Which sign is positive in the presence of ascites?

• A. Shifting dullness
• B. CVA tenderness
• C. Ballottment sign
• D. Cutaneous hypersensitivity

Answer: (A)

Free intraperitoneal fluid settles with gravity, so a classic bedside sign of ascites is shifting dullness. When you percuss the abdomen with the patient lying flat, you'll usually hear tympanic notes where gas-filled bowels dominate and dull notes over the dependent areas where fluid collects. If you then roll the patient to the side, the fluid shifts and the area of dullness moves accordingly. A positive shifting dullness test means the dullness originally in one area has moved to another as gravity changes, confirming the presence of free fluid in the abdomen.

CVA tenderness points to kidney problems rather than ascites, and cutaneous hypersensitivity reflects peritoneal irritation rather than fluid accumulation. Ballottement can be used to assess abdominal fluid, but shifting dullness remains the most straightforward and reliable sign for ascites in common clinical practice.