After recording a careful history, the physician will want to perform a physical examination. Visual inspection of the abdomen can provide certain information, such as whether or not the stomach is distended or the gallbladder or liver visibly enlarged. but visual inspection is rarely sufficient in itself. The physician may use the stethoscope to listen to the abdomen; the presence of unusual or irregular sounds may indicate an internal disturbance. such as an abnormal release of gastric fluids. He will probably also press, or palpate, the abdomen with his hands in order, primarily, to feel for any unusual formations within the abdomen, and also to determine what areas are sensitive to pressure.
Tenderness of a particular organ or of the tissue surrounding the organ will show the physician where to concentrate his investigation. This is why the patient will generally not be given any anesthetic or pain to relieve drugs during the examination, even if he is complaining of moderate pain at the time. The pain itself is an important clue to the physician, and masking it with drugs would only hinder diagnosis. The physician may also percuss the abdomen by extending two or three fingers flat over the abdomen and tapping them sharply with two fingers of his other hand. By listening carefully to the sound this produces, he can make certain deductions regarding the condition of the organs lying just beneath his hand.
Referred to a gastroenterologist
Depending upon the patient’s symptoms and the physician’s degree of specialization in this area, he may wish to make further examinations. or he may wish to refer the patient to another physician who specializes in disorders of the abdomen or of the particular organ or system that is suspect. Often the patient may be referred to a gastroenterologist, or to a general surgeon if the examining physician feels that surgical intervention will probably be necessary.