Tympany Predominates In All Four Quadrants

Percussion helps you to assess the amount and distribution of gas in the abdomen and to identify possible masses that are solid or fluid filled. Its use in estimating the size of the liver and spleen will be described in later sections.

Percuss the abdomen lightly in all four quadrants to assess the distribution of tympany and dullness. Tympany usually predominates because of gas in the gastrointestinal tract, but scattered areas of dullness due to fluid and feces there are also typical.

■ Note any large dull areas that might indicate an underlying mass or enlarged organ. This observation will guide your palpation.

A protuberant abdomen that is tympanitic throughout suggests intestinal obstruction. See Table 9-9, Protuberant Abdomens (p. 361).

Pregnant uterus, ovarian tumor, distended bladder, large liver or spleen

■ On each side of a protuberant abdomen, note where abdominal tympany changes to the dullness of solid posterior structures.

Briefly percuss the lower anterior chest, between lungs above and costal margins below. On the right, you will usually find the dullness of liver; on the left, the tympany that overlies the gastric air bubble and the splenic flexure of the colon.

Dullness in both flanks indicates further assessment for ascites (see pp. 345-347).

In situs inversus (rare), organs are reversed: air bubble on the right, liver dullness on the left.

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