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 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 [due topossible cause of primary peritonitis: heart failure (cardiac insufficiency)].
- Examination of the lungs (due topossible causes of primary peritonitis):
- Auscultation (listening) of the lungs.
- Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (attenuated or absent: e.g., in pleural effusion). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
- Voice fremitus (checking the transmission of low frequencies; the patient is asked to say the word “99” several times in a low voice, while the doctor puts his hands on the chest or back of the patient)[increased sound conduction due to pulmonary infiltration / compaction of lung tissue (eg, in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (greatly attenuated or absent: in pleural effusion). The consequence is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
- Examination of the abdomen (abdomen)
- Auscultation (listening) of the abdomen [vascular or stenotic sounds?, bowel sounds?]
- Percussion (tapping) of the abdomen.
- Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if you tap 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.
- 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 the gallbladder region and the right lower ribcage.
- Palpation (palpation) of the abdomen (abdomen) with an attempt to palpate the liver (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial ports? renal bearing palpation?) [leading symptom: acute abdominal pain; symptoms in secondary peritonitis: defensive tension of the abdominal wall, meteorism (bloated abdomen; excessive accumulation of gas in the digestive tract)][due topossible cause of primary peritonitis: chronic hepatitis (liver inflammation)][due topossible causes of secondary peritonitis:
- Appendicitis (inflammation of the appendix).
- Incarcerated inguinal hernia (incarcerated inguinal hernia)]
- Digital rectal examination (DRU): examination of the rectum (rectum) [due topossible causes of secondary peritonitis:
- Diverticulitis (disease of the colon in which inflammation forms in outpouchings of the mucosa (diverticula)) with perforation).
- Gastrointestinal perforation (intestinal perforation) – intestinal perforation can occur due to:
- Inflammation
- Ulceration (ulceration)
- Chronic inflammatory bowel disease
- Iatrogenic (due to medical interventions), e.g., endoscopic examinations/surgeries.
- Vascular (vascular) as in ischemia (reduced blood flow), embolism (occlusion of a blood vessel).
- Obstruction / ileus (intestinal obstruction)
- Neoplasms
- Foreign body]
- Inspection (viewing).
- If necessary, gynecological examination [due topossible causes:
- Extrauterine pregnancy – pregnancy outside the uterus; extrauterine pregnancy is present in approximately 1% to 2% of all pregnancies: Tubargravidity (tubal pregnancy), ovariangravidity (pregnancy in the ovary), peritonealgravidity or abdominalgravidity (abdominal pregnancy), cervicalgravidity (pregnancy in the cervix).
- Salpingitis (inflammation of the fallopian tubes)]
- If necessary, neurological examination [accompanying symptom: encephalopathy (disease or damage to the brain)]
Square brackets [ ] indicate possible pathological (pathological) physical findings.