A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye [accompanying symptom: pallor (anemia)].
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Anal region/anal canal [redness?, swelling, nodules?, lobules?, prolapsed tissue?, hemorrhoids?, ulcer in the anoderm (ulcer in the anal mucosa)?]
- Examination of the abdomen (abdomen)
- Auscultation (listening) of the abdomen [vascular or stenotic sounds?, bowel sounds?]
- Percussion (tapping) of the abdomen.
- Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if you tap against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand (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?, defensive tension?, hernial orifices?, renal bearing knocking pain?).
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation [anal fissure?, hemorrhoids?; evidence of rectal cancer (rectal or rectal cancer), if any].
- Inspection (viewing).
- If necessary, gynecological examination [due todifferential diagnosis: endometriosis].
- Cancer screening
