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 and mucous membranes [accompanying symptom: pallor (anemia)]
- 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 [due todifferential diagnosis (leading to upper gastrointestinal bleeding): hemoptysis (coughing up blood)]
- Examination of the abdomen (abdomen)
- Auscultation (listening) of the abdomen [vascular or stenotic sounds?, bowel sounds?]
- Percussion (tapping) of the abdomen.
- [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.
- Cholelithiasis (gallstones): tapping pain over gallbladder region and right lower rib]
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?) [due todifferential diagnoses (lead to upper gastrointestinal bleeding):
- Erosive duodenitis (duodenitis).
- Erosive gastritis (gastritis).
- Ulcus duodeni (duodenal ulcer)
- Ulcus ventriculi (gastric ulcer)]
- Digital rectal examination (DRU): examination of the rectum (rectum) [leading symptoms: Hematochezia (red blood stool or rectal bleeding); melena (tarry stool) – stool abnormally black in color due to blood admixtures, usually also foul-smelling and shiny][due todifferential diagnoses (lead to lower gastrointestinal bleeding):
- Anal fissure (tear in the mucosa of the anus).
- Hemorrhoids
- Crohn’s disease (chronic inflammatory bowel disease; it usually progresses in episodes and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal segments may be affected, which are separated by healthy sections).
- Proctitis (rectal inflammation)
- Rectal ulcers (ulcers in the rectum)]
- Inspection (viewing).
- Cancer screening[due todifferential diagnoses (lead to upper gastrointestinal bleeding):
[due todifferential diagnoses (lead to lower gastrointestinal bleeding):
- Colon tumors
- Small bowel tumors]
- Gynecological examination [due todifferential diagnosis (leading to lower gastrointestinal bleeding):
- Endometriosis (presence of endometrium (lining of the uterus) outside the uterus, for example, in or on the ovaries (ovaries), tubes (fallopian tubes), urinary bladder, or bowel)]
Square brackets [ ] indicate possible pathologic (pathological) physical findings.