Exam (elaborations)
Osce- acute abdomen
- Module
- Osce
- Institution
- The University Of Aberdeen (Aberd)
A step by step detailed guide on answering OSCE station specific to a patient with acute abdomen and scoring those extra points.
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Acute Abdomeno History
Character of pain: sharp implies peritoneal pain; dull, diffucse pain is
commonly visceral pain. Note location , shifting, radiation, onset, severity,
exacerbating and ameliorating factors, temporal nature (constant v. colicky).
GI and systemic symptoms (e.g. anorexia, nausea/emesis); ask about
constipation, bloody diarrhea or hematochezia.
Hematuria (GU disorders), STD risk factors (PID is a common cause of
abdominal pain), fever/chills
Note the patient’s menstral history, family history (acute intermittent
porphyria, familial Mediterranean fever), and past medical and surgical
history (vasculitis, SLE, sickle cell disease).
o Physical
Low BP and high HR are signs of shock or impending shock. High fever in the
presence of abdominal pain is a concern.
Abdominal distention suggests a surgical abdomen.
Manipulate the lower extremity to elicit pain (suggestive of appendicitis)
and check for CVA tenderness (pylo)
o Differential
Abrupt, excrutiating pain
Biliary colic
Utereral colic
MI
Perforated ulcer
Ruptured aneurysm
Rapid onset of severe, constant pain
Acute pancreatitis
Mesenteric thrombosis, strangulated bowel
Ecgtopic pregnancy
Gradual, steady pain
Acute cholecystitis, acute cholangitis, acute hepatitis
Appendicitis, acute salpingitis
Diverticulitis
Intermittent, colickypain, crescendo with free intervals
Early pancreatitis(rare)
SBO
IBD
o Evaluation
CBC/lytes, amylase, ABG if pt hypoxic or unstable, lactate, LFTs, PT/PTT,
UA/Cx, and stoll guiac.
All women of childbrearing age need B-HCG
Abdominal plain X-ray followed by studies based onclinical suspicion.
Contrast studeies are often performed – NO barium if a lower bowel
obstruction is suspected
If RUQ pain do US/HIDA scan for cholecystitis.
Paracentesis if there is acites
o Treatment
Emergency surgery
D/C oral feeds, insert NG tube if obstruction
Provide analgesia and supportive care
Type and Cross all
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