{"id":212,"date":"2010-12-02T11:27:38","date_gmt":"2010-12-02T11:27:38","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/percussion\/"},"modified":"2023-01-11T23:36:35","modified_gmt":"2023-01-11T23:36:35","slug":"percussion","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-abdomen\/the-abdominal-examination\/percussion\/","title":{"rendered":"Percussion"},"content":{"rendered":"<h2>Procedure<\/h2>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/122520397?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<ul>\n<li>Lay your non-dominant hand flat on the area to be percussed with fingers spread apart slightly [Figure 17]<\/li>\n<li>Press the middle finger (or the index or ring finger) firmly against the underlying skin (this finger is referred to as the pleximeter finger)<\/li>\n<li>Using the tip of the half-bent middle finger (the plexor) of the opposite hand, tap on the distal interphalangeal joint or distal phalynx of the pleximeter finger<\/li>\n<li>Taps should be short, elastic, and supple, using the wrist; keep the lower arm still and the fingers as relaxed as possible<\/li>\n<li>Tap two or three times with a frequency of approximately two taps per second; make sure the taps are clearly audible, and use a consistent force for each tap<\/li>\n<li>Move the fingers calmly. Abrupt movements can startle the patient<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-209\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-17.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-17.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-17-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 17<\/span><\/span><\/p>\n<ul>\n<li>First percuss all abdominal regions systematically (comparative percussion) [Figure 18]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-210\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-18.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-18.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-18-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 18: Percussion points<\/span><\/span><\/p>\n<ul>\n<li>Percuss the site of abdominal pain last<\/li>\n<li>For each location, determine the sound of the percussion and whether the percussion is painful<\/li>\n<li>Lastly, determine by percussion the perimeters of the areas with dull percussion and areas with pain on percussion. For this examination, lay the pleximeter finger parallel to the border in question<br \/>\n<em>These areas can be indicated on a diagram [Figure 19]<\/em><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-211\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-19.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-19.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-19-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 19: Schematic representation of the percussion findings<\/span><\/span><\/p>\n<p><em><strong>Focus points<\/strong><\/em><\/p>\n<ul>\n<li>Determine tympanic regions and areas dull to percussion<br \/>\n<em>Tympany indicates gas retention, and dull percussion suggests a \u2018solid\u2019 underlying structure. Normally, the percussion sound changes across the abdomen (\u2018normal percussion sounds\u2019) <\/em><\/li>\n<li>Determine the location and extent of areas with dull percussion sounds (identify the borders of dullness)<br \/>\n<em>Normally, the liver is the only part of the abdomen that is large enough to produce an obvious dull percussion sound. If dull percussion sounds are also found under the right costal arch, the presence of hepatomegaly should be determined (see &#8220;The examination of the liver and gall blader&#8221;)<\/em><br \/>\n<em>If there is dullness above the left costal arch (Traube\u2019s space), it should be determined whether splenomegaly is present (see &#8220;The examination of the spleen&#8221;)<\/em><\/li>\n<li>Be aware of any tenderness on percussion. Determine the location and extent of the area of percussion tenderness<br \/>\n<em>Ask the patient to tell you when the percussion hurts. Be sure to monitor the patient\u2019s face. If the patient feels pain, ask where it hurts. It may be a different location than that percussed. Percussion tenderness is indicative of peritoneal irritation, particularly if it is felt at another location<\/em><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Procedure Lay your non-dominant hand flat on the area to be percussed with fingers spread apart slightly [Figure 17] Press the middle finger (or the index or ring finger) firmly against the underlying skin (this finger is referred to as the pleximeter finger) Using the tip of the half-bent middle finger (the plexor) of the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[22],"tags":[126],"class_list":["post-212","post","type-post","status-publish","format-standard","hentry","category-the-abdominal-examination","tag-the-examination-of-the-abdomen"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Percussion - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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