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, mucous membranes and sclerae (white part of the eye).
- 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.
- Examination of the abdomen
- Percussion of the abdomen/examination of the abdomen by tapping the abdominal wall with the fingers.
- [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 (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?) [see under differential diagnoses]
- Percussion of the abdomen/examination of the abdomen by tapping the abdominal wall with the fingers.
- Inspection (viewing).
- Gynecological examination [in case of pregnancy; vomiting in the morning].
- ENT medical examination [torsional vertigo?, tinnitus (ringing in the ears)?; neuronitis vestibularis, Meniere’s disease (disease of the inner ear characterized by attacks of torsional vertigo); labyrinthitis (inflammation of the inner ear)]
- Neurological examination (meningismus?; headache?) [due todifferential diagnoses: cerebral abscess, cerebral hemorrhage, brain tumor, hydrocephalus (hydrocephalus; pathological expansion of the liquid-filled fluid spaces (cerebral ventricles) of the brain)]
- Psychiatric examination [due todifferential diagnoses: anorexia nervosa (anorexia), bulimia nervosa (binge eating disorder), depression]
- Urological examination [uremia (occurrence of urinary substances in the blood above normal values), urolithiasis (urinary stones)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
