Abdominal distension

Abdominal distension may indicate the presence of serious intra-abdominal or systemic disease, but it is also a common symptom of benign disease, such as irritable bowel syndrome.

• Ascites

  • Exudative: low serum-ascites albumin gradient (e.g., peritoneal carcinomatosis)

  • Transudative: high serum-ascites albumin gradient (e.g., portal hypertension)

• Bowel dilatation

  • Mechanical obstruction (e.g., adhesions, volvulus)

  • Adynamic (paralytic) ileus (e.g., toxic megacolon, neuropathy)

• Other

  • Abdominal mass

  • Irritable bowel syndrome

  • Organomegaly (e.g., hepatomegaly)

  • Pelvic mass (e.g., ovarian cancer [see Abdominal Masses and Pelvic Masses — 2])

Given a patient with abdominal distension, the candidate will diagnose the cause, severity, and complications, and initiate an appropriate management plan. In particular, the candidate should differentiate ascites from bowel obstruction.

• list and interpret critical clinical findings derived from the patient’s history and physical examination to

  • differentiate ascites from distended bowel or mass, and

  • identify the underlying cause of the ascites or bowel distention (e.g., cirrhosis, colon cancer);

• list critical investigations and imaging and interpret their results (e.g., liver enzymes, ascitic fluid results, abdominal imaging, ultrasonography);

• construct an effective management plan, including

  • determining if specific therapy for ascites is required (e.g., dietary modification, pharmacotherapy, therapeutic paracentesis),

  • determining if specific therapy for mechanical or paralytic bowel obstruction is required, and

  • determining whether the patient requires specialized care.