Friday, February 12, 2021

Abdomen examination

Basic Abdomen Examination



In this post I will also add in a sample OSCE questions for EPR. Hopefully you will understand the structure and question style of EPR part II. 


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: 

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