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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