GIT OSCE

History taking

Cardinal symptoms

Pain

Subtopic

Questions to ask: SOCRATES

Dysphagia

Do you have problems initiating swallowing?

Heartburn

S retrosternal
O Post-meals
C Burning
R Travels UP eso.
A Waterbrash, Acid regurg (sour/bitter)
T Eating habits
E Bending, lying supine, reduced eso. sphinter tone.
Transient relief with antacids

Dyspepsia

GERD/malignancy
Ulcers
Duodenitis/Gastritis

Appetite and weight change

Questions to ask:

- Intentional?
- Amount loss?
- Rate of weight loss?

Causes:

LoA
Dysphagia
Associated pain with eating

Throwing up

Shitting

Distention of abdomen

Jaundice

Questions to ask

Pruritis?
Urine color?
Stool color/float?

Subtopic

Overview

Examination:

1) WIPE

Make sure to test
PERSON
PLACE
TIME

2) General observation

Surroundings

O2
Walking aids
Catheter bag (if yes, comment on urine)
Distress button

Patient

Acute abdomen? Shallow breathing + lying still
Jaundice?
Distention?
Weight/wasting?
Scars?
Skin? Pruritis, tattoos, needle tracks
Kidney dish (for vomitting)?
Cannula?
Colostomy bag?

3) Upper limb

Temperature!

Nails

Deficiencies:
Leukonychia (albumin)
Koilonychia (Fe def. anemia)

Clubbing
CLD
Malnutrition

Capillary refill time
Peripheral cyanosis

Palm

Erythem (estrogen excess)
Pallor
Dupuytren's
Asterixis

Elbow

Dermatitis herpetiformis (IBS)

Arm

4) Face/Neck

Eyes
Scleral icterus
Conjunctival pallor
Xanthelasmata
Keyser-Fleischer rings

Parotids
Pt. to clench teeth
Palpate behind massater

Mouth

Lips
Angular stomatitis (B2)

Oral mucosa
Leukoplachia
Candidiasis
Ulcers

Gingivitis (hypertrophy of gums)
Scurvy (Vit C)
Poor dental hygiene

Teeth
Lead poisoning (Blue line at gm margin)
Dental carries
REAL OR FAKE

Tongue

Glossitis (Vit B's - folate, thiamine)
Central cyanosis
Glossitis
Dry - sjogren's, dehydration

Breath
Fetor hepaticus,
Uremic breath

Neck
Cervical LN
Virchow's (L supraclavicular)
JVP

EXPOSE.
PT SUPINE.

5) Inspection of torso

CHECK FOR PAIN!!!
Then get on your knees, fool.

6) Light palpation/Deep palpation

Masses?
Rigidity? (involuntary)
Guarding? (voluntary)
Rebound?

7) Organ by organ inspection

Palpation --> Percussion; EXCEPTION: SPLEEN

8) Auscultation

Bowel sounds - Just lateral to umbilicus:
- Normal (gurgling)
- Borborygmus (Flatulence)
- Tinkling (obstruction)
- Absent (severe obstruction)

Bruits:
- AAA - Just superior to umbilics
- RAA - 2-3 cm superior and lateral to umbilicus

9) Reverse WIPE:
- Wash your filthy hands.
- Thank the patient.
- AND FOR THE LOVE OF GOD MAN, GIVE THE PATIENT HIS
DAMN SHIRT BACK
- Summarize findings.

HERNIAS
DRE
GENITALIA

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