Puddle sign... What's that?
Puddle is a small pool of fluid. Similarly P uddle sign is found when a pool of fluid gets accumulated in the peritoneal cavity ( ASCITES ). This auscultatory sign can successfully detect as less as 120 ml of free fluid in the abdomen. On the other hand the two signs of percussion and palpation, namely shifting dullness and fluid thrill are elucited when the peritoneal fluid volume is more than 500 ml and 1500 ml respectively. " Like the silence before the storm, there is dullness before the thrill ." Let us presume that we have a patient with ascites and we are required to perform a diagnostic paracentesis (25ml fluid withdrawn using 5ml syringe). What are we required to look at? Color : Clear or cloudy yellow : Normal/TB Straw colored : Cirrhosis, Cancer (Ca), CHF, Nephrotic syndrome Bloody : Ca, TB, Pancreatic (Contain RBCs) Milky (Chy...
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