Spontaneous bacterial peritonitis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Guillermo Rodriguez Nava, M.D. [3]
Overview
If a patient presents with a full, bulging abdomen, percussion of the flanks can provide valuable information to diagnose ascites. The presence of shifting dullness has 83% sensibility and 56% specificity to diagnose ascites. A patient without flank dullness has less than 10% chance of having ascites.[1]
Physical Examination
Appearance of the patient
- The patient may appear toxic and in distress because of pain in the abdomen.
Vital Signs
Temperature
- May have increase in temperature due to infection.
- It may decreased if disease progresses to septic shock.
Blood Pressure
- Hypertension can be seen if associated with any heart condition or renal disease.
- Hypotension can be seen in cases of volume loss due diarrhea or severe ascites.
Pulse
- May be normal or increased in rate due to infection.
- It may be low in volume due to dehydration.
Skin
- Skin over abdomen is tense due to ascites.
- Skin changes due to cirrhosis may be seen like spider nevus.
Eyes
- Jaundice may be seen in cases of liver cirrhosis.
- Periorbital puffiness may be noticed in cases of renal failure.
Neck
- Jugular venous distension may be seen in cases of heart failure causing ascites.
Heart
- Signs of heart failure may be seen like S3.
Lungs
- Signs of any infection, or signs of volume overload in lungs due to heart failure.
Abdomen
- Tense and distended abdomen is noticed.
- Tenderness on palpation.
- Shifting dullness on percussion, but it may be painful due to infection.
Neurologic
Following may be noticed when spontaneous bacterial peritonitis complicates or due to underlying liver or renal failure.
References
- ↑ Cattau EL, Benjamin SB, Knuff TE, Castell DO (1982). "The accuracy of the physical examination in the diagnosis of suspected ascites". JAMA. 247 (8): 1164–6. PMID 7057606.