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; furthermore:
- Inspection (viewing):
- Skin, mucous membranes, and sclerae (white part of eye)* [yellowing of skin and mucous membranes, most likely seen in sclerae]
- Abdomen (abdomen):
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Examination of the abdomen:
- 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]
- Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?) [hepatitis (liver inflammation) of any etiology; liver metastases; see further under differential diagnoses]
- Percussion (tapping) of the abdomen.
- Inspection (viewing):
- Gynecological examination [pregnancy cholestasis – bile stasis that occurs during pregnancy].
Square brackets [ ] indicate possible pathological (pathological) physical findings.
* Visible icterus is usually from a bilirubin concentration of 2 mg/dl. Yellowing and a bilirubin concentration between 1 and 2 mg/dl are referred to as subicterus.
