Ascites physical examination

Ascites Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Ascites from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Ascites physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ascites physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Ascites physical examination
CDC on Ascites physical examination
Ascites physical examination in the news
Blogs on Ascites physical examination
Directions to Hospitals Treating Ascites
Risk calculators and risk factors for Ascites physical examination

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.
• Physical exam findings in patients with ascites are as followings:

Appearance of the Patient

• 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

• Jaundice
• Bruises
• Spider angioma

HEENT

• Icteric sclera

Neck

• Jugular venous distension
• Hepatojugular reflux

Lungs

• Decreased breath sounds
• Dull percussion in lower chest

Heart

• S3
• S4
• Gallops

Abdomen

• Abdominal distention
• Abdominal tenderness in the right upper abdominal quadrant
• Splenomegaly
• 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. © 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