Basic Abdomen Examination
Physical examination video.
1; check from the end of the bed first
(include RR, age, confusion, pain, scars, septic looking, pallor )
then... check
--> the hand(palm, finger clubbing and straighten hand)
--> arms and axilla
--> face+mouth
-->lymph node
--> chest (spider naevi>5 is significant)
2. Abdomen
--> observation
--> palpation of 9 segment! light palpation and deep palpation-
-> access the location, size, shape, surface, consistency, mobility
--> palpate the liver: liver edge then percuss from up to down
--> the gall bladder (murphy sign)
--> palpate the spleen start diagonally (look for rib 11, splenic notch)then percuss to confirm
--> ballot the kidney (make sure your hand is symmetrical)
--> palpate the aorta (2cm side and up, on the corners)
--> palpate the bladder
--> percussion for shifting dullness
--> auscultation for bowel sounds- bruits
3. peripheral check up
- check limbs (pitting edema)
Investigations
1. FBC
- WBC: high/low any infection
- Hb: anemia, bleeding, IDA
- PLT: low - spleen issue
2. coag
- PT prolong - if its high to suspect some liver damage/ vit K usage/ anticoagulant usage/ liver disease
- APTT - prolong ppt --> liver disease
3. LFT
- AST : in the blood may indicate hepatitis, cirrhosis, mononucleosis, or other liver diseases. High AST levels can also indicate heart problems or pancreatitis.
- ALT : high--> might be acute hepatits/ viral hepatitis infection
- ALP: can indicate liver disease or bone disorders
4. viral screening
- Hep B and Hep C (HbsAg, ANTI-HCV)
5. for differential diagnosis
- malignancy, tumor, abscess - to confirm with fnac/biopsy
- infection
- autoimmune disease
- thrombosis
- myeloma
- primary biliary cirrhosis
Sample cases for OSCE:
Sample Answer:
English to Malay terms
References:
https://www.moh.gov.my/index.php/pages/view/168
CPG management of upper GI bleeding
CPG Acute variceal bleeding management
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