Physical examination maneuver

Physical Exam

Abdomen Percussion

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Video coming soon

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

Showing 2 of 5 findings

Ascites

Flank dullness
Rule in
Somewhat helpfulNo CI
Rule out
Somewhat helpfulNo CI
Evidence:Moderate

Hepatomegaly

Liver span enlarged on percussion (>10 cm in the midclavicular line)
Rule in
Not helpful
Rule out
Not helpful
Evidence:Moderate

Related Bedside Tests

🎬Video coming soon
Abdomen Palpation
Rule in:VHExtrahepatic Biliary Obstruction, VHIntussusception, VHPyloric Stenosis +32 more
Rule out:VHHepatocellular Jaundice, HAppendicitis, SHDiverticulitis +32 more
🎬Video coming soon
Liver Percussion
Rule in:NHHepatomegaly, IEPerforated Viscus
Rule out:NHHepatomegaly, IEPerforated Viscus
🎬Video coming soon
Abdomen Inspection
Rule in:VHBowel Obstruction, SHAscites, ICCushing Syndrome +3 more
Rule out:SHAscites, SHBowel Obstruction, NHCushing Syndrome +3 more
🎬Video coming soon
Liver Palpation
Rule in:SHCirrhosis, SHHepatomegaly, NHMalignant Lymphadenopathy +7 more
Rule out:SHCirrhosis, SHHepatomegaly, NHMalignant Lymphadenopathy +7 more
🎬Video coming soon
Shifting Dullness
Rule in:HCirrhosis, SHAscites, IEHepatopulmonary Syndrome
Rule out:SHAscites, MHCirrhosis, IEHepatopulmonary Syndrome
🎬Video coming soon
Edema Assessment
Rule in:SHAscites, SHCirrhosis, SHCushing Syndrome +14 more
Rule out:HAscites, MHHeart Failure, NHCirrhosis +14 more

Related Systems / Regions

AbdomenGastrointestinal

Related Diagnoses

AscitesHepatomegalyPerforated ViscusPeritonitisUrinary Retention

Related Chief Complaints

Abdominal DistensionAbdominal FullnessAbdominal PainAbdominal TendernessConfusionDark UrineDribbling UrineEasy BruisingFatigueFeverInability to UrinateIncidental FindingItchingJaundiceLeg SwellingLoss of AppetiteLower Abdominal PainNausea and VomitingRight Upper Quadrant PainRigid AbdomenSuprapubic PainUrinary FrequencyWeak Urinary StreamWeight Loss

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.