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GIT OSCE (Week 9) : Mention You Would Observe General Appearance and Take Vitals

1. The document outlines the steps for performing a full abdominal examination, including inspection, auscultation, percussion, and palpation of the abdomen and specific organs. 2. Key areas that would be examined include the liver, gallbladder, spleen, kidneys, appendix, abdominal aorta, and inguinal regions to check for hernias. 3. Specific examination techniques are described such as Murphy's sign for the gallbladder, ballottement and punch test for the kidneys, Rovsing's sign and rebound tenderness for the appendix.

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604 views3 pages

GIT OSCE (Week 9) : Mention You Would Observe General Appearance and Take Vitals

1. The document outlines the steps for performing a full abdominal examination, including inspection, auscultation, percussion, and palpation of the abdomen and specific organs. 2. Key areas that would be examined include the liver, gallbladder, spleen, kidneys, appendix, abdominal aorta, and inguinal regions to check for hernias. 3. Specific examination techniques are described such as Murphy's sign for the gallbladder, ballottement and punch test for the kidneys, Rovsing's sign and rebound tenderness for the appendix.

Uploaded by

renae_vard
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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GIT

OSCE (week 9) * Hands


Hand Hygiene and 1. Wash hands * Intro
Introduction 2. Introduction and explanation of examination * General appearance
Observation and * Vitals
Vitals Mention you would observe general appearance and take vitals

Inspection 1. Hands: (perfusion, palmar creases nails)
∗ Fingers, nails, palms
∗ Asterixes – ask patient to stretch arms in front of hem and extend
wrists (check for tremor)
2. Arms: Petechia, scratch marks, bruising, spider naevi
3. Head:
∗ Check eyes, Observe face (Conjunctiva, pallor, Iritis, Xanthelama)
∗ Mouth and Breath (Dentation, gum health, ulcerations)

4. Chest and Abdomen (mention you would observe)
• Contour – Round/flat, bulges, umbilicus contour
• Distension – Fluid, foetus, faces, fat, flatus
• Movement – Pulsations, peristatltic waves, rigidity
• General – Scars, masses, 1ruising, striae

5. Grey Turner’s Sign (bruising of the flanks) – acute pancreatitis, pancreatic
haemorrhage, retro-peroneal haemorrhage, ectopic pregnancy, AAA

Auscultation 1. Bowel sounds of abdomen
Increased bowel sounds: - Absent or present (depends on time on meal)
* Mechanical bowel obstruction - High pitched sound = obstruction
* Gastroenteritis
- Absent sounds = paralytic ileus (>4min)
* Empty bowels
***Move on from auscultation once you’ve heard bowel sounds***
Decreased bowel sounds: ***Leave stethoscope for 2min to give time for bowel sounds***
* Paralytic ileus after surgery *** Start away from pin***
* Peritonitis
2. Mention: would auscultate AA and renal iliac arteries (RIA)

Abdominal Aorta and RIA:
Bruits indicate:
* Aneurysm
* Atheriosclerosis
* Anaemia


Percussion 1. Percuss abdomen

Ascites 2. Mention: Would perform “Shifting-dullness/ Flick test” if suspected ascites

Palpation 1. Superficial palpation
2. Deep palpation

Organ Specific Liver 1. Percuss upper border of liver
• Percuss down along the R lung field
along the mid-clavicular line – middle portion
of liver
1. Liver • Percuss down along the right
parasternal line – medial portion of the liver
2. Gallbladder
2. Palpate lower border of the liver
3. Spleen • Palpate starting from the RIF,
• Align examining hand parallel to
4. Kidneys the costal margin and ask patient
to breath in and out.
5. Appendix • Attempt to feel for the lower
border of the liver during
6. Abdominal Aorta inspiration phase.
• Hand is kept still during inspiration feeling for liver inferior edge
7. Inguinal Hernias contacting it.

Gallbladder • Apply deep pressure on GB using
double thumb contact
Murphy’s • Ask patient to breath in while
Sign maintaining contact
• Positive: Arrested inspiration with
pain (lung pushes into liver/ GB,
compresses GB against contact)

Spleen • Patient side lying (right side down)
• Dr deep palpation during breathing
from R ASIS towards L inferior rib
cage
• Spleen is only palpated when its x3
bigger than the normal size –
splenomegaly

Kidneys Ballottement Kidney Punch Test



Appendix Rovsing’s Sign Rebound Tenderness
(McBurney’s)
Right lumbar Located 1/3 distance from right
region ASIS to umbilicus
• Appendicitis: if deep
McBurney's palpation at this point causes
pain
• Peritonitis: Pain on quick
withdrawal of examining hand

(rebound tenderness)
AA



Hernia Inguinal hernia (Para-umbilical hernia)
• Patient in standing position
• Palpate the inguinal region for any lumps or masses
• Ask patient to cough or bear down and feel for any bulging

or cough impulse

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