Master the Abdominal Exam: OSCE Prep

Preparation Wash hands thoroughly. Introduce yourself and confirm the patient's identity. Explain the procedure to the patient and ensure they are comfortable. Expose the abdomen: The patient should be lying supine, with the abdomen exposed from the xiphoid process to the pubic symphysis. The knees should be slightly flexed to relax the abdominal muscles. Ensure privacy and warmth in the room. 2. General Inspection Look for any obvious signs: Abdominal distention (e.g., bloating, ascites) Surgical scars or wounds Visible peristalsis or pulsations Signs of jaundice (yellowing of the skin or sclerae) Any masses or asymmetry Rashes, lesions, or hernias 3. Auscultation Listen for bowel sounds: Start in the right lower quadrant (RLQ) and proceed clockwise. Normal bowel sounds are irregular, gurgling sounds. Hyperactive bowel sounds suggest increased peristalsis (could indicate infection, diarrhea). Hypoactive or absent bowel sounds may indicate peritonitis or bowel obstruction. Listen for vascular sounds (bruits): Use the stethoscope over the aorta, renal arteries, iliac arteries, and femoral arteries to check for any abnormal vascular sounds, which may indicate stenosis or aneurysms. 4. Percussion Percuss over all four quadrants: Start in the RLQ and move clockwise. Tympany: Normally heard over air-filled structures (stomach, intestines). Dullness: Normally heard over solid organs (liver, spleen) and fluid-filled structures (bladder, ascites). Percuss for the liver: Start from the right lower quadrant (RLQ) and move upwards in the midclavicular line. When dullness is noted, this marks the lower edge of the liver. Percuss downward to find the upper border. Measure the liver span (normal: 6–12 cm). Percuss for splenomegaly: Percuss the left lower quadrant for a change from tympany to dullness. Shifting dullness (for ascites): Ask the patient to roll to one side. Percuss the abdomen; shifting dullness indicates fluid accumulation. 5. Palpation Light palpation: Use the pads of your fingers to palpate all four quadrants. Check for tenderness, muscle guarding, and superficial masses. Note any signs of rebound tenderness (indicative of peritoneal irritation). Deep palpation: Palpate deeper to assess for organ enlargement (liver, spleen), masses, or abnormal structures. The liver edge should be smooth and non-tender. The spleen may be palpable if it is enlarged, but normally it is not. Assess for any tenderness or masses, and note the location, size, and consistency of any abnormal findings. Palpate for the kidneys: Place one hand behind the patient (at the lower ribs) and the other on the abdomen. Ask the patient to take a deep breath while you try to feel the kidneys. 6. Special Tests Murphy’s sign: Ask the patient to breathe in while you palpate under the right costal margin. Sudden pain or interruption of inspiration suggests gallbladder inflammation (cholecystitis). Shifting dullness (for ascites): Already mentioned, but ensure this is noted during palpation. Rebound tenderness: Press down gently on the abdomen, then suddenly release. Pain upon release suggests peritonitis. Rovsing's sign: Press on the left lower quadrant. Pain in the right lower quadrant is a sign of appendicitis. Psoas sign: Have the patient lie on their left side and extend their right leg. Pain in the right lower quadrant suggests appendicitis. Obturator sign: Flex the patient’s hip and knee, and rotate the hip internally. Pain in the right lower quadrant suggests appendicitis. 7. Closing the Exam Ask the patient if they have any further questions. Cover the patient up and ensure their privacy is respected. Wash your hands again. Document your findings thoroughly. 🎧 TRACK INFO : ➡️• MUSIC TITLE. | • FREE BACKSOUND CINEMATIC INOSSI - Illusion Vlog No Copyright Music ➡️• MUSIC SOURCE | • VDNVN (Music No Copyright) 🔻DOWNLOAD SOUND FREE : https://carapedi.id/cpxNkyYPEs Thanks for watching Like & Subscribe for more videos like this one