Advanced Physical Diagnosis
  • Techniques
  • Demonstrations
Associated Evaluations
  • Patient HX
  • Physical Exam
  • Laboratory & Imaging
Differential Dx
Evidence Base
• History
• Physical Exam
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[Skill Modules >> Liver & Ascites >> Patient Hx ]

Patient Hx: Liver & Ascites

Alcohol intake

  • Quantity and duration
  • Has ascites diminished/resolved intermittently in relation to abstinence from alcohol?

Risk factors for viral hepatitis

  • IV drug use
  • Tattoos
  • Acupuncture
  • Sexual history
  • Travel history, where born

Family history (Wilson's disease, hemochromatosis)

How rapidly has the increase in abdominal girth occurred?

Does the patient have a history of cirrhosis?

Symptoms suggestive of malignancy?

  • Prior history of cancer
  • Associated abdominal pain
  • History of long-standing cirrhosis followed by abrupt development of ascites: consider hepatocellular carcinoma

History of cardio-pulmonary disease

  • Congestive heart failure (CHF)
  • Cardiomyopathy
  • Constrictive pericarditis
  • Cor pulmonal

Symptoms of infections

  • Consider spontaneous bacterial peritonitis (SBP) in patient with ascites and fever or abdominal discomfort
  • History of tuberculosis - more likely in patient with alcoholism, poor nutritional status, or recent immigration to the US
  • HIV infection (more commonly have small amount of ascites incidentally detected)

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