A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
- Inspection (viewing):
- Of the skin, mucous membranes, and sclerae (white part of the eye) [jaundice?]
- Abdomen
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Gait pattern (fluid, limping).
- Body posture (upright, bent over, gentle posture).
- Auscultation (listening) of the abdomen [aneurysm: vascular or stenotic sounds?, bowel sounds?]
- Percussion (tapping) of the abdomen:
- [Ascites (abdominal fluid): phenomenon of the 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.
- Cholelithiasis (gallstones): tapping pain over the gallbladder region and the right lower ribcage.
- Hepatomegaly (liver enlargement) and/or spenomegaly (spleen enlargement): estimation of liver and spleen size.
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Palpation of abdomen, palpation of quadrants (tenderness?, knocking pain?, release pain?, coughing pain?, guarding?, bowel sounds?, hernial orifices?, renal bearing knock?).
- [Peritonitis (inflammation of the peritoneum): direct or indirect palpation dolence (tenderness) and severe tenderness to touch?
- Enlarged and palpable liver?
- Splenomegaly (enlargement of the spleen)]
- Digital rectal examination (DRU): examination of the rectum and adjacent organs with the finger by palpation [hematochezia; melena – stool abnormally black in color due to blood admixtures, usually also malodorous and shiny; polyp?, carcinoma?; Douglas pain in pelvic inflammatory disease?]
- Inspection (viewing):
- Gynecological examination [due todifferential diagnoses:
- Cervical carcinoma (cervical cancer).
- Endometrial carcinoma (cancer of the uterus)
- Ovarian tumor (ovarian tumor)/ovarian carcinoma (ovarian cancer).
- Ovarian cyst (ovarian cyst)
- Pregnancy]
- Urological examination [due todifferential diagnoses:
- Ischuria (urinary retention).
- Renal tumor]