Summary
Summary OSCE ABDOMEN-HEPATOLOGY EXAMINATION
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this document provides a step by step overview to get you prepared for the upcoming osce exams and your daily ward rounds.
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IC3 OSCE Abdomen- Hepatology Medicine“This is a medical station. You have 5 minutes to complete an examination to assess this patient for features of liver disease. I will then ask you
to present your findings and answer a question”.
Examination Expected/Normal Comments Potential/Abnormal Comments
Introduction
Hand hygiene Abbreviation key (NB: these abbreviations are not
Cleans hands with alcohol gel necessarily medically acceptable abbreviations and
have been abbreviated for the purposes of this
Introduction, explanation and consent Hi my name is X. I’m a third year medical student
document only):
at RCSI. What’s your name? Nice to meet you. I’ve RHC = right hypochondrium
• Introduces self with name and level, explains been asked to examine your abdomen today. That EPG = epigastrium
what he/she will be doing and obtains consent
will involve me looking at, feeling and listening to LHC = left hypochondrium
for same
your abdomen. Would that be ok? RF = right flank
LF = left flank
Position and exposure Mr/Mrs A is appropriately positioned and exposed UMB = umbilicus
• Patient positioned at 180 degrees, undressed to for this examination. RIF = right iliac fossa
the waist, with hands placed at the sides LIF = left iliac fossa
SPC = suprapubic
Enquires about pain ‘Are you in any pain?’ AA = abdominal aorta
• Prior to examining
General Inspection
Equipment
Performed from the end of the bed IV access, emesis bowl, NG tube, PEG tube,
‘On general inspection Mr/Mrs A appears well, medications, aids/devices, O2 delivery
Inspects for there are no peripheral stigmata of liver disease, Patient
o Equipment
and no equipment around the bed.’
Appears unwell/in pain/pale/jaundice
o Patient BMI e.g. cachexia, muscle wasting
Obvious wounds, scars, dressings, catheters,
stomas, herniae, masses, pulsations etc.
Hands & Arms & Face
Performed from the right hand side of the bed Hands
Clubbing (IBD, Cirrhosis, Coeliac disease)
Inspects hands for
Leuconychia (Hypoalbuminaemia)
o Clubbing
o Leuconychia Koilonychia (Iron deficiency anaemia)
o Koilonychia Palmer erythema (Cirrhosis)/crease pallor
o Palmer erythema/crease pallor ‘ On inspection of the hands, arms and face there (anaemia)
o Dupytren’s Contracture are no signs of liver disease ‘ Dupytren’s contracture (Excess alcohol)
o Hepatic flap Hepatic flap (Hepatic encephalopathy or
o Asks patient to fully extend arms + uraemia)
wrists and then spread fingers. Arms
o Observes for downward movement
Pigmentation changes(Jaundice)
of the hands for 10-15 seconds.
Scratch marks (Cholestasis)
Eyes
Inspects arms for
Conjunctival pallor (Anaemia)
o Pigmentation changes
o Scratch marks Scleral icterus (Liver disease)
Xanthelasma (Hyperlipidaemia)
Inspects the eyes for Mouth
o Conjunctival pallor Angular stomatitis (Iron/B12 deficiency)
o Scleral icterus Mouth (Aphthous) ulcers (Crohn’s/Coeliac
o Xanthelasma disease)
Inspects the mouth for Candidiasis (Immunodeficiency)
Tongue glossitis (Iron/B12/Folate deficiency)
o Angular stomatitis
o Mouth (Aphthous) ulcers
o Candidiasis
o Tongue glossitis
Chest & Abdominal Inspection
Performed from the right hand side of the bed Chest
Inspects the chest for Spider Naevi (Chronic liver disease)
o Spider Naevi Gynaecomastia (Liver Cirrhosis)
o Gynaecomastia Abdomen
Shape
Inspects Abdomen for o Scaphoid / Distended
‘On inspection of the chest and abdomen there are Scars/wounds/dressings
o Shape
no stigmata of liver disease’ o Mercedes Benz/RUQ (Liver transplant)
o Scars/wounds/dressings
o Masses o Midline laparotomy
Ecchymosis o Lapraroscopic port sites/abdominal
paracentesis scars
o Pfannensteil, Kocher, McBurney/Lanz
o Paramedian, transverse etc
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