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ARTICLE |

Does This Patient Have Ascites?  How to Divine Fluid in the Abdomen

John W. Williams Jr, MD; David L. Simel, MD, MHS
JAMA. 1992;267(19):2645-2648. doi:10.1001/jama.1992.03480190087038.
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CLINICAL SCENARIOS—DO THESE PATIENTS HAVE ASCITES?  In each of the following cases, the clinician will need to determine whether the patient has ascites. Case 1: A 44-year-old cirrhotic man is admitted with fever but has no obvious source of infection. Case 2: A 57-year-old woman presents with an adnexal mass and recent weight gain but otherwise feels well. Case 3: A 65-year-old man with a history of prior myocardial infarction is admitted for decreased exercise tolerance, increased abdominal girth, and ankle edema.

WHY IS THIS AN IMPORTANT QUESTION TO ANSWER WITH A CLINICAL EXAMINATION?  Free fluid in the abdominal cavity is ascites. Ascites is a symptom that may have important diagnostic, prognostic, and therapeutic implications. When clinically detectable, ascites may indicate underlying heart failure, liver disease, nephrotic syndrome, or malignancy. In patients with liver disease, ascites has prognostic significance since operative mortality is increased and overall survival is decreased; ascites

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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