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).
- Altered odor of breath [sweet and foul, foetor hepaticus (specific breath odor of raw liver)).
- Inspection of hands [flapping tremor (flutter tremor; coarse hand tremor)].
- Auscultation (listening) of the heart.
- 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 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.
- Neurological examination – Symptoms: Impaired consciousness, mood swings, insomnia (sleep disturbance), confusion.
- For staging or detection of minimal forms (“minimal hepatic encephalopathy”):
- Psychometric testing procedures – number-connection test, line-tracing test, number-symbol test.
- Neuromuscular function testing – “paper-pencil tests” (writing samples).
- Arithmetic tests
- [due topossible sequelae:cerebral edema (brain swelling)]
- For staging or detection of minimal forms (“minimal hepatic encephalopathy”):
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
