Examine the abdomen for the liver edge (which may be near the right iliac crest in massive hepatomegaly), tumor masses, and for shifting dullness which may indicate ascites. An ultrasound scan may occasionally be useful to diagnose the cause of distention.

Intestinal obstruction causes distention (unless the obstruction is high) and increased bowel sounds. Retroperitoneal tumors can cause neurogenic dilation of the colon and abdominal distention. (see Intestinal Obstruction)

Constipation is usually obvious from a careful history. Feces may be palpable in the descending colon (unlike other masses, they indent). Plain x-ray may demonstrate fecal material throughout the colon, indicating constipation. (see Constipation)

Distention due to gas can occur after prolonged treatment with lactulose (consider changing the laxative), and is also a feature of malabsorption in pancreatic cancer which responds to pancreatic enzyme supplements.  Distention due to gas can also be caused by anxiety and repeated swallowing (of air).   (see Diarrhea)

Prolonged use of steroids produces abdominal distention (due to increased fat and weaker muscles) which can be distressing. Reduce steroid dose where possible.

Rarely a patient with advanced cancer can develop a bowel perforation, which is usually a terminal event. There is sudden abdominal pain with generalized abdominal tenderness and rebound tenderness. The abdomen may become distended. Treat with adequate doses of morphine by injection (since patients will usually have nausea and vomiting). Avoid the mistake of passing nasogastric or flatus tubes which add to the patient’s discomfort.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.