Intestinal Obstruction (Ileus): 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 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”?]
    • 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!
  • 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.