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; further:
- Inspection (viewing):
- Of the skin, mucous membranes and sclerae (white part of the eye).
- 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 (peritonitis): 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.
- Tumor
- Overfilled urinary bladder
- Attenuation of knocking sound due to enlarged liver or spleen, tumor, urinary retention?
- Palpation (palpation) of the abdomen, palpation of the quadrants (tenderness?, knocking pain?, release pain?, coughing pain?, defensive tension?, bowel sounds?, hernial orifices?, renal bearing knocking pain?)
- [Courvoisier sign: Combination of a palpable, painlessly enlarged bulging elastic gallbladder under the right costal arch and occlusive icterus (jaundice due to backwater of bile as a result of an obstruction to drainage) → gallbladder carcinoma (gallbladder cancer.
- Peritonitis (inflammation of the peritoneum): direct or indirect palpation dolence and heavy touch, pancreatic cancer sensitivity?
- Hydronephrosis (dilatation of the renal cavity system associated with destruction of renal tissue in the medium and long term), pyelonephritis (renal pelvic inflammation) and urolithiasis (urinary stones): renal lodge sensitive to palpation?]
- Digital rectal examination (DRU):[enlarged prostate? (benign prostatic hyperplasia/ benign enlargement of the prostate); tumor? ]
- Inspection (viewing):
- Gynecological examination [due todifferential diagnoses:
- Suspicion of extrauterine pregnancy (pregnancy outside the uterus).
- Pregnancy]
- Urological examination [due todifferential diagnoses:
- Ischuria (urinary retention).
- Urinary bladder carcinoma (cancer of the urinary bladder)
- Hypernephroma (renal cell carcinoma)]