Ascites physical examination: Difference between revisions

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VisualWikitext

Latest revision as of 13:35, 26 January 2018

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

Icteric sclera

Neck

dkq5Ld1vuAQ|600}}

Lungs

Decreased breath sounds
Dull percussion in lower chest

Heart

Abdomen

Back

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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

↑ 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.

Template:WH Template:WS

[pmid7057606-1] 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.

[2] Walker, H (1990). Clinical methods : the history, physical, and laboratory examinations. Boston: Butterworths. ISBN 0-409-90077-X.

[1]

[2]

@@ Line 2: / Line 2: @@
 {{Ascites}}
-{{CMG}} {{AE}} {{MUT}}
+{{CMG}} {{AE}} {{EG}}
 ==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==
-===Abdomen===
+*[[Physical examination]] of patients with ascites is usually remarkable for [[flank]] dullness, [[Shifting dullness|shifting dullnes]], and [[Fluid wave test|fluid wave]].
-Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology]
+*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>
-{| align="center"
+===Appearance of the Patient===
-|-valign="top"
+{| align="right"
-| [[Image:Ascites.png|thumb|Ascites in a patient with cirrhotic liver disease. Dilated abdominal veins are visible]]
+|{{#ev:youtube|JTUUQSe0-MA|600}}
-| [[Image:Ascites 1.jpg|thumb|[[Ascites]], the same patient, lateral view.]]
 |}
+*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]]
-{| align="center"
+=== HEENT ===
-|-valign="top"
+*[[Icterus (medicine)|Icteric]] [[sclera]]
-| [[Image:Ascites Child.jpg|thumb|A 2 month old child with [[ascites]]. [[Ascites]] is a common form of [[tuberculosis]] in higher incidence areas.]]
+===Neck===
-| [[Image:Ascites. Postmortem findings.jpg|thumb|Ascites: Postmortem findings]]
+{| align="right"
+|{{#ev:youtube|dkq5Ld1vuAQ|600}}
 |}
+*[[Jugular venous distension]]
+*[[Hepatojugular reflux]]
+===Lungs===
+*Decreased [[breath sounds]]
+*Dull [[percussion]] in lower [[chest]]
+===Heart===
-Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California
+*[[Heart sounds#Third heart sound S3|S3]]
+*[[Heart sounds#Fourth heart sound S4|S4]]
-{| align="center"
+*[[Heart sounds#Summation Gallop|Gallops]]
-|-valign="top"
+===Abdomen===
-|[[Image:Abdomen ascites.jpg|thumb|Ascites: Abdomen symetrically distended secondary to fluid buildup in    peritoneal cavity. Note bulging flanks as fluid distributes to most dependent areas of abdomen. Skin is also yellowed due to hyperbilirubinemia.]]
+*[[Abdominal distention]]
-| [[Image:Abdomen ascites2.jpg|thumb|Ascites with Shifting Dullness: Ascitic fluid will flow to the most    dependent portions of the abdomen. The air-filled intestines will float on top of this liquid. The technique of    shifting dullness makes use of this relationship in order to detect the presence    of ascitic fluid.]]
+*[[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]]
-{| align="center"
-|-valign="top"
-| [[Image:Abdomen ascites4.jpg|thumb|Ascites: Lateral view of abdomen tensely distended due to ascites.]]
-| [[Image:Abdomen ascites5.jpg|thumb|Ascites]]
-|}
 ==References==
 {{Reflist|2}}
+[[Category: Medicine]]
+[[Category: Up-To-Date]]
+[[Category: Gastroenterology]]
+[[Category: Hepatology]]
+[[Category: Emergency medicine]]
 {{WH}}
 {{WS}}