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Detecting ascites

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Most cases can be diagnosed by good clinical assessment at the bedside

The presence of ascites is a common physical finding and the detection of ascites is important for both diagnostic and prognostic reasons. Ascites is defined as the pathological accumulation of fluid in the peritoneal cavity.1 It may be due to a number of causes (Box 1). The most common is portal hypertension as a result of cirrhosis (> 75%) but malignancy (10%), heart failure (3%) and infection (2%) are other possibilities.1

Patients with ascites usually present to clinicians with increasing abdominal distension, weight gain and discomfort. However, ascites may be detected incidentally in patients developing other complications of their cirrhosis, such as variceal haemorrhage and encephalopathy. Moreover, a patient may present when their underlying heart failure or malignancy progresses.

Initial assessment of the patient will involve taking a history to determine the risk of liver disease. This will include questions about alcohol consumption and risk factors for chronic hepatitis, especially hepatitis C. Cardiac symptoms (shortness of breath and orthopnoea) can be assessed and patients should also be asked about symptoms that might indicate an underlying malignancy, such as weight loss and decreased appetite. Patients who do not complain…