Abdominal Mass: Examination

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?]
  • 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: