Can ascites and belly fat be differentiated just by physical examination, without ultrasound? is ascites hard or soft?

Yes: ascites is a collection of peritineal fluid and can be detected by a physical exam and tapping out the belly. It is often associated with liver disease increased venous pressure and malignancies. Fat can easily be distinguished from ascites. If there is a large collection of peritoneal fluid it can be tense and appear to be hard but it itself is liquid.