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{{CMG}} {{AE}} {{EG}}
 
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==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]] 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===
*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]]


==Physical Examination==
=== HEENT ===
*[[Icterus (medicine)|Icteric]] [[sclera]]
===Neck===
*[[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===
===Abdomen===
 
*[[Abdominal distention]]
* Visible [[Bulging flanks|bulging of the flanks]] in the reclining patient ("flank bulging")
*[[Abdominal tenderness]] in the [[Right upper quadrant (abdomen)|right upper abdominal quadrant]]
* "[[Shifting dullness]]" (difference in percussion note in the flanks that shifts when the patient is turned on the side)
*[[Splenomegaly]]
* In massive ascites with a "fluid thrill" or "[[Fluid wave test|fluid wave]]" (tapping or pushing on one side will generate a wave-like effect through the fluid that can be felt in the opposite side of the abdomen).
*[[Caput medusae|Caput medusa]]
*[[Gynecomastia]]
===Back===
*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]]


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]
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]


{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Ascites.png|thumb|Ascites in a patient with cirrhotic liver disease. Dilated abdominal veins are visible]]
| [[Image:Ascites.png|thumb|Ascites in a patient with cirrhotic liver disease. Dilated abdominal veins are visible]]
| [[Image:Ascites 1.jpg|thumb|[[Ascites]], the same patient, lateral view.]]
| [[Image:Ascites 1.jpg|thumb|[[Ascites]], the same patient, lateral view.]]
Line 25: Line 63:


{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Ascites Child.jpg|thumb|A 2 month old child with [[ascites]]. [[Ascites]] is a common form of [[tuberculosis]] in higher incidence areas.]]
| [[Image:Ascites Child.jpg|thumb|A 2 month old child with [[ascites]]. [[Ascites]] is a common form of [[tuberculosis]] in higher incidence areas.]]
| [[Image:Ascites. Postmortem findings.jpg|thumb|Ascites: Postmortem findings]]
| [[Image:Ascites. Postmortem findings.jpg|thumb|Ascites: Postmortem findings]]
|}
|}


Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California
Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California


{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
|[[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.]]
|[[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.]]
| [[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.]]
| [[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.]]
|}
|}


{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:Abdomen ascites4.jpg|thumb|Ascites: Lateral view of abdomen tensely distended due to ascites.]]
| [[Image:Abdomen ascites4.jpg|thumb|Ascites: Lateral view of abdomen tensely distended due to ascites.]]
| [[Image:Abdomen ascites5.jpg|thumb|Ascites]]  
| [[Image:Abdomen ascites5.jpg|thumb|Ascites]]  

Revision as of 19:29, 16 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

Appearance of the Patient

  • Patients with ascites usually appear ill.

Vital Signs

Skin

HEENT

Neck

Lungs

Heart

Abdomen

Back

  • Back examination of patients with ascites is usually normal.

Genitourinary

Neuromuscular

Extremities

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. © PEIR, University of Alabama at Birmingham, Department of Pathology

Ascites in a patient with cirrhotic liver disease. Dilated abdominal veins are visible
Ascites, the same patient, lateral view.
A 2 month old child with ascites. Ascites is a common form of tuberculosis in higher incidence areas.
Ascites: Postmortem findings

Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California

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.
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.
Ascites: Lateral view of abdomen tensely distended due to ascites.
Ascites

References

  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.

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