A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye).
- Abdomen (abdomen):
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Auscultation (listening) of the heart [right heart failure (right heart weakness)].
- Examination of the abdomen
- Percussion (tapping) of the abdomen
- [Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if one taps against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand on it (undulation phenomenon); flank attenuation.
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size]
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, guarding tension?, hernial orifices?, renal bearing knocking pain?) [fatty liver (steatosis hepatis); hepatitis (liver inflammation); pancreatic (pancreas) tumor, unspecified]
- Percussion (tapping) of the abdomen
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation: assessment of the prostate in size, shape and consistency.
- Inspection (viewing).
- Orthopedic/rheumatologic examination [due todifferential diagnoses:
- Chronic polyarthritis
- Felty syndrome – special form of rheumatoid arthritis that occurs mainly in men.
- Collagenoses (group of connective tissue diseases caused by autoimmune processes) – systemic lupus erythematosus (SLE), polymyositis (PM) or dermatomyositis (DM), Sjögren’s syndrome (Sj), scleroderma (SSc) and Sharp syndrome (“mixed connective tissue disease”, MCTD).
- Still syndrome (synonym: Still’s disease): systemic form of juvenile rheumatoid arthritis occurring in children with hepatosplenomegaly (liver and spleen enlargement), fever (≥ 39 °C, over 14 days), generalized lymphadenopathy (lymph node enlargement), carditis (inflammation of the heart), transient exanthema (skin rash), anemia (anemia). The prognosis of this disease is unfavorable].
- Urological examination [due todifferential diagnosis: unexplained renal enlargement, unspecified].
Square brackets [ ] indicate possible pathological (pathological) physical findings.