Physical examination Physical examination must completely complement the medical history in order to exclude systemic etiologies. Evidence of systemic disease, including degeneration of the nervous or muscular system and endocrine or metabolic disorders, should be sought. Furthermore, special attention needs to be paid to the examination of the abdomen and anorectal area. Abdomen The abdomen can be examined for excess stool or gas and the presence of surgical scarring as evidence of tumor or inflammatory bowel disease. Palpation may reveal a soft mass which is the patient’s fecal-filled dilated rectosigmoid colon, a painful mass in the left lower abdomen suggesting a diverticular disease, or a hard mass more characteristic of a tumor. Percussion can identify gas and distension from ascites. Finally, on auscultation, hyperactive bowel sounds can be heard when the distended patient is relaxed, and localized intestinal obstruction or hypoactive or no bowel sounds are characteristic.