i've been checking some physical assessment resources that i have to see if any of them describe dullness. what i am finding is that tympany
is the most common noting in the abdomen because of the presence of gas in the stomach, small bowel and colon. it has a drum-like sound. now, to me that means it kind of has an echo quality to it. here is what mark h. swartz has to say about percussion, dullness and flatness in his textbook of physical diagnosis: history and physical examination
, page 264: "percussion over a solid organ, such as the liver, produces a dull,
low-amplitude, short-duration note without resonance
. percussion over a structure containing air within a tissue, such as the lung, produces a resonant
, higher-amplitude, lower-pitched note. percussion over a hallow air-containing structure, such as the stomach, produces a typanic
, high-pitched, hollow-quality note. percussion over a large muscle mass, such as the thigh, produces a flat
, high-pitched note." based on that, i would be practicing these four percussions on either myself or willing volunteers and listening closely to distinguish between the differences in the sounds each produces. he goes on to say, "normally, in the chest, dullness
over the heart and resonance
over the lung fields are heard and felt. as the lungs are filled with fluid and become more dense, as in pneumonia, resonance
is replaced by dullness
. the term hyperresonance
has been applied to the percussioin note obtained from a lung of decreased density, as is found in emphysema. hyperresonance
is a low-pitched, hollow-quality, sustained resonant
note bordering on tympany
since i thought that it was important to look at percussion of the abdomen of someone with ascites, this is what i found on page 373. "while the patient is on his back [an] area of tympany
is present above the area of dullness
. this is due to gas in the bowel that is floating on top of the ascites [fluid]. the patient is then asked to turn on the side, and the examiner again determines the borders of the percussion notes. if ascites is present, dullness
will 'shift' to the more dependent position; the area around the umbilicus that was initially tympanic
will become dull
." i added the color and bold-facing.
you gotta feel like you're in music class after reading that! anyway, i'd be on the lookout for patients with ascites to examine and percuss.
now, after all that :stone
, this is what it says on page 15 of expert 10-minute physical examinations
by mosby published in 1997
- typany, a high-pitched, drum-like sound, is usually heard over normal lung tissue.
- hyperresonance, a loud, booming sound, is usually heard over a hyperinflated lung, as in patients with emphysema.
- dullness, a soft, high-pitched, thudlike sound, can generally be heard over dense organs, such as the liver.
- flatness, a soft-high-pitched sound, is generally heard over bones, muscles, and tumors.
if you read that all over about 5 times it starts to make some rational sense and tie together. you will still need to practice to teach your ear to distinguish between these different sounds that right now only have names that may not mean much to you. hope this has been a little helpful for you. happy percussing! :1luvu: