Physical examination
? It is the process of examining the patient’s body
to determine the presence or absence of
physical problems
? The goal of the physical examination is to obtain
valid information concerning the health of the
patient
? The examiner must be able to identify,analyze,
and synthesize the accumulated information into
a comprehensive assessment
The four cardinal principles of
physical examination
? Inspection
? Palpation
? Percussion
? Auscultation
“teach the eye to see,the finger to feel,and the ear
to hear”
? What is the fifth?
Smelling
Equipment for physical
examination
Required Optional
Stethoscope Gloves
Tongue blades Gauze pads
Penlight Lubricant gel
Tape measure Nasal speculum
Sphygmomanometer Turning fork,128 Hz,512Hz
Reflex hammer Pocket visual acuity card
Safety pins Oto-ophthalmoscope
Important aspects of physical
examination----physician
? Elegant appearance
? Decent manner
? Kind attitude
? Highly responsibility
? Good medical morals
Important aspects of physical
examination---physician
? Wash your hands,preferably while the
patient is watching
? Washing with soap and water is an
effective way to reduce the transmission
of disease
Important aspects of physical
examination---patient
The patient should be made as comfortable
as possible during the examination
The patient should be properly draped
Important aspects of physical
examination
Where is the bed placed?
? When possible,the examining table/bed be
situated so that the examiner has access to both
sides of the patient
? An ideal arrangement is to have the table
located in the center of the examining room
Important aspects of physical
examination
Where does the examiner stand?
? Stand right side of the bed
? Exam with one’ right hand
Important aspects of physical
examination
How to perform the physical examination?
? Sequential
? Proper expose
Sequential
? Conducted in head to toe order,head ---
neck---chest---abdomen---spine---
extremities---anal---genital---nerve system
? Patients tire quickly when asked to,sit up”,
“lie down”,“turn on your left side”,“sit up”,
“lie down” and so on
Proper expose
? Exposing only the area that are being examined at
that time without undue exposure of the other
areas
? When examining a women’s breasts,it is
necessary to check for any asymmetry by
inspecting both breasts at the same time
? After inspection has been completed,the
physician may use the patients gown to cover the
breasts not being examined
This caring for the patient’s privacy goes a long way in
establishing a good doctor-patient relationship
Important aspects of physical
examination
? The examiner should continue speaking to the
patient
? Showing care to his disease and answer to
patient’s questions
? It can not only release patient’s nerviness,but
also help to establish the good physician-patient
relationship
Precaution to take
? The use of gloves should provide adequate
protection when performing the physical
examination or when handling blood-soiled or
body fluid-soiled sheets or clothing
? Gloves should be worn when examining any
individual with exudative lesions or weeping
dermatitis
Precaution to take
? Hands or other contaminated skin surfaces
should be washed thoroughly and immediately it
accidentally soiled with blood or other body
fluids
? All sharp items,such as needle,must be
handled with extraordinary care to prevent
injuries
? A patient may be in isolation or on special
precautions if he/she is suffering from a
contagious disease
Inspection
? Method of observation used during physical
examination
? First step in examining a patient or body part
? It includes a general survey of the patient’s
mental status posture body movement
gait speech breath ordor
stature skin state of nutrition
How to inspect
? Make sure the room is a comfortable
temperature
? Use good lighting,preferably sunlight
? Look and observe before touching
? Completely expose the body part you are
inspecting while draping the rest
? Compare symmetrical body parts
Mental status and personal
grooming
? Does the patient look well or sick?
? Is he comfortable in bed?
? Does he appear in distress?
? Is he alert or is he groggy?
? Does he look acutely or chronically ill?
poor nutrition sunken eyes temporal wasting loose skin
? Does the patient appear clean?
? Is her hair combed?
? Does she bite her nails?
Mental status and personal
grooming
The answer to these questions may provide useful
information about the patient’s self-esteem
and mental status
Body habitus
? The body habitus is useful to observe because certain
disease states are more common in different body
builds
? The asthenic/ectomorphic patient is thin,has poor
muscle development and small bone structure and
appears malnourished
? The sthenic/mesomorphic patient is the athletic type
with excellent development of the muscles and large
bone structure
? The hypersthenic/endomorphic patient is a short,
round individual with good muscle development but
frequently has a weight problem
Posture
? It may reveal significant information
? Congestive heart failure,sit in a chair the entire night
? Patients with body/tail of the pancreatic cancer,
assuming an upright or sitting posture
? Thus the positions of the patient at the time of the
examination may suggest certain disease possibilities
? A history of assuming certain positions to obtain relief
from pain also may be of diagnostic importance
Body movement
? It can be classified as voluntary and involuntary
? Voluntary movements are associated with normal
routine body activity
? Involuntary movements are usually abnormal and may
occur in patients in either conscious or comatose states
? Convulsive movements are a series of violent
involuntary muscle contractions
either clonic or tonic in character
Gait
? The manner in which a patient walks is often of
diagnostic value
? There are a number of abnormal gaits,many of
which are either typical or suggestive of certain
disease
Palpation
? Methods of,feeling the hands used during
physical examinations
? The examiner touches and feels the patient’s
body part with his hands to examine the size,
consistency,texture,location,and tenderness of
an organ or body part
? The palpation of abdomen is particularly
important
How to perform palpation
? As with inspection,the initial step in palpation
may be facilitated by distracting conversation or
questions regarding the history
? It should be emphasized that during the
preliminary stages,muscle relaxation is the goal
ask the patient to flex the thighs and knees
How to perform palpation
? The degree of muscle rigidity or resistance may be
made by light palpation
? One should determine whether the abdominal wall
exhibits voluntary muscle tightening or actual rigidity
? Muscle spasm cannot be relaxed by voluntary effort
? Voluntary tensing of the muscle is brought about
through fear or nervousness,it can be overcome by
proper technique
? Always begin palpation in an area of the abdomen that
is farthest from the location of pain
Types of palpation
? Light palpation
? Deep palpation
deep slipping palpation
bimanual palpation
deep press palpation
ballottement
Light palpation
? Using the flat part of the right hand or the pads
of the fingers,not the fingertips
? The fingers should be together
? Sudden jabs are to be avoided
? The hand should be lifted from one area to area
instead of sliding over the abdominal wall
Light palpation
? The palpating hand should be warm,because
cold hands may produce voluntary muscular
spasm called,guarding”
? Engaging the patient in conversation often aids
in relaxing the patient’s abdominal musculature
? Ask patient to be in a supine position and to flex
the thighs and knees
Light palpation
? During expiration,the rectus muscles usually
relax and soften
? Used to feel for pulses,tenderness,muscle
spasm,rigidity,surface skin texture,temperature,
moisture or mass,its size,location,hardness and
outline
Light palpation
? Rigidity is involuntary spasm of the abdominal
muscles and is indicative of peritoneal irritation
? Rigidity may be,
diffuse (diffuse peritonitis)
localized (over an inflamed appendix or gallbladder)
? In patients with generalized peritonitis,the
abdomen is described as,board-like”
Deep palpation
? Used to determine organ size as well as the
presence of abdominal masses
? The flat portion of the right hand is placed on
the abdomen
? Pressure should be applied to the abdomen
gently but steadily
? The patient should be instructed to breathe
quietly through the mouth and to keep arms at
the sides
Deep slipping palpation
? The examiner uses his forefinger,middle finger
and ring finger that are tightly together,slowly
and gradually palpate the abdominal organs or
masses,slipping up-,down,right side and left
side
? It is frequently used for examining the deep
mass of abdomen or GI lesions
Bimanual palpation
? Uses two hands,one on each side of the body part
being palpated
? Placing the left hand over the pack of organs to be
examined,in order to fix or elevate the organs,It
may be helpful for the right hand palpation
? It is employed during the processes of liver,
spleen,kidney or abdominal masses examination
Deep press palpation
? The examiner uses his thumb or 2~3 fingers
together to palpate with gradually increasing
pressure,in order to identify deep organ lesions or
localize the area of abdominal pain
? Such as the pain produced by inflamed
gallbladder or appendicitis
? In a patient with abdominal pain,the rebound
tenderness should be determined
Rebound tenderness
? It is a sign of peritoneal irritation and can be
elicited by palpating deeply and slowly in an area
from the suspected area of local inflammation
? The palpating hand is then quickly removed
? The sensation of pain on the side of inflammation
that occurs on release of pressure is rebound
tenderness
Ballottement
? The examiner places 3~4 fingers together on the surface
of suspected abdominal area and push quickly and
shortly for several times with the motion from the wrist
? The fingertips might feel the abdominal organs are
floating,because it produce ascitic waves
? Employed in palpating the enlarged liver,spleen or
masses
? It may also elicit uncomfortable of the patient
? It is suggested do not push too hard
Percussion
? A methods of,tapping” of body parts during
physical examination with fingers,hands,or small
instruments to evaluate the size,consistency,
borders and presence of fluid in body organs
? Percussion of a body part produces a sound that
indicates the type of tissue within the organ
? It is particularly important in examining the chest
and abdomen
Percussion
? Tapping on the chest/abdominal wall is transmitted to the
underlying tissue,reflected back,and picked up by the
examiner’s tactile and auditory sense
? The sound heard and tactile sensation felt are dependent
on the air-tissue ratio
? The vibrations initiated by percussion of the chest enable
the examiner to evaluate the lung tissue to a depth of
only 5~6 cm,but percussion is valuable because many
changes in the air-tissue ratio are readily apparent
Percussion
It is used to detect diaphragmatic movement,the size
of heart,edge of liver and spleen and ascitis et al
Methods of Percussion
? Indirect percussion
? Direct percussion
Indirect Percussion
? The examiner places the middle finger of one hand (left
hand) firmly against the patient’s surface wall (chest or
abdomen),with palm and other fingers held off the skin
surface
? The tip of the right middle finger of the hand strikes a
quick,sharp blow to the terminal phalanx of the left
finger on the skin surface
? The motion of the striking finger should come from the
wrist and not from the elbow
? Deliver 2~3 quick taps and listen carefully
Indirect Percussion
? Light percussion
? Moderate percussion
? Heavy percussion
Light Percussion
? Localized and superficial lesions or normal
organs
? Heart /liver relative dullness borderline
Moderate Percussion
? Deep and generalized lesions or organs
? Heart/liver absolute dullness borderline
Heavy Percussion
? Deep lesions (7 cm inside of the surface)
Percussion
? It should be performed from upside to downside
sequential
? From one side to the other side
? Comparison
Quality of Percussion
According to the identity of the tissue,amount of air gas
containing and distance of the organ from the skin
surface,the percussion sound include,
resonance
tympany
hyperresonance
dullness
flatness
Quality of Percussion
? Resonance,percussion over a structure containing air
within a tissue,such as the lung,produces a resonant,
higher-amplitude,lower-pitched note
? Tympany,percussion over a hollow air-containing
structure,such as the stomach,produces a tympanic,
higher-pitched,hollow quality note
Quality of Percussion
? Hyperresonance,the quality of percussion sound is
between the resonance and tympany,Such as in children,
pulmonary emphysema
? Dullness,percussion over a solid organ,such as the liver,
produces a dull,low-amplitude,short-duration note
without resonance,
It occurs when the air content of the underlying tissue is
decreased and its solidity is increased,
Quality of Percussion
? Flatness,very short,and high pitched (absolute
dullness),Flatness occurs when there is no air
present in the underlying tissue,For example,
flatness is found over the muscle of the arm or
thigh,
Sounds produced by
Percussion
Record of finding Quality Where heard
Resonance Hollow Normal lung
Hyperresonance Booming Air-filled lungs
Tympany Drumlike Abdomen
Dullness Thudlike Liver
Flatness Flat Muscle,bone
Ausculation
? A method used to,listen” to the sounds of the
body during a physical examination
? Performed by listening through a stethoscope,and
to evaluate the frequency,intensity,during,
number and quality of sounds
Ausculation
Ausculation
? Direct ausculation
? Indirect ausculation
How to use the stethoscope
? Do’s
warm the diaphragm or bell
explain what you’re listening for and answer patient’s
question promptly
? Don’ts
do not apply too much pressure when using the bell
do not try to listen through clothing
How to ausculate
? Eliminate distracting noises
? Expose the body part you are going to ausculate
? Use the diaphragm to listen for normal heart sounds,and
bowel sounds
? Press the diaphragm firmly
? Use the bell to listen for abnormal heart sounds or bruits
? Hold the bell lightly
Smelling
? A method used to evaluate the relationship
between abnormal ordor from the patient and
disease
? The ordor is elicited from the exudates of skin,
mucosa,respiratory tract,GI,blood etc
? Abnormal ordor may also provide important clues
for the diagnosis of the disease
? It is the process of examining the patient’s body
to determine the presence or absence of
physical problems
? The goal of the physical examination is to obtain
valid information concerning the health of the
patient
? The examiner must be able to identify,analyze,
and synthesize the accumulated information into
a comprehensive assessment
The four cardinal principles of
physical examination
? Inspection
? Palpation
? Percussion
? Auscultation
“teach the eye to see,the finger to feel,and the ear
to hear”
? What is the fifth?
Smelling
Equipment for physical
examination
Required Optional
Stethoscope Gloves
Tongue blades Gauze pads
Penlight Lubricant gel
Tape measure Nasal speculum
Sphygmomanometer Turning fork,128 Hz,512Hz
Reflex hammer Pocket visual acuity card
Safety pins Oto-ophthalmoscope
Important aspects of physical
examination----physician
? Elegant appearance
? Decent manner
? Kind attitude
? Highly responsibility
? Good medical morals
Important aspects of physical
examination---physician
? Wash your hands,preferably while the
patient is watching
? Washing with soap and water is an
effective way to reduce the transmission
of disease
Important aspects of physical
examination---patient
The patient should be made as comfortable
as possible during the examination
The patient should be properly draped
Important aspects of physical
examination
Where is the bed placed?
? When possible,the examining table/bed be
situated so that the examiner has access to both
sides of the patient
? An ideal arrangement is to have the table
located in the center of the examining room
Important aspects of physical
examination
Where does the examiner stand?
? Stand right side of the bed
? Exam with one’ right hand
Important aspects of physical
examination
How to perform the physical examination?
? Sequential
? Proper expose
Sequential
? Conducted in head to toe order,head ---
neck---chest---abdomen---spine---
extremities---anal---genital---nerve system
? Patients tire quickly when asked to,sit up”,
“lie down”,“turn on your left side”,“sit up”,
“lie down” and so on
Proper expose
? Exposing only the area that are being examined at
that time without undue exposure of the other
areas
? When examining a women’s breasts,it is
necessary to check for any asymmetry by
inspecting both breasts at the same time
? After inspection has been completed,the
physician may use the patients gown to cover the
breasts not being examined
This caring for the patient’s privacy goes a long way in
establishing a good doctor-patient relationship
Important aspects of physical
examination
? The examiner should continue speaking to the
patient
? Showing care to his disease and answer to
patient’s questions
? It can not only release patient’s nerviness,but
also help to establish the good physician-patient
relationship
Precaution to take
? The use of gloves should provide adequate
protection when performing the physical
examination or when handling blood-soiled or
body fluid-soiled sheets or clothing
? Gloves should be worn when examining any
individual with exudative lesions or weeping
dermatitis
Precaution to take
? Hands or other contaminated skin surfaces
should be washed thoroughly and immediately it
accidentally soiled with blood or other body
fluids
? All sharp items,such as needle,must be
handled with extraordinary care to prevent
injuries
? A patient may be in isolation or on special
precautions if he/she is suffering from a
contagious disease
Inspection
? Method of observation used during physical
examination
? First step in examining a patient or body part
? It includes a general survey of the patient’s
mental status posture body movement
gait speech breath ordor
stature skin state of nutrition
How to inspect
? Make sure the room is a comfortable
temperature
? Use good lighting,preferably sunlight
? Look and observe before touching
? Completely expose the body part you are
inspecting while draping the rest
? Compare symmetrical body parts
Mental status and personal
grooming
? Does the patient look well or sick?
? Is he comfortable in bed?
? Does he appear in distress?
? Is he alert or is he groggy?
? Does he look acutely or chronically ill?
poor nutrition sunken eyes temporal wasting loose skin
? Does the patient appear clean?
? Is her hair combed?
? Does she bite her nails?
Mental status and personal
grooming
The answer to these questions may provide useful
information about the patient’s self-esteem
and mental status
Body habitus
? The body habitus is useful to observe because certain
disease states are more common in different body
builds
? The asthenic/ectomorphic patient is thin,has poor
muscle development and small bone structure and
appears malnourished
? The sthenic/mesomorphic patient is the athletic type
with excellent development of the muscles and large
bone structure
? The hypersthenic/endomorphic patient is a short,
round individual with good muscle development but
frequently has a weight problem
Posture
? It may reveal significant information
? Congestive heart failure,sit in a chair the entire night
? Patients with body/tail of the pancreatic cancer,
assuming an upright or sitting posture
? Thus the positions of the patient at the time of the
examination may suggest certain disease possibilities
? A history of assuming certain positions to obtain relief
from pain also may be of diagnostic importance
Body movement
? It can be classified as voluntary and involuntary
? Voluntary movements are associated with normal
routine body activity
? Involuntary movements are usually abnormal and may
occur in patients in either conscious or comatose states
? Convulsive movements are a series of violent
involuntary muscle contractions
either clonic or tonic in character
Gait
? The manner in which a patient walks is often of
diagnostic value
? There are a number of abnormal gaits,many of
which are either typical or suggestive of certain
disease
Palpation
? Methods of,feeling the hands used during
physical examinations
? The examiner touches and feels the patient’s
body part with his hands to examine the size,
consistency,texture,location,and tenderness of
an organ or body part
? The palpation of abdomen is particularly
important
How to perform palpation
? As with inspection,the initial step in palpation
may be facilitated by distracting conversation or
questions regarding the history
? It should be emphasized that during the
preliminary stages,muscle relaxation is the goal
ask the patient to flex the thighs and knees
How to perform palpation
? The degree of muscle rigidity or resistance may be
made by light palpation
? One should determine whether the abdominal wall
exhibits voluntary muscle tightening or actual rigidity
? Muscle spasm cannot be relaxed by voluntary effort
? Voluntary tensing of the muscle is brought about
through fear or nervousness,it can be overcome by
proper technique
? Always begin palpation in an area of the abdomen that
is farthest from the location of pain
Types of palpation
? Light palpation
? Deep palpation
deep slipping palpation
bimanual palpation
deep press palpation
ballottement
Light palpation
? Using the flat part of the right hand or the pads
of the fingers,not the fingertips
? The fingers should be together
? Sudden jabs are to be avoided
? The hand should be lifted from one area to area
instead of sliding over the abdominal wall
Light palpation
? The palpating hand should be warm,because
cold hands may produce voluntary muscular
spasm called,guarding”
? Engaging the patient in conversation often aids
in relaxing the patient’s abdominal musculature
? Ask patient to be in a supine position and to flex
the thighs and knees
Light palpation
? During expiration,the rectus muscles usually
relax and soften
? Used to feel for pulses,tenderness,muscle
spasm,rigidity,surface skin texture,temperature,
moisture or mass,its size,location,hardness and
outline
Light palpation
? Rigidity is involuntary spasm of the abdominal
muscles and is indicative of peritoneal irritation
? Rigidity may be,
diffuse (diffuse peritonitis)
localized (over an inflamed appendix or gallbladder)
? In patients with generalized peritonitis,the
abdomen is described as,board-like”
Deep palpation
? Used to determine organ size as well as the
presence of abdominal masses
? The flat portion of the right hand is placed on
the abdomen
? Pressure should be applied to the abdomen
gently but steadily
? The patient should be instructed to breathe
quietly through the mouth and to keep arms at
the sides
Deep slipping palpation
? The examiner uses his forefinger,middle finger
and ring finger that are tightly together,slowly
and gradually palpate the abdominal organs or
masses,slipping up-,down,right side and left
side
? It is frequently used for examining the deep
mass of abdomen or GI lesions
Bimanual palpation
? Uses two hands,one on each side of the body part
being palpated
? Placing the left hand over the pack of organs to be
examined,in order to fix or elevate the organs,It
may be helpful for the right hand palpation
? It is employed during the processes of liver,
spleen,kidney or abdominal masses examination
Deep press palpation
? The examiner uses his thumb or 2~3 fingers
together to palpate with gradually increasing
pressure,in order to identify deep organ lesions or
localize the area of abdominal pain
? Such as the pain produced by inflamed
gallbladder or appendicitis
? In a patient with abdominal pain,the rebound
tenderness should be determined
Rebound tenderness
? It is a sign of peritoneal irritation and can be
elicited by palpating deeply and slowly in an area
from the suspected area of local inflammation
? The palpating hand is then quickly removed
? The sensation of pain on the side of inflammation
that occurs on release of pressure is rebound
tenderness
Ballottement
? The examiner places 3~4 fingers together on the surface
of suspected abdominal area and push quickly and
shortly for several times with the motion from the wrist
? The fingertips might feel the abdominal organs are
floating,because it produce ascitic waves
? Employed in palpating the enlarged liver,spleen or
masses
? It may also elicit uncomfortable of the patient
? It is suggested do not push too hard
Percussion
? A methods of,tapping” of body parts during
physical examination with fingers,hands,or small
instruments to evaluate the size,consistency,
borders and presence of fluid in body organs
? Percussion of a body part produces a sound that
indicates the type of tissue within the organ
? It is particularly important in examining the chest
and abdomen
Percussion
? Tapping on the chest/abdominal wall is transmitted to the
underlying tissue,reflected back,and picked up by the
examiner’s tactile and auditory sense
? The sound heard and tactile sensation felt are dependent
on the air-tissue ratio
? The vibrations initiated by percussion of the chest enable
the examiner to evaluate the lung tissue to a depth of
only 5~6 cm,but percussion is valuable because many
changes in the air-tissue ratio are readily apparent
Percussion
It is used to detect diaphragmatic movement,the size
of heart,edge of liver and spleen and ascitis et al
Methods of Percussion
? Indirect percussion
? Direct percussion
Indirect Percussion
? The examiner places the middle finger of one hand (left
hand) firmly against the patient’s surface wall (chest or
abdomen),with palm and other fingers held off the skin
surface
? The tip of the right middle finger of the hand strikes a
quick,sharp blow to the terminal phalanx of the left
finger on the skin surface
? The motion of the striking finger should come from the
wrist and not from the elbow
? Deliver 2~3 quick taps and listen carefully
Indirect Percussion
? Light percussion
? Moderate percussion
? Heavy percussion
Light Percussion
? Localized and superficial lesions or normal
organs
? Heart /liver relative dullness borderline
Moderate Percussion
? Deep and generalized lesions or organs
? Heart/liver absolute dullness borderline
Heavy Percussion
? Deep lesions (7 cm inside of the surface)
Percussion
? It should be performed from upside to downside
sequential
? From one side to the other side
? Comparison
Quality of Percussion
According to the identity of the tissue,amount of air gas
containing and distance of the organ from the skin
surface,the percussion sound include,
resonance
tympany
hyperresonance
dullness
flatness
Quality of Percussion
? Resonance,percussion over a structure containing air
within a tissue,such as the lung,produces a resonant,
higher-amplitude,lower-pitched note
? Tympany,percussion over a hollow air-containing
structure,such as the stomach,produces a tympanic,
higher-pitched,hollow quality note
Quality of Percussion
? Hyperresonance,the quality of percussion sound is
between the resonance and tympany,Such as in children,
pulmonary emphysema
? Dullness,percussion over a solid organ,such as the liver,
produces a dull,low-amplitude,short-duration note
without resonance,
It occurs when the air content of the underlying tissue is
decreased and its solidity is increased,
Quality of Percussion
? Flatness,very short,and high pitched (absolute
dullness),Flatness occurs when there is no air
present in the underlying tissue,For example,
flatness is found over the muscle of the arm or
thigh,
Sounds produced by
Percussion
Record of finding Quality Where heard
Resonance Hollow Normal lung
Hyperresonance Booming Air-filled lungs
Tympany Drumlike Abdomen
Dullness Thudlike Liver
Flatness Flat Muscle,bone
Ausculation
? A method used to,listen” to the sounds of the
body during a physical examination
? Performed by listening through a stethoscope,and
to evaluate the frequency,intensity,during,
number and quality of sounds
Ausculation
Ausculation
? Direct ausculation
? Indirect ausculation
How to use the stethoscope
? Do’s
warm the diaphragm or bell
explain what you’re listening for and answer patient’s
question promptly
? Don’ts
do not apply too much pressure when using the bell
do not try to listen through clothing
How to ausculate
? Eliminate distracting noises
? Expose the body part you are going to ausculate
? Use the diaphragm to listen for normal heart sounds,and
bowel sounds
? Press the diaphragm firmly
? Use the bell to listen for abnormal heart sounds or bruits
? Hold the bell lightly
Smelling
? A method used to evaluate the relationship
between abnormal ordor from the patient and
disease
? The ordor is elicited from the exudates of skin,
mucosa,respiratory tract,GI,blood etc
? Abnormal ordor may also provide important clues
for the diagnosis of the disease
