Himali Meshram
Presenting features include abdominal distension, increasing weight, respiratory distress, associated pedal edema. Ascites associated with malignancies are usually painful while cirrhotic patients have painless ascites.1 Ascites needs to be differentiated from other causes of abdominal distension like gaseous distension, bowel obstruction, obesity or abdominal mass. The examination should also focus on signs of chronic liver disease and portal hypertension. Flank dullness is present in about 90% of patients and is the most sensitive physical sign.

Clinical grading of ascites:
• Mild: Puddle sign+
• Moderate: Shifting dullness +, no fluid thrill
• Severe: Fluid thrill+

Using a modified criterion of the European Association for the Liver Study, ascites grades were defined as follows:4
• Grade 1: ascites detected by only radiological tests such as ultrasound of abdomen.
• Grade 2: there is moderate abdominal distension detected on physical examination and/or by radiologic tests.
• Grade 3: there is gross ascites with marked abdominal distension.

Ascites Ascites 10/02/2019
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