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May 20, 1992

Does This Patient Have Ascites?How to Divine Fluid in the Abdomen

Author Affiliations

From the Ambulatory Care Service and The Center for Health Services Research in Primary Care, Durham Veterans Administration Medical Center, and the Division of General Internal Medicine, Duke University Medical Center, Durham, NC. Dr Williams is now with the University of Texas Health Science Center, San Antonio.

JAMA. 1992;267(19):2645-2648. doi:10.1001/jama.1992.03480190087038

CLINICAL SCENARIOS—DO THESE PATIENTS HAVE ASCITES?  In each of the following cases, the clinician will need to determine whether the patient has ascites. Case 1: A 44-year-old cirrhotic man is admitted with fever but has no obvious source of infection. Case 2: A 57-year-old woman presents with an adnexal mass and recent weight gain but otherwise feels well. Case 3: A 65-year-old man with a history of prior myocardial infarction is admitted for decreased exercise tolerance, increased abdominal girth, and ankle edema.

WHY IS THIS AN IMPORTANT QUESTION TO ANSWER WITH A CLINICAL EXAMINATION?  Free fluid in the abdominal cavity is ascites. Ascites is a symptom that may have important diagnostic, prognostic, and therapeutic implications. When clinically detectable, ascites may indicate underlying heart failure, liver disease, nephrotic syndrome, or malignancy. In patients with liver disease, ascites has prognostic significance since operative mortality is increased and overall survival is decreased; ascites

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