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).
- Auscultation (listening) of the heart.
- Auscultation of the lungs
- Examination of the abdomen (belly)
- Percussion (tapping) of the abdomen
- Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if you tap against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand (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.
- Cholelithiasis (gallstones): tapping pain over the gallbladder region and the right lower ribcage.
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial gates?, kidney bearing palpation?) [leading symptoms: pain in the right upper abdomen, which can radiate between the shoulder blades and into the right shoulder; defensive tension; positive Murphy’s sign? Examination procedure: deep palpation below the right costal arch; patient takes a deep breath; due to the breathing maneuver, the gallbladder moves downward during inspiration (inhalation) and presses against the examiner’s fingers.Murphy sign positive: if cholecystitis is present, the patient feels tenderness and stops breathing prematurely][due todifferential diagnosis:
- Gastric ulceration]
[due topossible sequelae:
- Transmigratory peritonitis (peritonitis due to migration of bacteria (here: through the gallbladder wall) into the abdominal cavity).
- Gallstone ileus (intestinal obstruction due to a usually very large gallstone).
- Subphrenic abscess (encapsulated collection of pus in the area below the diaphragm)]
- Percussion (tapping) of the abdomen
- Cancer screening [due todifferential diagnoses:
- Familial polyposis (hereditary disease characterized by the presence of very many polyps in the intestine).
- Colon carcinoma (colon cancer)
- Lymphoma (malignant disease originating in the lymphatic system).
- Pancreatic carcinoma (pancreatic cancer)]
[due topossible cause: gallbladder carcinoma (gallbladder cancer)]
- If necessary, gynecological examination[due todifferential diagnoses:
- Endometriosis (occurrence of endometrium outside the endometrial layer of the uterus).
- Extrauterine pregnancy – pregnancy outside the uterus; extrauterine pregnancy is present in approximately 1 to 2% of all pregnancies: Tubargravidity (tubal pregnancy), ovariangravidity (pregnancy in the ovary), peritonealgravidity or abdominalgravidity (abdominal pregnancy), cervicalgravidity (pregnancy in the cervix).
- Pedunculated ovarian cyst (water-filled tumor in the region of the ovary whose supplying vessels have been pinched off)]
- Urological examination [due todifferential diagnoses:
- Renal colic, mainly caused by kidney stones.
- Pyelonephritis (inflammation of the renal pelvis)]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.