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
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Auscultation (listening) of the heart [right heart failure (right heart weakness)].
- Examination of the abdomen
- Percussion of the abdomen/examination of the abdomen by tapping the abdominal wall with the fingers.
- [Ascites (abdominal fluid): phenomenon of 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.
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size]
- Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?) [see under differential diagnoses]
- Percussion of the abdomen/examination of the abdomen by tapping the abdominal wall with the fingers.
- Digital rectal examination (DRU) [colon carcinoma (colon cancer)]
- Inspection (viewing):
- Psychiatric examination [differential diagnoses: aerophagy (swallowing air); psychological distress]
- Urological examination [differential diagnoses: renal colic in nephrolithiasis (kidney stones) or other kidney diseases; uremia (occurrence of urinary substances in the blood above normal values)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
