From the Guidelines
The puddles sign is not a useful clinical demonstration for detecting ascites, as stated in the management of adult patients with ascites due to cirrhosis 1, 2. The puddles sign is mentioned in the context of physical examination for ascites, but it is not described in detail in the provided evidence. However, it is explicitly stated that the fluid wave and puddle sign are not useful in detecting ascites 1.
- The presence of a full, bulging abdomen should lead to percussion of the flanks to detect flank dullness, which is a more useful sign for detecting ascites 1, 2.
- Approximately 1,500 mL of fluid must be present before flank dullness is detected, and if no flank dullness is present, the patient has less than a 10% chance of having ascites 1, 2.
- The shifting dullness test has 83% sensitivity and 56% specificity in detecting ascites, making it a more reliable method than the puddles sign 2. Therefore, the puddles sign should not be relied upon for detecting ascites, and other methods such as percussion of the flanks and shifting dullness test should be used instead 1, 2.
From the Research
Demonstration of the Puddles Sign
The puddles sign is a bedside maneuver used to detect ascites.
- It involves the patient lying down and then getting up to see if a puddle of fluid forms on the abdomen, indicating the presence of ascites 3.
- The puddles sign has been compared to other methods of detecting ascites, such as auscultatory percussion and ultrasonography, in terms of sensitivity and specificity 3.
- Auscultatory percussion has been found to have a greater sensitivity than the puddles sign, but a lower specificity 3.
- The puddles sign is a simple and non-invasive method that can be used in clinical settings where ultrasonography may not be available 3.
Comparison with Other Methods
- The puddles sign has been evaluated in relation to other diagnostic tools, including shifting dullness and fluid wave, which are commonly used to detect ascites 3.
- Ultrasonography is considered a gold standard for detecting ascites, but the puddles sign can be a useful complementary tool, especially in resource-limited settings 3.
Clinical Context
- Ascites is a common complication of liver disease, particularly cirrhosis, and its detection is crucial for timely management and treatment 4, 5, 6.
- The management of ascites typically involves a combination of sodium restriction, diuretics, and other therapies, such as large volume paracentesis and transjugular intrahepatic portosystemic shunts 4, 5, 6.