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

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

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    renae_vard
    238 views3 pages
    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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    GIT-4

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    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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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    238 views3 pages

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

    Uploaded by

    renae_vard
    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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    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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