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; further:
- Inspection (viewing).
- Auscultation (listening) of the heart.
- Examination of the lungs (due topossible secondary diseases).
- Auscultation (listening) of the lungs
- Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (attenuated or absent: e.g., in pleural effusion). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
- Vocal fremitus (checking the conduction of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (attenuated: e.g. atelectasis; strongly attenuated or absent: in case of pleural effusion). The result is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
- 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) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial ports?, kidney bearing palpation?) [acute abdominal pain (abdominal pain) most important symptom – typical is a strong, probing and persistent pain in the upper abdomen, which may also radiate to the back, thorax (chest), flanks or lower abdomen and improves in a sitting or crouching position; typical finding: rubber belly (elastic abdominal wall tension), due toincipient peritonitic irritation and meteorism (flatulence); abdominal wall tension (peritonism; peritonitis); possibly subileus (precursor of ileus), possibly ileus (intestinal obstruction)][due todifferential diagnoses:
- Appendicitis (inflammation of the appendix).
- Gastric perforation – spontaneous opening of the stomach usually caused by a ventriculi ulcer (stomach ulcer)
- Ulcus ventriculi]
[due topossible sequelae:
- Digital rectal examination (DRU): examination of the rectum (rectum).
- Cancer screening [due todifferential diagnosis: pancreatic cancer][due topossible sequelae: pancreatic cancer].
- If necessary, gynecological examination [due topossible cause: pregnancy][wg.Differential diagnosis: Extrauterine pregnancy – pregnancy outside the uterus; extrauterine pregnancy is present in approximately 1 to 2% of all pregnancies: Tubargravidity (ectopic pregnancy), ovariangravidity (pregnancy in the ovary), peritonealgravidity or abdominalgravidity (abdominal pregnancy), cervicalgravidity (pregnancy in the cervix)]
- If necessary, psychiatric examination [due topossible sequelae: psychosis].
- Urological/nephrological examination [due todifferential diagnosis: renal colic][due topossible sequelae:
- Acute tubular necrosis (ATN) (renal disease).
- Azotemia (abnormal increase of nitrogenous end products of protein metabolism in the blood).
- Renal artery and/or renal vein thrombosis.
- Oliguria (decreased urine production)]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.