Puddle sign

In gastroenterology, the puddle sign is a physical examination maneuver that can be used to detect the presence of ascites. It is useful for detecting small amounts of ascites—as small as 120 mL; shifting dullness and bulging flanks typically require 500 mL.

The steps are outlined as follows:
 * 1) Patient lies prone for 5 minutes
 * 2) Patient then rises onto elbows and knees
 * 3) Apply stethoscope diaphragm to most dependent part of the abdomen
 * 4) Examiner repeatedly flicks near flank with finger. Continue to flick at same spot on abdomen
 * 5) Move stethoscope across abdomen away from examiner
 * 6) Sound loudness increases at farther edge of puddle
 * 7) Sound transmission does not change when patient sits

In relation to auscultatory percussion, the puddle sign is more specific, but less sensitive.