Ascites physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: M.Umer Tariq [2]

Physical Examination

Abdomen

• Visible bulging of the flanks in the reclining patient ("flank bulging")
• "Shifting dullness" (difference in percussion note in the flanks that shifts when the patient is turned on the side)
• In massive ascites with a "fluid thrill" or "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).

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