Makindo Medical Notes

Related Subjects: |OSCE Eye Exam |OSCE Ear Exam |OSCE Abdominal Exam |OSCE Ascites Exam |OSCE Testicular Exam |OSCE Inguinal Exam |OSCE Upper limb Neurology |OSCE Lower limb Neurology |OSCE Face Neurology

🫗 Key Principle: Gas-filled bowel floats up, fluid sinks to dependent areas. So ascites reveals itself by **shifting dullness** and **fluid thrill**. 📌 Always suggest differentials + investigations → LFTs, albumin, U&Es, abdominal ultrasound, ascitic tap if safe.

👋 Introduction

• 🧼 Hand Hygiene: Wash hands before starting.
• 🙂 Introduction: Greet patient, confirm name & DOB, explain you will examine for fluid in abdomen.
• 📝 Consent & Privacy: Obtain consent, ensure dignity with drapes and lighting.
• 📖 Explain: Ascites = fluid in peritoneal cavity, common causes include cirrhosis, right heart failure, malignancy, TB.

🧰 Equipment Needed

• Gloves
• Towel/drape
• Optional stethoscope (for broader abdominal exam)

📚 Background: Common Causes of Ascites

🪜 Examination Steps

• 👀 Step 1: Inspection
  • Patient supine, abdomen exposed with dignity.
  • Look for distension (flank bulging, globular contour).
  • Cachexia + ascites = think malignancy or cirrhosis.
  • Caput medusae = portal hypertension.
  • Striae, scars, dilated veins → clues to underlying cause.
• 🤲 Step 2: Palpation
  • Light palpation → tenderness, masses.
  • Deep palpation → hepatomegaly/splenomegaly.
  • Feel flanks for resistance/fluctuation.
• 🥁 Step 3: Percussion
  • Percuss midline → resonance, move laterally → dullness.
  • Dullness at flanks, resonance centrally = fluid distribution.
• ↔️ Step 4: Shifting Dullness
  • Mark resonance/dullness borders supine.
  • Roll patient to side, wait 1–2 min.
  • If dullness shifts → positive for ascites.
• 🌊 Step 5: Fluid Wave
  • Assistant/hand on midline to dampen skin wave.
  • Tap one flank, feel wave on other.
  • Positive = large ascites (>1–2L usually).

✅ Closure

• Thank patient, redress, ensure comfort.
• Summarise: “Findings suggest possible ascites — we’d confirm with ultrasound.”
• Wash hands, document findings accurately.

⭐ Key OSCE Points

• Systematic: Inspection → Palpation → Percussion → Shifting Dullness → Fluid Wave.
• Explain each step to patient → builds rapport.
• Allow time for fluid to shift → don’t rush.
• Always mention investigations (USS, ascitic tap with SAAG if safe).

🚫 Common Pitfalls

• Inadequate exposure → miss subtle signs.
• Rushing → false negatives.
• Not comparing both flanks systematically.
• Forgetting to correlate with signs of CLD or systemic disease.

📚 References

• Clinical Examination – Talley & O’Connor
• Geeky Medics OSCE Guide
• OSCEstop – Online practice bank