Gastro

Question 1

1

Answer 1

Introduce

“today ive been asked to examine your abdomen. this will involve me looking at the end of the bed, feeling various areas of the abdomen and then listening at the end, is that ok. any pain at all?”

Inspect patient

Question 2

2

Answer 2

Inspect hands

“I’d like to start by looking at your hands, if you could just bring them up in front of you please… and turn them over”

• clubbing
• temp as well

Question 3

3

Answer 3

Asterixis

“if you could bring your hands out in front of you and cock your wrists and keep it there”

Question 4

4

Answer 4

Check pulse and BP

Question 5

5

Answer 5

Examine the forearms for muscle wasting and for scratches suggestive of pruritis (itching)

Question 6

7

Answer 6

Eyes -
look/inspect for a sec

pull down on lower eyelid
look down for me - and pull up looking for jaundice

“im now going to have a look at your face and eyes, if you could look straight ahead for me. I’m now going to pull down on your lower eye lid”

Question 7

8

Answer 7

inspect face

then inspect mouth

Question 8

9

Answer 8

palpate the lymph nodes

“sit forward for me, now going to feel for the glands in the neck”

Question 9

10

Answer 9

inspect chest

“id now like to more closely inspect the chest”

AND NOW INSPECT POSTERIOR WALL (MS)

Question 10

11

Answer 10

says to lower the bed?

“I’m going to now closely inspect the tummy now, im just going to lower the bed. if you could sit up for me. and lie back”

Question 11

12

Answer 11

inspect!!! - take 10 seconds on this

“im going to closely inspect your tummy”

Question 12

13

JUST GOING TO HAVE A FEEL OF YOUR TUMMY

Answer 12

Light palpation of 9 regions

“I’m now going to feel different areas of the tummy, can i just check if you have any pain at all”

Question 13

14

Answer 13

Deep

“im now going to press a little harder”

Question 14

15

Answer 14

Palpate the liver

“If you could now take some deep breaths in and out for me”
does 4

Question 15

16

Answer 15

Palpate the spleen

*carry on deep breaths. Go from RIF to L costal margin. Bring other hand round the back of the ribs and get patient to move slightly towards you

Question 16

17

Answer 16

Ballottttttt

*use same hand on top and bottom both sides

Question 17

18

Answer 17

Full bladder

Palpate the suprapubic region for a full bladder

Question 18

19

Answer 18

Abdominal aorta

-squeeze to hands together centrally near stermum

Question 19

20

Answer 19

Femoral pulse

Question 20

21

Answer 20

Murphys sign

• press down on the gall bladder. when you find it and have firm pressure on it, ask the patient to take a deep breath in (lungs expand and move it down)

Question 21

22

Answer 21

Percussion

“im now going to tap on your tummy”

• liver
• spleen*
• bladder

For spleen. put finger you’re palpating with on the costal margin near spleen. tap it now=resonant. when in right place get them to take a deep breath. should be resonant again cause spleen isnt enlarged and pushed down by lungs
*https://www.youtube.com/watch?v=5YVkGfoY5pM

Question 22

23

Answer 22

Auscultate

“im now going to listen to your tummy”

Question 23

24

Answer 23

Assess for aortic bruit and renal artery bruit.

central (for aortic) and then go next to that for renal artery

Question 24

25

Answer 24

“In summary I performed an abdominal exam on….
they and no peripheral stigmata of gastrointestinal disease. His abdomen was soft and non-tender with no masses or organomegaly. On ausculation he had normal bowel sounds. this was a normal abdominal exam.

“to complete i would like to …

Question 25

26

Answer 25

ISHRUG. In the OSCE, you should omit
these but should state a list to the examiner, without prompting, at the conclusion of
your physical examination:
BLOOD PRESSURE ON ALL 3 CORE

o Inguinal lymph nodes
o Stools – examine the stools if clinically indicated
o Hernial orifices (femoral and inguinal)
o Rectal examination (always with a chaperone)
o Urine – obtain urinalysis
o Genitalia (examine the male external genitalia). A vaginal examination may be
indicated in parous or sexually active females (only when clinically indicated
and always with a chaperone)

Question 26

27

inspect post wall
bladder palpate
percuss spleen

Answer 26

• Thank the patient and request them to redress

* Wash your hands