Diaphragmatic Hernia (Hiatal Hernia): Examination

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 and mucous membranes
    • 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 [tachycardia (heartbeat too fast: > 100 beats per minute), which occurs mainly after eating or angina pectoris attacks (chest tightness)] [due todifferential diagnoses: coronary artery disease (CAD); myocardial infarction (heart attack)]
  • Auscultation of the lungs
  • Examination of the abdomen (belly)
    • Percussion (tapping) of the abdomen
      • Meteorism (flatulence): hypersonoric tapping sound.
      • Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
    • Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)[due topossible sequelae:
      • Gastritis (inflammation of the gastric mucosa).
      • Incarceration (hernia incarceration).
      • Gastric ileus (gastric obstruction)
      • Gastric ulcers (stomach ulcers)
      • Reflux esophagitis (esophagitis due to reflux (backflow) of acidic gastric juice)]
• If necessary, cancer screening [due topossible cause: tumors in the abdomen][due todifferential diagnoses:
  • Cardiac carcinoma (gastric inlet carcinoma).
  • Esophageal carcinoma (cancer of the esophagus)
  • Tumors of the mediastinum (middle pleural space)]

Square brackets [ ] indicate possible pathologic (pathological) physical findings.