Ascites physical examination: Difference between revisions
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{{Ascites}} | {{Ascites}} | ||
{{CMG}} {{AE}} {{ | {{CMG}} {{AE}} {{EG}} | ||
==Overview== | ==Overview== | ||
[[Physical examination]] of patients with ascites is usually remarkable for [[flank]] dullness, [[Shifting dullness|shifting dullnes]], and [[Fluid wave test|fluid wave]]. The presence of decreased [[breath sounds]] or dull [[percussion]] in lower [[chest]] on physical examination is diagnostic of [[pleural effusion]] beside ascites. | |||
==Physical Examination== | ==Physical Examination== | ||
=== | *[[Physical examination]] of patients with ascites is usually remarkable for [[flank]] dullness, [[Shifting dullness|shifting dullnes]], and [[Fluid wave test|fluid wave]]. | ||
*The presence of decreased [[breath sounds]] or dull [[percussion]] in lower [[chest]] on physical examination is diagnostic of [[pleural effusion]] beside ascites.<ref name="pmid7057606">{{cite journal |vauthors=Cattau EL, Benjamin SB, Knuff TE, Castell DO |title=The accuracy of the physical examination in the diagnosis of suspected ascites |journal=JAMA |volume=247 |issue=8 |pages=1164–6 |year=1982 |pmid=7057606 |doi= |url=}}</ref> | |||
*Physical exam findings in patients with ascites are as followings:<ref>{{cite book | last = Walker | first = H | title = Clinical methods : the history, physical, and laboratory examinations | publisher = Butterworths | location = Boston | year = 1990 | isbn = 0-409-90077-X }}</ref> | |||
===Appearance of the Patient=== | |||
{| align="right" | |||
|{{#ev:youtube|JTUUQSe0-MA|600}} | |||
|} | |||
*Patients with ascites usually appear [[Ill feeling|ill]]. | |||
===Vital Signs=== | |||
*[[Low-grade fever]] | |||
*[[Hypothermia]] may be present | |||
*[[Tachypnea]] | |||
*[[Kussmaul respirations]] may be present in advanced disease state | |||
===Skin=== | |||
*[[Jaundice]] | |||
*[[Bruises]] | |||
*[[Spider angioma]] | |||
=== HEENT === | |||
*[[Icterus (medicine)|Icteric]] [[sclera]] | |||
===Neck=== | |||
{| align="right" | |||
|{{#ev:youtube|dkq5Ld1vuAQ|600}} | |||
|} | |||
*[[Jugular venous distension]] | |||
*[[Hepatojugular reflux]] | |||
===Lungs=== | |||
*Decreased [[breath sounds]] | |||
*Dull [[percussion]] in lower [[chest]] | |||
===Heart=== | |||
*[[Heart sounds#Third heart sound S3|S3]] | |||
*[[Heart sounds#Fourth heart sound S4|S4]] | |||
*[[Heart sounds#Summation Gallop|Gallops]] | |||
===Abdomen=== | |||
*[[Abdominal distention]] | |||
*[[Abdominal tenderness]] in the [[Right upper quadrant (abdomen)|right upper abdominal quadrant]] | |||
*[[Splenomegaly]] | |||
*[[Caput medusae|Caput medusa]] | |||
*[[Gynecomastia]] | |||
===Back=== | |||
{| align="right" | |||
|{{#ev:youtube|Or65nOrcz1A|600}} | |||
|} | |||
*Back examination of patients with ascites is usually normal. | |||
===Genitourinary=== | |||
*[[Testicular atrophy]] | |||
===Neuromuscular=== | |||
*Patient may be not oriented to persons, place, and time | |||
*Altered [[mental status]] | |||
*[[Asterixis]] ([[flapping tremor]]) | |||
*[[Clonus]] may be present | |||
===Extremities=== | |||
*[[Pitting edema]] of the [[lower extremities]] | |||
*[[Muscle atrophy]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: Medicine]] | |||
[[Category: Up-To-Date]] | |||
[[Category: Gastroenterology]] | |||
[[Category: Hepatology]] | |||
[[Category: Emergency medicine]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 13:35, 26 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Physical examination of patients with ascites is usually remarkable for flank dullness, shifting dullnes, and fluid wave. The presence of decreased breath sounds or dull percussion in lower chest on physical examination is diagnostic of pleural effusion beside ascites.
Physical Examination
- Physical examination of patients with ascites is usually remarkable for flank dullness, shifting dullnes, and fluid wave.
- The presence of decreased breath sounds or dull percussion in lower chest on physical examination is diagnostic of pleural effusion beside ascites.[1]
- Physical exam findings in patients with ascites are as followings:[2]
Appearance of the Patient
| JTUUQSe0-MA|600}} |
- Patients with ascites usually appear ill.
Vital Signs
- Low-grade fever
- Hypothermia may be present
- Tachypnea
- Kussmaul respirations may be present in advanced disease state
Skin
HEENT
Neck
| dkq5Ld1vuAQ|600}} |
Lungs
- Decreased breath sounds
- Dull percussion in lower chest
Heart
Abdomen
- Abdominal distention
- Abdominal tenderness in the right upper abdominal quadrant
- Splenomegaly
- Caput medusa
- Gynecomastia
Back
| Or65nOrcz1A|600}} |
- Back examination of patients with ascites is usually normal.
Genitourinary
Neuromuscular
- Patient may be not oriented to persons, place, and time
- Altered mental status
- Asterixis (flapping tremor)
- Clonus may be present
Extremities
References
- ↑ Cattau EL, Benjamin SB, Knuff TE, Castell DO (1982). "The accuracy of the physical examination in the diagnosis of suspected ascites". JAMA. 247 (8): 1164–6. PMID 7057606.
- ↑ Walker, H (1990). Clinical methods : the history, physical, and laboratory examinations. Boston: Butterworths. ISBN 0-409-90077-X.