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Gastrointestinal Examination OSCE Note

OSCE note

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Koshila Bennett
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54 views

Gastrointestinal Examination OSCE Note

OSCE note

Uploaded by

Koshila Bennett
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Gastrointestinal Examination

WASH HANDS
Introduction
Explain, Consent
Name, age,
Expose patient
ideally check patient’s height, weight and waist circumference and calculate BMI

ASK FOR PAIN

IF YOU EXPERIENCE ANY DISCOMFORT PLEASE LET ME KNOW

EXPLAIN AS YOU GO ALONG

Inspection
Patient looks comfortable in a supine position. Patient is of normal colour, normal weight, not obese or
malnourished.
No IV drips, vomit bowls, or nutritional supplements.

Closer inspection
Hands:
Normal temperature.
no tar staining,
No clubbing(eye level- curvature and check fluctuation):

 gastro: hepatic cirrhosis, inflammatory bowel disease (Ulcerative colitis, Crohn’s), malabsorption
syndromes, coeliac disease

No leukonychia(hyperalbuminaemia, kwashiorkor, malabsorption),


no koilonychia (iron deficiency).
No Dupuytren's contracture(thickening of palmar fascia- liver disease, occupation or familial),
no palmer erythema(chronic liver disease, pregnancy),
No tremor.
Extend and cock up hands at 90, no hepatic flap (hepatic encephalopathy- brain affected by raised
ammonia in blood stream. Liver damage caused accumulation- confusion, drowsiness, jerky
movements).

Radial pulse and Respiratory rate


Ideally this is done for one minute but I will do each for 15 seconds and multiply by 4.
Felt lateral to the flexor carpi radialis tendon.
Rate: ## beats per minute,
Rhythm: regular, Character: Normal, Volume: Strong
Respiratory rate: ## breaths per minute

Blood pressure
Eyes: White sclera, no pallor (anaemia- malnutrition), no sign of jaundice(liver disease). No Kayser
Fleisher rings (wilson’s disease- high Cu)
Mouth: tongue out and up, good dentition, no halitosis, no angular stomatitis (iron or vitamin b
deficiency),
no aphthous ulcers seen (Crohn’s), ask about ulcers,
no glosittis (b12 deficiency),
or central cyanosis.

Neck:
LYMPH NODES
Sit up, explain. From behind, Palpate one side at a time: lymph nodes not enlarged.

1. Submental
2. Pretracheal
3. lower cervical
4. middle cervical
5. submandibular
6. upper cervical
7. preauricular
8. postauricular
9. posterior triangle
10. supraclavicular- left: Virchow’s node for
Troiser’s sign – intraabdominal malignancy

Body Inspection
Chest
no spider neavi (>5- liver disease),
no gynacomastia(chronic liver disease),
no stretch marks, warts, bruising.

Abdomen
eye level- abdomen not distended (obesity- umbilicus is unken, ascites- umbilicus is everted.)
no obvious masses, scars, stomas.
No caput medusa(portal hypertension),
Palpation:
WATCH PATIENT. If there is any pain please let me know.

patient lying flat


9 quadrants of the abdomen,
Left iliac fossa, supra pubic region, right iliac fossa, right flank, right hypochondrium, epigastrium, left
hypochondrium, left flank, umbilicus.

Light palpation- one hand, Deep palpation- 2 hands.


No guarding, no rigidity, no rebound tenderness (peritonitis), and no masses felt.
The patient reported no pain.

Liver

Palpation:
Tell patient to take deep breath in and out mouth.
One hand, sideways palm. So the border of the index finger is parallel to ribs.
Place hand in and up. Liver edge descends on inspiration.

Gall bladder tenderness (Cholecystitis)- palpate right upper quadrant at mid clavicular line.
(Inflamed gall bladder- pain causes inspiration to stop.)
Negative murphy’s sign.

Percussion:
RIF and move up till note changes from resonant to dull.
From top: tell patient to breathe in, out and hold. Percuss from top right Intercostal space in
midclavicular line to locate upper border.

Liver is a normal size of 7cm. No hepatomegaly detected (chronic parenchymal liver disease, fatty liver
disease)(enlarged in early cirrhosis, shrunken in late cirrhosis).

Spleen

Palpation:
take deep breath in through mouth.
Only right hand obliquely, start from RIF.
Feel spleen edge as it descends on inspiration.
move towards left hypochondrium between each breath.
feel along left costal margin.
if can’t feel, ask patient to roll towards you, put hand under

Percussion:
RIF to left costal margin (resonant to dull) and slightly above.

No splenomegaly detected (pancytopenia- low Plt, wcc, hb)


Bladder:
Palpation: from umbilicus down to pubic symphysis.
Percussion: from umbilicus down to pubic symphysis.

Bladder not distended.

Kidneys
balloting: left hand under patient at left flank. Right hand over.
on expiration, push hands together, and inspiration, try ballot. Push with right hand. Feel with left.
Repeat on other side.
Kidneys are not palpable.

Aorta

Palpation: Hands on either side between xiphisternum and umbilicus. Press posterior and medial.

Abdominal aorta is pulsatile and not expansile.


or abdominal aorta is impalpable (muscular or obese)

Auscultation:

Midline above umbilicus.


No aortic bruit. (atheromatous plaque, aneurismal aorta, superior mesenteric artery stenosis)

Auscultation:
Bowel sounds- steth at right of umbilicus. Bowel sounds are heard every 5-10 seconds.
(absence- paralytic ileus, peritonitis.)
(increases frequency, volume, pitch, “tinkling”- intestinal obstruction)

Renal artery bruit: steth 2-3cm above and lateral to umbilicus on both sides.
No audible bruit (renal artery stenosis)

Liver bruit: listen over liver (hepatoma or acute alcoholic hepatitis)


friction rub- rubbing fingers together- may be heard over liver(perihepatitis)or spleen (perisplenitis).
No liver bruit (or friction rub)

(Succusion splash sounds- lift from hips, shake. If water heard >4 hours after food/drink, then delayed
gastric emptying- pyloric stenosis.)

Ascites
Place hand vertical on the midline, percuss to left flank. Resonant to dull- is the gas- fluid interface. Ask
patient to roll towards you. Ideally wait for 10 seconds (ascites will trickle down). Percuss the same point
again. If resonant- then there is shifting dullness.
No shifting dullness.

Fluid thrills.
Ask patient to keep edge of palm on midline. Keep your right hand on left side of body, flick from your
end.

No thrills felt.

To complete the examination:


Examine hernia orifices, external genitalia for any masses, pain, discoloured skin or deformity.
a digital rectal exam to exclude obstruction or masses, fresh blood or melena
urinary dipstick to exclude a cause of abdominal pain
pregnancy test if the patient is female- to rule out ectopic pregnancy

Summary
Name, age, came in for GI exam
Pulse, respiratory rate
On palpation, no abnormalities detected, patient feels no pain, no guarding, rigidity or tenderness.
liver and spleen not enlarged, bladder not distended. No gall bladder tenderness. Kidneys impalpable.
Abdominal aorta is pulsatile. No aortic bruits, renal bruits, liver bruits. No shifting dullness.

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