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; further:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye) [primary lesion (trypanosome chancre) at the site of pathogen invasion (sting, wound, etc.) – heals spontaneously after a few weeks; exanthema (rash): truncal, itchy, annular (ring-shaped); lymphadenopathy (lymph node enlargement), especially of the nuchal lymph nodes; anemia (anemia)]
- 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
- Abdominal (stomach) examination [hepatosplenomegaly (liver and spleen enlargement)?]
- 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.
- Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?).
- Percussion (tapping) of the abdomen.
- Inspection (viewing).
- Neurological examination – checking reflexes, strength, orientation, etc. [Meningoencephalitic stage (after months/years in the West African form; much faster in the East African form)]
