The basic diagnosis
The physical examination is usually done on undressed, lying patients. Externally visible signs of disease (inspection) are eg water retention, signs of emaciation or skin changes such as liver asterisks or jammed veins. Also, scars, asymmetries and bulges (eg in a hernia) give the doctor hints.
For palpation, the patient must have as relaxed an abdominal wall as possible. Helpful for this is a pillow under your head and knees. The doctor palpates the organs, especially the liver, and also makes sure that certain pressure points cause pain.
By listening (auscultation) and tapping (percussion) of the abdomen, the bowel sounds can be assessed and the size of some organs and free fluid in the abdomen can be determined.
Also important is the rectal examination, so the palpation of the anal area and rectum. At the same time, the prostate is scanned in men. This investigation belongs to the health insurance paid cancer prevention.
Depending on the question, various laboratory values in the blood are often determined during the initial examination, eg blood count, coagulation, sugar, fats, liver and kidney values, minerals and proteins. Also, the stool is examined, for example, on blood components to exclude a tumor, on pathogens in chronic diarrhea or on the fat content in the suspected indigestion.
Ultrasound (sonography) is an important procedure for examining the abdominal area. It has the advantage that on the one hand it is quite easy to carry out, is uncomfortable and inexpensive for the patient, and on the other hand it allows many structures and changes to be represented. However, the assessment requires some experience.
With an additional device, the blood stream can be made visually perceptible and audible by means of Doppler and duplex sonography. With the help of special transducers and cannulas, the doctor can control suspicious areas under ultrasound control and remove tissue samples there. An x-ray of the abdomen (abdominal overview) has almost only meaning for the representation of free air under the diaphragmatic dome; otherwise it offers no advantage over sonography. However, coupling them with the administration of contrast media (swallowed as a porridge or as enema) and possibly air (double contrast recording) allows the intestinal movement and rough structure to be assessed.
The areas of application of computed tomography (CT) are comparable to those of ultrasound; however, the resolution and thus distinctness is better. By contrast, the radiation exposure for the patient and the higher costs.
With magnetic resonance imaging, changes in the liver, bile ducts and pancreas can be primarily visualized.
If there is suspicion of vascular disease or bleeding, angiography may also be indicated. In this case, a small tube is inserted into the vessels, placed on contrast agent and its distribution in the X-ray image.