The two most important factors in the development of ascites are failure of the liver to synthesize albumin and portal venous hypertension. The abdomen is distended with fluid and by air in the dilated intestines. The fullness is more conspicuous in the flanks. The umbilicus is flattened. The intra-abdominal hypertension favours the protrusion of hernias.
Scrotal oedema is frequent.
The raised diaphragm may cause dyspnea. It is due to defects in the diaphragm allowing ascites to pass into the pleural cavity. Right pleural effusion may be seen in the absence of ascites due to the negative intrathoracic pressure during breathing, drawing the peritoneal fluid through the diaphragmatic defects into the pleural cavity.