Diverticular Disease: 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).
    • 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 [due todifferential diagnosis:
    • Myocardial infarction (heart attack)]
  • Auscultation of the lungs
  • Examination of the abdomen (belly)
    • Auscultation of the abdomen [bowel sounds?]
    • 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 (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, surgical scars?, renal bearing knocking pain?)[Leading symptoms:
      • Pain in the lower abdomen (colicky), usually in the left lower quadrant (left lower abdomen), both spontaneous and release pain, lasting up to a few days [motion dependence of pain is suggestive of sigmoid diverticulitis].
      • Tenesmus (constant painful urge to defecate).
      • Roll-shaped tumor (palpable and pressure-dolent/painful roll in the left lower abdomen).
      • Signs of local peritonitis (inflammation of the peritoneum) such as guarding]
  • Digital rectal examination (DRU): examination of the rectum (rectum)[accompanying symptom:
    • Rectal bleeding (bleeding from the rectum) – more common in diverticulosis (in 10-30% of cases) than in diverticulitis]
• Cancer screening [due todifferential diagnoses:
  • Familial polyposis (synonym: familial adenomatous polyposis) – is an autosomal dominant inherited disorder. This leads to polyps in the colon (large intestine), which degenerate if left untreated and lead to colon carcinoma (colorectal cancer)
  • Colon carcinoma (colon cancer)
  • Lymphoma (malignant disease originating in the lymphatic system).
  • Pancreatic carcinoma (pancreatic cancer)]
• If necessary, gynecological examination [due todifferential diagnoses:
  • Adnexitis (inflammation of the fallopian tubes and ovary).
  • Endometriosis (occurrence of endometrium outside the endometrial layer of the uterus).
  • Pedunculated ovarian cyst (water-filled tumor in the region of the ovary whose supplying vessels have been pinched off)]
• Urological examination [due todifferential diagnoses:
  • Ureteral colic
  • Renal colic, mainly caused by kidney stones
  • Pyelonephritis (inflammation of the renal pelvis)
  • Urolithiasis (urinary stone disease)
  • Cystitis (cystitis)]
• Health check

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