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
- Abdominal wall and inguinal region (groin area).
- Percussion (tapping) of the abdominal wall (ascites?) [Phenomenon of fluctuation wave. This can be triggered as follows: tapping against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand (undulation phenomenon); flank attenuation].
- Palpation (palpation) of the abdominal wall (soft? depressible?, defensive tension?, tumor palpable?) and the inguinal region (palpable lymph nodes?).
- Inspection (viewing).
- Gynecological examination
- Inspection
- Vulva (external, primary female sex organs) [fluorine/discharge? color? foetor/odor?]
- Speculum:
- Vagina (vaginal) [blood?, fluorine? (color? foetor?), mucus?]
- Cervix uteri (cervix), or portio (cervix; transition from cervix uteri to vagina (vagina)) [blood?, ectopy?, fluor? (color? Foetor?), mucus?], if necessary, taking a Pap smear (for early detection of cervical cancer).
- Palpation (bimanual; palpation with both hands) of the internal genital organs.
- Cervix uteri (cervix) [dolence/pain on movement?, cervical sliding, wiggling, venting pain?]
- Uterus (uterus) [normal size?, difficult to move?, fixed?, displaced?, pressure dolent?]
- Adnexa (palpable resistance in the lesser pelvis in the adnexal area or Douglas, separable from the uterus? Pressuredolent?]
- Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [free? pressure dolence/pressure pain?, resistance/resistance?]
- Pelvic walls [free?]
- Douglas space (pocket-like bulge of peritoneum (abdominal wall) between rectum (rectum) posteriorly and uterus (uterus) anteriorly) [free? palpable resistance?]
- Inspection
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.