Flank Pain: 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; 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? ]
  • Gynecological examination [due todifferential diagnoses:
  • Urological examination [due todifferential diagnoses:
    • Ischuria (urinary retention).
    • Urinary bladder carcinoma (cancer of the urinary bladder)
    • Hypernephroma (renal cell carcinoma)]