Is there a past history of heart failure, cancer, or tuberculosis?
Obtain vital signs (temperature, respiratory rate, blood pressure, and weight). Ascites is rarely the sole physical finding. Examine for evidence of liver disease (jaundice, spider angiomata, Dupuytren’s contracture, caput medusae); hepatomegaly may be absent if chronic cirrhosis exists. Examine the skin for evidence of intravenous (IV) drug use, tattoos, and pigment changes (hemochromatosis). Jugular venous distention, a third heart sound, pulmonary crackles, and peripheral edema suggest heart failure. Abdominal tenderness can reflect pancreatitis or infection. Tests for ascites include shifting dullness, bulging flanks, flank dullness, fluid wave, and the “puddle” sign (i.e., percussing the abdomen with the patient on hands and knees). The reliability of these tests are unpredictable (2).
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- Is there a past history of heart failure, cancer, or tuberculosis?
