A comprehensive clinical examination is the basis for selecting further diagnostic steps:
General physical examination – including blood pressure, pulse, body weight, 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 todifferential diagnoses: heart failure (cardiac insufficiency); subacute bacterial endocarditis (endocarditis of the heart)].
- Auscultation of the lungs [due todifferential diagnosis: berylliosis – disease caused by contact with beryllium compounds; can manifest in various organs]
- 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 spenomegaly (spleen enlargement): estimate liver and spleen size]
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?)
- Percussion (tapping) of the abdomen
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation: assessment of the prostate in size, shape and consistency.
- Orthopedic/rheumatologic examination [due todifferential diagnoses:
- Felty syndrome – special form of rheumatoid arthritis that occurs mainly in men.
- Juvenile rheumatoid arthritis – form of rheumatoid arthritis that occurs in children / adolescents.
- Collagenoses (group of connective tissue diseases caused by autoimmune processes) – systemic lupus erythematosus (SLE), polymyositis (PM) or dermatomyositis (DM), Sjögren’s syndrome (Sj), scleroderma (SSc) and Sharp’s syndrome (“mixed connective tissue disease”, MCTD).
- Rheumatoid arthritis (synonym: chronic polyarthritis) – most common inflammatory disease of the joints.
- Systemic lupus erythematosus (SLE) – collagenosis affecting mainly the skin and many internal organs]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
