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
- 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)
- Auscultation (listening) of the abdomen
- [Vascular or stenotic sounds?
- Ringing, high-pitched bowel sounds? (= signs of intestinal peristalsis working against a mechanical obstruction).
- “Dead silence” (= sign of advanced mechanical ileus or paralytic ileus)]
- Percussion (tapping) of the abdomen.
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of 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 (abdominal) (tenderness?, tapping pain?, coughing pain?, guarding?, hernial orifices? (examine both sides for incarcerated hernias; watch for possible femoral hernia (femoral hernia; femoral hernia; thigh hernia) in women), renal bearing palpation?) [abdomen tense?, abdomen “board hard”?]
- Auscultation (listening) of the abdomen
- Digital rectal examination (DRU): examination of the rectum (rectal) [palpable tumor of the rectum (rectal tumor)?, blood on the fingerling? (Indication of an ischemic, bleeding mucosa (invagination (invagination of a section of intestine), strangulation (strangulation of the intestine))]Note: Approximately 58% of all recurrent carcinomas (rectal cancers) are palpable with the finger!
- Inspection (viewing).
- Urological/nephrological examination [due topossible causes of paralytic ileus: Renal colic, uremia (occurrence of urinary substances in the blood above normal values)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.