Physical examination maneuver

Physical Exam

Shifting Dullness

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How to Perform

With the patient supine, percuss the abdomen directly on skin from the umbilical region toward each flank and identify where tympany changes to dullness. Ask the patient to roll onto one side, wait briefly, then percuss the now-upper flank again. The test is positive if the boundary of dullness shifts toward the dependent side, causing the previously dull upper flank to become tympanitic.

How to Interpret

Showing 2 of 3 findings

Ascites

Shifting dullness positive
Rule in
Somewhat helpfulNo CI
Rule out
Somewhat helpfulNo CI
Evidence:Moderate

Cirrhosis

Ascites present on examination
Rule in
Helpful
Rule out
Minimally helpful
Evidence:Strong

Related Bedside Tests

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Abdomen Inspection
Rule in:VHBowel Obstruction, SHAscites, ICCushing Syndrome +3 more
Rule out:SHAscites, SHBowel Obstruction, NHCushing Syndrome +3 more
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Edema Assessment
Rule in:SHAscites, SHCirrhosis, SHCushing Syndrome +14 more
Rule out:HAscites, MHHeart Failure, NHCirrhosis +14 more
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Liver Palpation
Rule in:SHCirrhosis, SHHepatomegaly, NHMalignant Lymphadenopathy +7 more
Rule out:SHCirrhosis, SHHepatomegaly, NHMalignant Lymphadenopathy +7 more
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Spleen Palpation
Rule in:VHSplenomegaly, HMalaria, SHCirrhosis +13 more
Rule out:SHMyelofibrosis, MHInfectious Mononucleosis, MHSplenomegaly +13 more
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Abdomen Percussion
Rule in:SHAscites, NHHepatomegaly, IEPerforated Viscus +2 more
Rule out:SHAscites, NHHepatomegaly, IEPerforated Viscus +2 more
🎬Video coming soon
Skin Inspection and Palpation
aka Skin examination
Rule in:VHNecrotizing Soft-tissue Infection, HCirrhosis, HHyperthyroidism +12 more
Rule out:HFever, HShock, SHHepatopulmonary Syndrome +12 more

Related Systems / Regions

AbdomenGastrointestinal

Related Diagnoses

AscitesCirrhosisHepatopulmonary Syndrome

Related Chief Complaints

Abdominal DistensionAbdominal FullnessConfusionDark UrineEarly SatietyEasy BruisingFatigueItchingJaundiceLeg SwellingLoss of AppetiteRight Upper Quadrant PainShortness of BreathWeight GainWeight Loss

References

Research in progress on one or more findings above; ratings may change.

  • 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
  • Udell JA, Wang CS, Tinmouth J, et al. Does this patient with liver disease have cirrhosis? JAMA. 2012;307(8):832-842. PMID 22357834.
  • Alizadeh AHM, Fatemi SR, Mirzaee V, et al. Clinical features of hepatopulmonary syndrome in cirrhotic patients. World J Gastroenterol. 2006;12(12):1954-1956. PMID: 16610006.

Research last updated September 10, 2026.