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).
- 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.
- Auscultation of the lungs [due topossible cause: chronic lung disease (such as chronic obstructive pulmonary disease (COPD)]
- Examination of the abdomen (abdomen)
- Percussion (tapping) of the abdomen
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Cholelithiasis (gallstones): knocking pain over the gallbladder region and the right lower ribcage.
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?) [pain in the upper abdomen (may occur late after food intake, at night or but in the fasting state (fasting phases/fasting pain) or independently of food intake)][due todifferential diagnoses:
- Functional dyspepsia (irritable stomach syndrome).
- Gastritis (gastritis)
- Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
- Ulcus ventriculi (gastric ulcer)]
[due topossible secondary diseases:
- Gastrocolic fistulas (unphysiological connections between the stomach and colon).
- Gastric outlet stenosis (narrowing of the gastric outlet).
- Gastric bleeding
- Gastric perforation (stomach rupture)
- Penetration of the ulcer (penetration of the ulcer from the stomach into adjacent organs such as the pancreas (pancreas))]
- Percussion (tapping) of the abdomen
- Inspection (viewing).
- Cancer screening [due todifferential diagnoses:
- Gastric carcinoma (stomach cancer)
- Pancreatic carcinoma (pancreatic cancer)]
[due topossible sequelae:
- Gastric carcinoma (stomach cancer)
- MALT lymphoma (lymphoma of the mucosa-associated lymphoid tissue, MALT); so-called extranodal (arising outside the lymph nodes) lymphomas; about 50% of all MALT lymphomas are diagnosed in the stomach (80% in the gastrointestinal tract); MALT lymphomas are highly favored in their development by chronic infections with the bacterium Helicobacter pylori resp. favored by inflammation; by an Erdikationstherapie (antibiotic therapy) disappear not only the bacteria, but as a result in 75% of cases also the gastric lymphoma]
- Urological examination [due topossible causes: chronic renal insufficiency (kidney weakness);nephrolithiasis (kidney stones)]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.