GI OSCE

Order of Note

Demographics
CC
HPI
VS
General
Abdomen: I A P P
Assessment
Differential diagnosis 1 and 2

Abdomen Inspection

looking for contour, skin lesions, discolorations, scars, masses, or hernias

Abdomen Inspection Note

Thin/flat/protuberant/scaphoid/distended abdomen. Skin color is dark/light/homogenous without lesions, scars, or discoloration. Symmetry is noted without evidence of masses or hernias.

Abdomen Auscultation

Auscultate with the diaphragm in 2 areas in each of the 4 quadrants. Use the bell to check for abdominal aortic, renal, or femoral artery bruits bilaterally.

Abdomen Auscultation Note

Hyperactive/normoactive/hypoactive/absent bowel sounds heard in all four quadrants. No evidence of abdominal aortic bruit or renal or femoral artery bruits bilaterally. Femoral pulses 2+ bilaterally.

Abdomen Percussion

Percuss over the liver, stomach, and intestines to distinguish dullness, resonance, or tympany sounds. Have the patient sit up to check for costovertebral angle (CVA) tenderness at the end.

Abdomen Percussion Note

Percussion revealed expected pattern of dullness over liver (RUQ), tympany over stomach (LUQ), and resonance over the intestines (LLQ and RLL). No CVA tenderness noted bilaterally.

Abdomen Palpation

Lightly palpate the abdomen in all four quadrants to check for any masses, guarding, or tenderness. Then deeply palpate the abdomen to also check for any masses, guarding, or tenderness. Explain that this deep palpation might be slightly uncomfortable and let me know if you experience any tenderness. Palpate the liver while the patient takes deep breaths through their mouth. Palpate the abdominal aorta and use both hands to check for equal pulse.

Abdominal Palpation Note

No masses, guarding, or tenderness to light or deep palpation noted in all quadrants. Palpation of the liver revealed a firm, smooth lower edge descending (with deep inspiration) about 2 cm below right costal margin. No liver tenderness noted. Deep palpation of mid-abdominal area revealed 1+ pulsations of the abdominal aorta (AA).