RN Nursing · GI Assessment · Practice question
Which of the following conditions is most likely to present with dullness on percussion of the protuberant abdomen?
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Paralytic ileus.
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Increased gas production.
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✓
Large solid tumor.
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Intestinal obstruction.
Answer & explanation
Correct: Large solid tumor.
Percussion of the abdomen normally produces tympany over areas containing gas and dullness over solid organs or fluid. A large solid tumor occupies space previously filled with gas-containing bowel, replacing the resonant tympanic sound with dullness because solid tissue does not allow sound waves to reverberate in the way gas does. This is analogous to percussing over the liver, which also produces dullness. A protuberant abdomen with a large solid mass will therefore generate widespread dullness across the affected region. Paralytic ileus involves loss of peristalsis and accumulation of gas within bowel loops, which would increase tympany rather than produce dullness. Increased gas production similarly shifts percussion toward hyperresonance or tympany throughout the abdomen. Intestinal obstruction, especially in early stages, also results in distended, gas-filled loops of bowel, yielding tympanic percussion notes. The key distinguishing feature of a large solid tumor is that it displaces air-containing viscera and presents as a dense, non-resonant mass on percussion, making dullness the expected finding. Students should associate solid or fluid-filled masses with dullness and gas-filled structures with tympany when interpreting abdominal percussion findings.
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