Ascites & Venous Patterns
- Begin percussing in the center or most protuberant part of the abdomen. You should hear tympany from air in the loops of bowel that have floated up.
- Percuss laterally towards you from that point till you encounter dullness. KEEP YOUR FINGERS THERE.
- Ask patient to turn to the side away from you. Wait a few seconds (for fluid to move to the new dependent area and for bowel to float up).
- Now when you percuss it should be tympanitic.
Fluid Thrill or Wave
- Ask pt or assistant to press the edge of one hand vertically down the midline of the abdomen.
- Tap or flick one flank sharply with fingertips while palm of the other hand is resting on the other flank.
- The positive finding is a “thrill” which is a better descriptor than wave.
- Because cirrhosis is the most common cause of ascites, many patients with ascites demonstrate the stigmata of liver disease.
- An elevated JVP suggests a cardiac cause (e.g. heart failure, constrictive pericarditis) of ascites.
Abdominal Venous Patterns
- Need to distinguish three kinds of flow in visible veins.
- Flow away from the umbilicus (portal hypertension).
- Flow to the umbilicus (rare, in portal vein thrombosis).
- Flow from down to up (IVC obstruction).
Key Learning Points
- Learn how to test for shifting dullness
- Learn how to test for a fluid wave
- Describe abdominal venous patterns
The Stanford Medicine 25
- Ankle Brachial Index
- Ascites & Venous Patterns
- Bedside Ultrasound
- Cardiac Second Sounds
- Cerebellar Exam
- Deep Tendon Reflexes
- Dermatology Exam: Acne vs. Rosacea
- Dermatology Exam: Learning the Language
- Dermatology Exam: Nevi (Mole) Exam
- Examination of the Liver
- Examination of the Spleen
- Fundoscopic Exam
- Gait Abnormalities
- Internal Capsule Stroke
- Involuntary Movements
- Knee Exam
- Liver Disease, Head to Foot
- Lymph Node Exam
- Neck Veins & Wave Forms
- Precordial Movements
- Pulmonary Exam: Percussion & Inspection
- Pulsus Paradoxus and Blood Pressure Measurement Techniques
- Pupillary Responses
- Rectal Exam
- Shoulder Exam
- The Hand in Diagnosis
- The Tongue in Diagnosis
- Thyroid Exam