🧼 Wash your hands before approaching.
Introduce yourself, confirm patient’s name & DOB.
Explain: “I’d like to examine your abdomen by looking, feeling, tapping, and listening.”
Gain consent and ensure supine position, exposed from xiphisternum → pubic symphysis, with privacy & draping.

👀 Step 1: General Inspection

From end of bed: Distress, weight loss, jaundice, distension.
Hands: Clubbing, leukonychia, koilonychia, palmar erythema, Dupuytren’s contracture.
Face: Scleral icterus, conjunctival pallor, angular stomatitis, glossitis, foetor hepaticus.

👀 Step 2: Inspection of Abdomen

Scars, striae, rashes, caput medusae.
Contour: flat, scaphoid, distended.
Obvious masses, hernias, visible pulsations or peristalsis.

✋ Step 3: Palpation

Light palpation: 9 regions → tenderness, guarding, rigidity.
Deep palpation: Masses (size, shape, consistency, mobility, tenderness).
Liver: Start RIF, move to costal margin during inspiration → edge, texture, tenderness, nodularity.
Spleen: Start RIF, diagonally toward LCM → splenic edge on inspiration.
Kidneys: Bimanual ballotment for enlargement/tenderness.
Aorta: Above umbilicus → width, expansile pulsation (AAA suspicion 🚨).

🥁 Step 4: Percussion

Liver span (MCL upper + lower border).
Spleen (Traube’s space) → percussion dullness = splenomegaly.
Percuss masses → dull = solid, resonant = gas.
Shifting dullness / fluid thrill if ascites suspected.

🎧 Step 5: Auscultation

Bowel sounds → present/absent, hyperactive (obstruction), absent (ileus).
Bruits → aorta, renal, iliac arteries.
Rare: Venous hum, friction rub (hepatic pathology).

🧪 Step 6: Special Tests

Murphy’s sign: RUQ tenderness + arrest of inspiration = cholecystitis.
McBurney’s point tenderness: RIF pain = appendicitis.
Rovsing’s, Psoas, Obturator signs: Appendicitis/retrocecal irritation.
Ascites tests: Shifting dullness, fluid thrill.

✅ Step 7: Closure

Thank patient, cover up, ensure comfort.
Wash hands 🧼.
Summarise & document findings clearly.

⭐ Key OSCE Tips

Systematic: Inspection → Palpation → Percussion → Auscultation.
Palpate gently first → avoid causing pain early.
Expose adequately but maintain dignity.
Always compare sides.
Be ready with differentials (e.g. ascites → cirrhosis, ovarian cancer, right heart failure).

🚫 Common Pitfalls

Forgetting light palpation first.
Inadequate exposure → missing scars/hernias.
Skipping inspection before palpation.
Neglecting auscultation (and sequence differences - OSCEs expect consistency).
Poor communication with patient.

📚 References

Macleod’s Clinical Examination – Abdominal Chapter
Geeky Medics OSCE Guide
OSCEstop – OSCE practice stations

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OSCE Abdominal Examination

👋 Introduction