Gastroenterology Examination (OSCE)

Related Subjects: |Breast Anatomy and Examination (OSCE) |Shoulder examination(OSCE) |Testicular examination(OSCE) |Hernia Examination (OSCE) |Rectal examination (OSCE) |Liver Examination (OSCE) |Cerebellar Examination (OSCE) |Upper and Lower Limb Neurology (OSCE) |Gastroenterology Examination (OSCE) |Respiratory Examination (OSCE) |Cardiology Examination (OSCE) |OSCE Eye Exam |OSCE Ear Exam |OSCE Abdominal Exam |OSCE Ascites Exam |OSCE Jaundice Exam |OSCE Testicular Exam |OSCE Inguinal Exam |OSCE Upper limb Neurology |OSCE Lower limb Neurology |OSCE Face Neurology |OSCE Visual Fields

🩺 The abdominal exam is an active, hypothesis-driven process - inspect, palpate, percuss, auscultate systematically while thinking about underlying pathology (liver, spleen, bowel, kidneys, aorta, herniae). Time goal: 6–8 minutes. Verbalise every step aloud (gains marks even if you miss something). Always finish by stating how you’d complete the exam: “To complete, I would examine the hernial orifices, perform a digital rectal examination, check external genitalia, examine lymph nodes, dip urine, and arrange bloods, ultrasound, and endoscopy as appropriate.”

🔑 Step-by-Step Abdominal Examination Sequence (High-Yield OSCE Flow)

1. 🧼 Preparation & Introduction (30–45 s)
   • Wash hands, introduce yourself, confirm name/DOB/hospital number.
   • Explain: “I’m going to examine your abdomen. It involves looking, listening, tapping, and feeling. It shouldn’t hurt much, but please tell me if it does. You can stop me anytime.”
   • Gain verbal consent, offer chaperone, expose abdomen from nipples to pubic symphysis (preserve dignity with blanket/towel), position flat with one pillow (or 45° if orthopnoeic/ascites).
   • Verbalise: “I’m positioning the patient flat with arms by sides for optimal relaxation.”
2. 👀 General Inspection (End of Bed – 15–20 s)
   • Patient: cachexia, jaundice/icterus, pallor, pigmentation (Addison’s), gynaecomastia (cirrhosis), spider naevi, muscle wasting, visible veins (caput medusae), abdominal distension, respiratory pattern.
   • Environment: NG tube, stoma bags (ileostomy/colostomy), TPN line, paracentesis drains, CAPD catheter, nutritional supplements, fluid balance chart, mobility aids.
   • Verbalise: “From the end of the bed, I note jaundice, spider naevi, and a distended abdomen with an ileostomy bag.”
3. ✋ Hands & Upper Limbs (30 s)
   • Inspection: clubbing (IBD, cirrhosis, coeliac), leukonychia (hypoalbuminaemia), koilonychia (iron deficiency), palmar erythema, Dupuytren’s contracture (alcohol-related cirrhosis), liver flap/asterixis (hepatic encephalopathy), scratch marks (pruritus – cholestasis), tendon xanthomata (familial hypercholesterolaemia).
   • Pulse: rate (tachycardia – dehydration, sepsis), rhythm (AF in hyperthyroidism → diarrhoea/malabsorption), character (bounding in liver failure).
   • Temperature: warm peripheries (sepsis), cold (shock).
4. 🫀 Face, Eyes, Mouth & Neck (45 s)
   • Eyes: scleral icterus (jaundice), conjunctival pallor (GI bleed, malabsorption), xanthelasma (primary biliary cholangitis), Kayser–Fleischer rings (Wilson’s disease – slit-lamp).
   • Mouth: glossitis/angular stomatitis (B12/folate/iron deficiency), aphthous ulcers (Crohn’s, coeliac), fetor hepaticus (severe liver failure), poor dentition (malabsorption risk).
   • Face: malar flush (mitral stenosis – can coexist with rheumatic fever → abdominal signs), temporal wasting.
   • Neck: JVP (fluid overload, Budd–Chiari), Virchow’s node (Troisier’s sign – gastric cancer metastasis), cervical/supraclavicular nodes (lymphoma, malignancy).
5. 👕 Chest & Abdominal Inspection (45 s)
   • Chest: spider naevi (cirrhosis), gynaecomastia (cirrhosis, drugs), hair loss, gynaecomastia scars.
   • Abdomen: scars (laparotomy, subcostal Kocher’s, Mercedes-Benz for liver transplant, laparoscopic ports, stoma sites), striae (Cushing’s, pregnancy), distension (5 Fs: fat, fluid, flatus, faeces, fetus), caput medusae (portal hypertension), visible peristalsis (obstruction), pulsations (AAA), herniae (umbilical, incisional).
   • Verbalise: “I note a Mercedes-Benz scar and caput medusae, suggestive of previous liver transplant and portal hypertension.”
6. 🤲 Palpation (2–3 minutes – kneel, watch patient’s face)
   • Light palpation: all 9 regions → tenderness, guarding, rebound, rigidity (peritonitis), masses, hernia orifices (cough impulse).
   • Deep palpation: liver (start RIF, move up; normal span 6–12 cm MCL, smooth/irregular, tender), spleen (RIF diagonally up to left hypochondrium; enlarged if crosses midline), kidneys (ballotable in flanks), aorta (expansile pulsation >3 cm → AAA).
   • Special signs: Murphy’s (cholecystitis – inspiratory arrest on deep palpation under right costal margin), Rovsing’s (appendicitis – LIF pain on RIF palpation), renal angle tenderness (pyelonephritis).
   • Verbalise: “I’m starting in the right iliac fossa to avoid missing a palpable spleen or liver edge.”
7. 🥁 Percussion (45–60 s)
   • Liver span: mid-clavicular line (normal 6–12 cm; enlarged in hepatomegaly, shrunken in cirrhosis).
   • Spleen: Traube’s space (dullness on percussion if enlarged) or Nixon’s method.
   • Ascites: shifting dullness (dull in flanks when supine, resonant centrally; fluid shifts on rolling), fluid thrill/wave (tap one flank, feel wave on opposite).
   • Bladder: dullness above pubis if distended (retention).
   • Verbalise: “Shifting dullness is positive - suggestive of ascites.”
8. 🎧 Auscultation (30–45 s)
   • Bowel sounds: normal (5–35/min), increased (obstruction, early peritonitis), tinkling/high-pitched (small bowel obstruction), absent (ileus, late peritonitis).
   • Renal artery bruits (renal artery stenosis – hypertension), aortic bruits (AAA, atherosclerosis).
   • Verbalise: “Bowel sounds are tinkling and high-pitched, suggestive of mechanical obstruction.”
9. 🔎 Additional Checks & Completion
   • Legs: peripheral oedema (nephrotic, cirrhosis, portal HTN), muscle wasting, bruising (coagulopathy).
   • Sacral oedema (if immobile).
   • To complete: hernia orifices (cough impulse), digital rectal exam (masses, blood, tone), external genitalia (scrotal oedema, hydrocele), supraclavicular nodes, urine dip (protein, blood), stool chart.

📊 High-Yield Abdominal Examination Findings Table (OSCE Master Reference)

🚩 Red Flags & Do-Not-Miss OSCE Points

• Jaundice + weight loss + palpable gallbladder (Courvoisier’s sign) → pancreatic head malignancy.
• Caput medusae + ascites + spider naevi → portal hypertension/cirrhosis.
• Virchow’s node + epigastric mass → gastric cancer.
• Rebound tenderness + guarding → peritonitis (perforated viscus, appendicitis).
• Absent bowel sounds + distension → ileus or obstruction (emergency).

💡 OSCE Examiner & Candidate Pearls

• Always kneel when palpating deep structures (better control, less tiring, shows thoroughness).
• Verbalise: “I’m starting palpation in the right iliac fossa to avoid missing a palpable spleen tip.”
• Spleen: start palpation from RIF, move diagonally up to left hypochondrium; only palpable if enlarged >3× normal.
• Liver: percuss span first, then palpate edge during inspiration.
• State missing steps: “To complete, I would examine the hernial orifices, perform a digital rectal exam, check external genitalia, palpate lymph nodes, dip urine for protein/blood, and arrange bloods, ultrasound, and endoscopy.”
• Common fail points: insufficient exposure (missing scars), rushing palpation, forgetting mouth/lymph nodes, not checking for ascites when distension present.

📚 References & Resources (Feb 2026)

• Talley & O’Connor – Clinical Examination (9th ed., 2025 update).
• Geeky Medics Abdominal Examination OSCE Guide (2026 revision).
• OSCEstop & PassMedicine GI sections.
• BSG Guidelines: Ascites & Portal Hypertension (2025).