A 53-year-old male was referred to a gastroenterology clinic. He had a history of generalized abdominal distension and weight gain. The GP detected what he thought was ‘shifting dullness’ on examination of his abdomen, indicative of fluid. The patient explained that abdominal distension had developed over the last few months. He had noticed ankle swelling prior to this.
He felt breathless on exertion but denied any orthopnea or paroxysmal nocturnal dyspnea. Medical history: Hypertension, for which he was taking bendroflumethiazide, amlodipine, and ramipril; chronic obstructive pulmonary disease Social history: Two home measures of whiskey per night and 40 cigarettes per day Physical examination Elevated jugular pressure, normal heart sounds, and a clear chest There were no stigmata of chronic liver disease. He had shifting dullness but no demonstrable fluid thrill. There was no palpable…
