Faculty of Medicine

Gastrointestinal Presentation (GIP 502) Helwan University

(Abdominal Examination OSCE Checklist) Internal Medicine Department

I. General approach Achieved Unachieved

A. Greet the patient and introduce yourself.
B. Wash your hands prior to the examination.
C. Describe the nature of the examination to the patient.
D. Inform the patient to let you know if he feels any discomfort.
E. Check that the patient has an empty bladder prior to the examination.
F. Examine the patient in good light and warm surroundings.
G. Position the patient supine with his arms beside or folded across the chest.
H. Stand on the right side of the patient.
I. Exposure: from the nipple line to the symphysis pubis (leaving chest and legs covered).
II. Inspection:
A. Mapping the abdomen: (4 quadrants/ 9 regions).
B. Inspect abdominal wall at the same level of the patient.
C. Abdominal Contour.
D. Symmetry: (Stands at the patient’s head or toes).
E. Flanks.
F. Subcostal angle.
G. Divarication of recti and hernial orifices.
H. Abdominal surface, comment on:
✓ Skin pigmentation
✓ Scars (site, length, healing)
✓ Striae
✓ Dilated superficial veins
✓ Ulcer, fistula, or hernia.
✓ Hair distribution

I. Umbilicus, comment on:

✓ Shape
✓ Position
✓ Pigmentation
✓ Dilated veins around the umbilicus.
✓ Abnormal discharge from the umbilicus.
J. Movement:
✓ Respiratory: rate, type.
✓ Intestinal
K. Pulsations:
✓ Epigastric.
✓ Hepatic.
L. Examine the back.
M. External Genitalia.
III. Palpation checklist:
• Ensure your hands are warm and clean.

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 Faculty of Medicine
Gastrointestinal Presentation (GIP 502) Helwan University

(Abdominal Examination OSCE Checklist) Internal Medicine Department

• Ask the patient to show you where any pain is and to report any tenderness
during palpation.
• Use your right hand, keeping it flat and in contact with the abdominal wall.
• Observe the patient’s face throughout for any sign of discomfort.
• Begin with light superficial palpation away from any site of pain.
• Palpate each region in turn, and then repeat with deeper
palpation.
• Test abdominal muscle tone using light, dipping finger movements.
• Describe any mass: site, size, surface, shape, consistency, movement with
respiration, mobility, and decide is it an enlarged abdominal organ or separate
mass.
IV. Liver examination checklist:
A. Palpation:
• Palpate the right lobe of the liver starting from the right iliac fossa.
• Palpate the left lobe of the liver starting from the umbilicus.
• Apply the right technique for palpation.
• If you feel the liver edge, describe:
✓ Size (liver span or Cms below the costal margin).
✓ Surface: smooth or irregular
✓ Edge: smooth or irregular.
✓ Consistency: soft or hard.
✓ Tenderness
✓ Pulsatility.
B. Percussion:
• Percuss to detect the upper border of the liver (heavy).
• Percuss to detect the lower border of the liver (light).
C. Auscultation:
• Listen over the liver for bruit and rub.
V. Spleen examination checklist:
A. Palpation:
• Palpate the lower edge starting from the right iliac fossa.
• Apply the right technique (including palpation to detect mild splenomegaly).
• If you feel the splenic edge, describe:
✓ Size (Cms below the costal margin).
✓ Surface: smooth or irregular
✓ Edge: smooth or irregular, (± notch)
✓ Consistency: soft or hard.
✓ Tenderness.
✓ Pulsatility.
B. Percussion:
• Percussion of the Traub’s area.
C. Auscultation:
• Listen over the spleen for bruit and rub.
VI. Kidney examination checklist:
A. Palpation:

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 Faculty of Medicine
Gastrointestinal Presentation (GIP 502) Helwan University

(Abdominal Examination OSCE Checklist) Internal Medicine Department

• Palpate the kidneys (Apply Ballottement).

• Palpate the urinary bladder.
B. Percussion:
• Percuss the renal angles.
• Percuss the urinary bladder.
C. Auscultation:
• Listen for abdominal bruit over the epigastrium both renal arteries.
VII. Ascites examination checklist:
• Apply shifting dullness.
• Apply transmitted thrill (if massive ascites).
• Palpate for organomegaly or masses (dipping technique).
VIII. Abdominal auscultation:
• Listen for intestinal sound (4 quadrants).
• Listen over the liver for bruits and rub.
• Listen over the spleen for bruits and rub.
• Listen for abdominal bruits over the epigastrium and over both renal arteries.
• Test for a succussion splash.
IX. Hernia examination:
X. Digital rectal examination (DRE):

Approved by: Prof.Dr. Rasha Refaie

Revised by: Ass.Prof. Abeer Sabry
Prepared and designed by: Dr. Alshymaa Eltahan.
Reference: Macleoid's Clinical Examination, 14th ed. Churchill Livingstone: Elsevier,
2018. Douglas G, Nicol F and Robertson C.

Good Luck

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