Puddle's Sign

Some signs can be better understood and remembered by knowing the meaning of word. Of course, most of the signs are named after people, but we are lucky to have few signs otherwise. For example, when I asked one medical student why Puddle's sign is named so, he told me that it was named after Dr. Puddle and he didnot remember what the sign was about.

So what's a puddle? A puddle is a small collection of liquid, usually we refer to a puddle of water in the ground after a rain etc. This is used to detect minimal fluid collection in the abdomen i.e. minimal ascitis.

Now to remember, you have the picture given below. There's a puddle, a sign board reading 120 ml and a Gorilla. Puddle sign can detect ascitis as less as 120 ml. What's the Gorilla doing there? The Gorilla's position is the position we use to elicit puddle sign. To make this more clear, let us see how to elicit this sign.

 Let patient lie prone for 5 minutes, after which he/she has to rise on his/her elbow and knees (that's like the Gorilla!) and by the method of auscultatory percussion you find that there is resonant note in the flanks and dull note towards the center of abdomen i.e. the puddle forms at the central part of abdomen.