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[Physical diagnosis--ascites].

H G Schipper1, M H Godfried

  • 1Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Inwendige Geneeskunde, Meibergdreef 9, 1105 AZ Amsterdam. h.g.schipper@amc.uva.nl

Nederlands Tijdschrift Voor Geneeskunde
|March 10, 2001
PubMed
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Diagnosing ascites relies heavily on clinical history and physical examination, significantly increasing diagnostic likelihood. Abdominal ultrasound is reserved for cases where clinical assessment is inconclusive or findings are clinically relevant.

Area of Science:

  • Medical Diagnostics
  • Clinical Medicine
  • Gastroenterology

Background:

  • Ascites, the abnormal accumulation of fluid in the abdominal cavity, requires accurate diagnosis for effective management.
  • Clinical assessment, including patient history and physical examination, forms the initial approach to suspected ascites.

Purpose of the Study:

  • To evaluate the diagnostic utility of clinical history and physical examination in identifying ascites.
  • To determine the role of abdominal ultrasound in the diagnostic pathway of ascites.

Main Methods:

  • Review of diagnostic parameters including patient-reported symptoms (weight gain, abdominal girth, ankle edema) and physical examination findings (fluid wave, shifting dullness, bulging flanks, flank dullness).
  • Assessment of likelihood ratios associated with positive and negative clinical findings.

Related Experiment Videos

  • Evaluation of the necessity of abdominal ultrasound based on pre-test probability derived from clinical assessment.

    • Main Results:

    • A positive clinical history can increase the likelihood of ascites 3 to 4-fold.
    • Positive physical examination findings, combined with a positive history, can increase diagnostic likelihood 10 to 20-fold.
    • Abdominal ultrasound is not always necessary when ascites diagnosis is very likely or unlikely based on clinical evaluation alone.

    Conclusions:

    • Clinical history and physical examination are powerful tools for diagnosing ascites, often obviating the need for immediate imaging.
    • Abdominal ultrasound serves as a crucial confirmatory tool when clinical suspicion is high and findings have clinical relevance, or when initial assessment is equivocal.