Abdominal distention may be related to increased gas in the gastrointestinal tract or to the presence of ascites. Increased gas can result from malabsorption, irritable colon, or air swallowing (aerophagia). Ascites can have a variety of causes, such as cirrhosis, congestive heart failure, portal hypertension, peritonitis, or neoplasia. To try to identify the cause of abdominal distention, ask these questions:
How long have you noticed your abdomen to be distended?''
Is the distention intermittent?''
Is the distention related to eating?''
Is the distention lessened by belching or by passing gas from below?''
Is the distention associated with vomiting? loss of appetite? weight loss? change in your bowel habits? shortness of breath?''
Gaseous distention related to eating is intermittent and is relieved by the passage of flatus or belching. A patient with ascites has the insidious development of increased abdominal girth, noted through a progressive increase in belt size. Loss of appetite is often associated with cirrhosis and malignancy, although end-stage congestive heart failure may produce this symptom as well. Shortness of breath and ascites may be symptoms of congestive heart failure, but the shortness of breath may be the result of a decrease in pulmonary capacity owing to ascites from another cause. Questions related to alcoholic abuse are most appropriate and are outlined in Chapter 1, The Interviewer's Questions.
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