. 1992;267(19):2645-2648. PMID: 1573754
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.