DDx

• gas (flatus )
• excessive peritoneal cavity fluid (Ascites )
• feces (Constipation )
• Pregnancy
• Abdominal Mass
• Obesity

History

• Is it symmetrical or asymmetrical, constant or intermittent and what are the alleviating or exacerbating factors (eating, passing gas or stool)?
• Ask about associated symptoms (change in bowel habit, heartburn, weight loss, anorexia, swallowed air (aerophagia), ankle swelling, signs of liver disease)?
• Always suspect Ascites in patients with liver disease and progressive increase in abdominal girth
  • Abdominal girth is the measurement of the distance around the abdomen at a specific point.
  • Measurement is most often made at the level of the belly button (navel).

Physical Exam

• Routine Abdominal Exam
  • Percussion:
    • tympanic note: intestinal obstruction predominates as the cause
    • dull note: ascites predominates as the cause