Shifting Dullness to Detect Ascites on Physical Exam
1) Perform with the patient supine.
2) Percuss across the abdomen for flank dullness, with the point of transition from tympany to dullness noted.
3) Roll the patient onto his/her side away from the examiner, and repeat percussion from the umbilicus to flank area.
4) Positive test: When ascites is present, the area of dullness will shift to the dependent site. The area of tympany will shift toward the top.

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