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 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]

• Patients with ascites usually appear ill.

• Low-grade fever
• Hypothermia may be present
• Tachypnea
• Kussmaul respirations may be present in advanced disease state

• Jaundice
• Bruises
• Spider angioma

• Icteric sclera

• Jugular venous distension
• Hepatojugular reflux

• Decreased breath sounds
• Dull percussion in lower chest

• S3
• S4
• Gallops

• Abdominal distention
• Abdominal tenderness in the right upper abdominal quadrant
• Splenomegaly
• Caput medusa
• Gynecomastia

• Back examination of patients with ascites is usually normal.

• Testicular atrophy

• Patient may be not oriented to persons, place, and time
• Altered mental status
• Asterixis (flapping tremor)
• Clonus may be present

• Pitting edema of the lower extremities
• Muscle atrophy

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