Gallstones (Cholelithiasis): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing).
    • Skin, mucous membranes and sclerae (white part of the eye) [due topossible sequelae: jaundice].
    • 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
  • 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) with the search for defensive tension and resistances (pressure pain?, knocking pain?, coughing pain?, defensive tension?, hernial ports? renal bearing knock pain?) [positive Murphy 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: in the presence of cholecystitis, the patient feels a pressure pain and stops the breathing movement prematurely]. [due topossible causes: severe liver disease such as alcoholic cirrhosis, primary biliary cholangitis (formerly primary biliary cirrhosis), chronic intrahepatic cholestasis (biliary stasis)] [due todifferential diagnoses:
      • Appendicitis (inflammation of the appendix).
      • Stomach infections
      • Irritable stomach
      • Ulcus ventriculi (gastric ulcer)]
• Cancer screening [due todifferential diagnosis: gastric carcinoma (stomach cancer)] [due topossible sequelae:
  • Cholangiocellular carcinoma (bile duct cancer).
  • Gallbladder carcinoma (gallbladder cancer)]
• Gynecological examination [due topossible cause: pregnancy (increased cholesterol excretion due to estrogen depletion)] [due todifferential diagnoses:
  • [adnexitis (inflammation of the fallopian tubes and ovaries).
  • Ovarian cysts (fluid-filled tissue cavity on the ovary).
  • Extrauterine pregnancy – pregnancy outside the uterus; extrauterine pregnancy is present in approximately 1 to 2% of all pregnancies: Tubalgravidity (tubal pregnancy), ovariangravidity (pregnancy in the ovary), peritonealgravidity or abdominalgravidity (abdominal pregnancy), cervicalgravidity (pregnancy in the cervix)]
• Urologic/nephrologic examination [due todifferential diagnoses:
  • Renal colic
  • Uremia (occurrence of urinary substances in the blood above normal levels).
  • Ureteral stones (ureteral stones)]
• Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.