Evaluation for ascites

Definition:

 The use of clinical examinations to determine the presence of ascites in patient. Ascites is a clinical term used to describe an accumulation of fluid in the peritoneal cavity. Common causes include liver cirrhosis, advanced liver pathologies and metastatic cancer.

 Test procedure and findings:

Flank dullness test: with the patient lying supine, percuss the patient’s abdomen starting at the umbilicus and moving towards the flanks. The point of transition from tympany to dullness is noted. A positive sign would be for the percussion to sound hollow (tympanitic) over the umbilical area and dull in the flanks, as the fluid settles.

Shifting dullness test: The patient lies supine. The practitioner percusses across the patient’s abdomen from the umbilicus towards the flanks. The point of transition from tympanic sounds to dullness are noted.
Once the above is complete, the patient lies on their side away from the practitioner and percussion from the umbilicus to the flanks is repeated. A positive for this test would be for the area of tympany to shift from around the umbilicus as the patient is lying supine, to around the superior flank when the patient is on their side.

Special considerations:

Mild ascites is hard to notice using only the aforementioned tests and is more easily detected using ultrasound. Moderate to severe ascites will distend the abdomen and produce visible signs such as bulging flanks when lying supine. A common complaint for patients suffering from ascites is shortness of breath, due to the mechanical pressure exerted onto the diaphragm.

Other signs of ascites include: portal hypertension, often co-existing with liver pathology, swelling of the feet and distal legs, gynecomastia, haemetemisis and ecchymoses.