Abdominal distension

Rationale

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.

Causal Conditions

(list not exhaustive)

1. Ascites
   1. Exudative: low serum-ascites albumin gradient (e.g., peritoneal carcinomatosis)
   2. Transudative: high serum-ascites albumin gradient (e.g., portal hypertension)
2. Bowel dilatation
   1. Mechanical obstruction (e.g., adhesions, volvulus)
   2. Adynamic (paralytic) ileus (e.g., toxic megacolon, neuropathy)
3. Other
   1. Abdominal mass
   2. Irritable bowel syndrome
   3. Organomegaly (e.g., hepatomegaly)
   4. Pelvic mass (e.g., ovarian cancer [see Abdominal Masses and Pelvic Masses — 2])

Key Objectives

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.

Enabling Objectives

Given a patient with abdominal distention, the candidate will

1. list and interpret critical clinical findings derived from the patient’s history and physical examination to
   1. differentiate ascites from distended bowel or mass, and
   2. identify the underlying cause of the ascites or bowel distention (e.g., cirrhosis, colon cancer);
2. list critical investigations and imaging and interpret their results (e.g., liver enzymes, ascitic fluid results, abdominal imaging, ultrasonography);
3. construct an effective management plan, including
   1. determining if specific therapy for ascites is required (e.g., dietary modification, pharmacotherapy, therapeutic paracentesis),
   2. determining if specific therapy for mechanical or paralytic bowel obstruction is required, and
   3. determining whether the patient requires specialized care.