Ascites is the pathological accumulation of fluid within the peritoneal cavity secondary to portal hypertension, hypoalbuminaemia and sodium retention. In patients with chronic liver disease it marks the transition from compensated to decompensated cirrhosis. The severity ranges from mild, detected only by imaging, to gross, producing marked physical and metabolic disturbances. Metabolic disturbancesHyponatraemia, muscle cramps and hypervolaemic dilutional anaemia reflect advanced renal sodium retention and impaired free-water clearance. Progressive abdominal distensionPainless increase in girth is usually the first complaint; patients note tight clothing, difficulty bending forward, and a sensation of heaviness in the flanks. Shifting dullness and fluid thrillOn percussion,... Learn more