{"id":248,"date":"2010-12-02T11:34:55","date_gmt":"2010-12-02T11:34:55","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/ascites\/"},"modified":"2023-01-11T23:28:23","modified_gmt":"2023-01-11T23:28:23","slug":"ascites","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-abdomen\/specific-examination-techniques\/ascites\/","title":{"rendered":"Ascites"},"content":{"rendered":"<p>Fluid accumulation in the abdominal cavity space is referred to as ascites. Ascites is always a symptom of a serious condition. It can arise through increased fluid production in the peritoneum, which may be caused by carcinomatous peritonitis, or by problems with normal circulatory fluid back-flow, e.g. due to hypoalbuminaemia or portal hypertension.<\/p>\n<p><strong>Inspection<\/strong><br \/>\nNote the shape of the abdomen, particularly the flanks.<br \/>\n<em>Fluid sinks to the lowest point. If the patient lies on their back, the flanks will bulge out due to the weight of the fluid and the navel will protrude.<\/em><br \/>\nAlso note other signs of hypoalbuminaemia, such as oedema, or liver abnormalities (see &#8220;The examination of the liver and gall bladder&#8221;).<\/p>\n<p><strong>Percussion<\/strong><br \/>\nSuspected ascites in a patient with a swollen abdomen can be confirmed by percussion. Again, fluid sinks to the lowest point and the air-filled intestines will \u2018float\u2019 to the top.<\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/122520287?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<h2>Procedure<\/h2>\n<ul>\n<li>Ask the patient to lie on their back.<\/li>\n<li>Begin percussion at the navel and progress in different directions toward the flanks [Figure 45].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-246\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-45.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-45.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-45-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 45<\/span><\/span><\/p>\n<ul>\n<li>Note the transition from tympany (intestines) to dullness (fluid).<br \/>\n<em>This border will run horizontally along the fluid level.<\/em><\/li>\n<li>Ask the patient to lie on their side.<\/li>\n<li>Repeat percussion starting at the elevated side in a downward direction and note the transition from tympany to dullness [Figure 46].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-247\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-46.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-46.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Abdomen_ab-fig-46-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 46<\/span><\/span><\/p>\n<ul>\n<li>If ascites is present, the elevated flank will exhibit tympany while the lower flank will display dullness upon percussion. This is refered to as shifting dullness.<\/li>\n<\/ul>\n<p><strong>Palpation<\/strong><br \/>\nIf a great deal of free fluid is present (more than 1,5 litres), it is possible to evoke undulation. A quick jab in one flank with one hand will produce a wave effect that can be felt in the opposite flank with the other hand.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Fluid accumulation in the abdominal cavity space is referred to as ascites. Ascites is always a symptom of a serious condition. It can arise through increased fluid production in the peritoneum, which may be caused by carcinomatous peritonitis, or by problems with normal circulatory fluid back-flow, e.g. due to hypoalbuminaemia or portal hypertension. Inspection Note [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[23],"tags":[126],"class_list":["post-248","post","type-post","status-publish","format-standard","hentry","category-specific-examination-techniques","tag-the-examination-of-the-abdomen"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Ascites - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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