Ascites: simple or complex?

Question 1What does simple ascites look like?

1. aA thick-walled collection
2. bFluid full of strands and septations
3. cBright fluid with shadowing
4. dBlack fluid with no internal echoes, free between floating bowel loops

Question 2A patient with cirrhosis has fever and simple-looking ascites. What next?

1. aDiagnostic tap, because spontaneous bacterial peritonitis usually looks simple
2. bRepeat the scan next week
3. cDischarge
4. dNo tap is needed

Question 3Ascites with septations and separate pockets suggests what?

1. aNormal fluid
2. bUncomplicated cirrhosis only
3. cInfection, tuberculosis, malignancy or previous surgery
4. dDehydration

Question 4What can mimic septations in ascites?

1. aThe gallbladder
2. bThe aorta
3. cThe liver capsule
4. dFloating bowel and omentum

Question 5Where do you look first for a small volume of ascites?

1. aThe dependent spaces: Morison's pouch, around the spleen and the pelvis
2. bThe chest
3. cThe anterior abdominal wall only
4. dThe epigastrium