Reassess perihepatic fluid. Elevating total bilirubin. LIVER: Noncirrhotic liver morphology. Mildly coarse parenchymal echogenicity. No focal lesion. Normal hepatopedal portal venous blood flow at 29 cm/s. No intrahepatic biliary ductal dilatation. Complex fluid collection posterior to the left hepatic lobe now measures 8.7 x 5.4 x 5.6 cm, increased from the prior, appearing to communicate with the adjacent complex fluid as seen on CT.Septated perihepatic ascites.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder without gallbladder wall thickening, pericholecystic fluid or focal tenderness. No gallstones.PANCREAS: Obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 13.2 cm in length.RIGHT KIDNEY: The right kidney measures 9.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. The cortex is echogenic. Color Doppler demonstrates hilar blood flow. OTHER: In the left upper quadrant there is a 14.4 x 11.2 x 12.6 cm complex heterogeneous presumed collection. The left kidney is not visualized. Moderate volume of complex septated ascites..
1. Normally distended gallbladder without wall thickening or focal tenderness.2. Increasing size of the complex collection posterior to the left hepatic lobe which appears to communicate with complex abdominal fluid. Left upper quadrant complex collection is new from the prior ultrasound but may correspond to increasing complex ascites. At least moderate volume of complex septated ascites.3. Echogenic renal parenchyma compatible with medical renal disease. Coarse hepatic echogenicity compatible with parenchymal dysfunction without biliary ductal dilatation.