Harrison's Internal Medicine Chapter 44. Abdominal Swelling and Ascites Abdominal Swelling Abdominal swelling or distention is a common problem in clinical medicine and may be the initial manifestation of a systemic disease or of otherwise unsuspected abdominal disease. Subjective abdominal enlargement, often described as a sensation of fullness or bloating, is usually transient and is often related to a functional gastrointestinal disorder when it is not accompanied by objective physical findings of increased abdominal girth or local swelling. Obesity and lumbar lordosis, which may be associated with prominence of the abdomen, may usually be distinguished from true increases in the volume. | Chapter 044. Abdominal Swelling and Ascites Part 1 Harrison s Internal Medicine Chapter 44. Abdominal Swelling and Ascites Abdominal Swelling Abdominal swelling or distention is a common problem in clinical medicine and may be the initial manifestation of a systemic disease or of otherwise unsuspected abdominal disease. Subjective abdominal enlargement often described as a sensation of fullness or bloating is usually transient and is often related to a functional gastrointestinal disorder when it is not accompanied by objective physical findings of increased abdominal girth or local swelling. Obesity and lumbar lordosis which may be associated with prominence of the abdomen may usually be distinguished from true increases in the volume of the peritoneal cavity by history and careful physical examination. Clinical History Abdominal swelling may first be noticed by the patient because of a progressive increase in belt or clothing size the appearance of abdominal or inguinal hernias or the development of a localized swelling. Often considerable abdominal enlargement has gone unnoticed for weeks or months either because of coexistent obesity or because the ascites formation has been insidious without pain or localizing symptoms. Progressive abdominal distention may be associated with a sensation of pulling or stretching of the flanks or groins and vague low back pain. Localized pain usually results from involvement of an abdominal organ . a passively congested liver large spleen or colonic tumor . Pain is uncommon in cirrhosis with ascites and when it is present pancreatitis hepatocellular carcinoma or peritonitis should be considered. Tense ascites or abdominal tumors may produce increased intraabdominal pressure resulting in indigestion and heartburn due to gastroesophageal reflux or dyspnea abdominal wall hernias inguinal and umbilical orthopnea and tachypnea from elevation of the diaphragm. A coexistent pleural effusion more commonly on the right presumably due
