Aerophagia typically results from gulping food; chewing gum; smoking; or as a response to anxiety, which can lead to repetitive belching. irritable bowel syndrome and bloating. IBD: Lower abdominal pain and bloating associated with alteration of bowel habits and abdominal discomfort relieved with defecation. Subjective sense of abdominal pressure is attributable to impaired intestinal transit of gas. Or increased lumbar lordosis.

Cushing's syndrome: Features unusual for age (i.e., osteoporosis or hypertension in young patients), Less-usual features, such as unexplained psychiatric symptoms (including depression), Unexplained nephrolithiasis, Polycystic ovary syndrome, Pituitary adenomas, Adrenal adenomas; Exam: Progressive proximal muscle weakness, Bruising without obvious trauma, Facial plethora or rounding, Violaceous striae, Supraclavicular fat pad, Dorsocervical fat pad. Obesity.

severe constipation or intestinal obstruction--> stool in colon. accompanied by abdominal discomfort or pain, nausea, and vomiting and can be diagnosed by imaging. Obstruction. Exam: absence of bowel sounds, presence of high-pitched localized bowel sounds, palpable bowel loops, TENDER, RESONANT. Diabetic gastroparesis: diabetes mellitus and previous abdominal surgery that may result in vagal nerve injury; post-prandial nausea, vomiting, early satiety, epigastric pain, fullness, bloating; Exam: succussion splash.

hepatomegaly, splenomegaly, AAA, bladder distension, malignancies, abscesses, or cysts

Alcoholic hepatitis: hx of excessive drinking, jaundice, abdominal discomfort, nausea; Exam: jaundice, tender hepatomegaly, hepatic bruit, spider angiomas, palmar erythema, signs of hepatic encephalopathy. Hepatitis C: blood/body fluid exposure (e.g., hx drug use, blood transfusion); Exam: jaundice.

Peritoneal carcinomatosis (10%): hx of underlying gastrointestinal, lung, or breast malignancy or malignant melanoma; Exam: periumbilical lymph nodes, positive stool occult blood (GI cancer), hepatic bruits (hepatocellular carcinoma). Heart failure (3%): exertional dyspnoea, fatigue limiting exercise tolerance, leg swelling, abdominal swelling, HTN, diabetes, valvular heart disease, smoker, FHx sudden cardiac death, MI, stroke, peripheral arterial disease, hx chest pain, ; Exam: peripheral oedema, rales, dyspnoea, jugular venous distention, cool extremities, narrow pulse pressure, pleural effusions. Tuberculosis (2%): residence in/visit to high-prevalence area, close contact with active TB; hx of anorexia, malaise, weight loss, fever, or night sweats; chronic cough productive of sputum, occasionally associated with haemoptysis; immunosuppressed (AIDS) Exam: fever, cachexia, tachycardia; asymmetry in chest movement and dullness to percussion due to pleural effusion, bronchial breathing, crackles, rales due to an infiltrate or rhonchi in presence of significant bronchial purulence; palpable extra-thoracic lymphadenopathy is uncommon.

Less common: Pancreatitis (1%): acute onset abdominal pain radiating to the back; nausea, vomiting; Exam: epigastric abdominal tenderness. Renal disease--nephrotic syndrome (1%): abdominal distension/discomfort/pain, limb swelling, eye swelling, HTN, hx oliguria; Exam: oedema (orbital, scrotal, labial, or peripheral), abdominal distension, HTN, hypovolaemic episodes, orthostatic hypotension, tachycardia, peripheral vasoconstriction. massive hepatic metastasis: cachexia; Exam: nodular liver, jaundice. Chlamydia infection. Rare: hypothyroidism and familial Mediterranean fever

Spontaneous Bacterial Peritonitis. PMN ≥250/μL in ascitic fluid, monopathogenic: Escherichia coli and Klebsiella, as well as streptococci and enterococci. Multiple pathogens + elevated PMN--> secondary peritonitis from a ruptured viscus or abscess. Multiple pathogens + normal PMN--> bowel perforation from the paracentesis needle. Hepatic hydrothorax cause shortness of breath, hypoxia, and infection

ascitic protein level of ≥2.5 g/dL ---cardiac ascites (high BNP), early Budd-Chiari syndrome, IVC obstruction or sinusoidal obstruction syndrome.

ascitic protein level <2.5 g/dL --- cirrhosis, late Budd-Chiari syndrome, or massive liver metastases

tuberculous peritonitis, peritoneal carcinomatosis, or pancreatic ascites.

Turbid fluid -- infection or tumor cells. White, milky fluid--TG level >200 mg/dL (and often >1000 mg/dL), which is the hallmark of chylous ascites--steatorrhoea. Chylous ascites results from lymphatic disruption that may occur with trauma, cirrhosis, tumor, tuberculosis, or certain congenital abnormalities. Dark brown fluid --high bilirubin conc due to biliary tract perforation. Black fluid --pancreatic necrosis or metastatic melanoma.