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Make the Diagnosis: Ascites

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During the general physical examination, patients should not be evaluated for ascites. When it is important to detect smaller amounts of peritoneal fluid, radiologic images will be necessary because the clinical examination will not be useful, which is especially important when evaluating for abdominal malignancies or for patients with blunt abdominal trauma.

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Prior Probability

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The prevalence of ascites in an unselected population is low, likely on the order of less than 1% (expert opinion).

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The prevalence of ascites among general medical patients will be slightly higher, but still less than 5% (expert opinion).

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Population for Whom the Symptoms and Signs Should be Evaluated

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  • Cirrhosis

  • Congestive heart failure

  • Constrictive pericarditis

  • Nephrotic syndrome

  • Malnutrition, chronic diarrhea

  • Neoplastic disorders (any peritoneal fluid might be important)

  • Systemic infectious diseases

  • Blunt abdominal trauma (any peritoneal fluid might be important)

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The absence of findings does not rule out the presence of smaller amounts of peritoneal fluid. See Tables 6-8 and 6-9.

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Table Graphic Jump Location
Table 6-8Symptoms of Ascites
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Table Graphic Jump Location
Table 6-9Signs for Ascites
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Reference standard tests

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  • Ultrasonography

  • Computed tomography

  • Diagnostic paracentesis

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Original Article: Does This Patient Have Ascites? How to Divine Fluid in the Abdomen

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Clinical Scenarios

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In each of the following cases, the clinician will need to determine whether the patient has ascites.

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Case 1
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A 44-year-old man with cirrhosis is admitted with fever but has no obvious source of infection.

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Case 2
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A 57-year-old woman presents with an adnexal mass and recent weight gain but otherwise feels well.

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Case 3
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A 65-year-old man with a history of myocardial infarction is admitted for decreased exercise tolerance, increased abdominal girth, and ankle edema.

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Why Is This an Important Question to Answer With a Clinical Examination?

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Free fluid in the abdominal cavity is ascites. Ascites may have important diagnostic, prognostic, and therapeutic implications. When clinically detectable, ascites may indicate underlying heart failure, liver disease, nephrotic syndrome, or malignancy. In patients with liver disease, ascites ...

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