Additionally, the presence of an umbilical hernia or a newly formed fluid wave can be the first visual clues. A moderate volume, often seen in cirrhosis, presents with shifting dullness but no visible contour changes.
Shifting Dullness Techniques and Key Physical Findings
Guarding or rigidity is also noted, as these signs may suggest an inflammatory or infectious process, such as spontaneous bacterial peritonitis, complicating the ascites. Hernia Examination and Skin Turgor A focused assessment of the groin and abdominal wall is integral to the exam.
A large volume results in marked abdominal distension, stretching of the skin, and difficulty in breathing as the diaphragm is pushed upward. Stretch marks, or striae, may be visible if the distension has occurred rapidly.
Ascites Shifting Dullness: Performing the Exam Correctly
Skin turgor is tested by pinching a fold of skin on the abdomen; in severe dehydration, the skin may tent, although this is often masked by the fluid in true ascites. Existing inguinal or umbilical hernias are evaluated for incarceration or enlargement, as the increased intra-abdominal pressure from ascites can exacerbate these conditions.
More About Ascites physical exam
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More perspective on Ascites physical exam can make the topic easier to follow by connecting earlier points with a few simple takeaways.
