colostomies are typically located in the left iliac fossa, whereas ileostomies are usually located in the right iliac fossa). Stoma bag(s): note the location of the stoma bag(s) as this can provide clues as to the type of stoma (e.g.Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status: Asking the patient to cough will usually cause hernias to become more pronounced. Hernias: may be visible from the end of the bed (e.g.pancreatic/bowel/stomach cancer) and advanced liver failure. Cachexia is commonly associated with underlying malignancy (e.g. Cachexia: ongoing muscle loss that is not entirely reversed with nutritional supplementation.ascites) and is often associated with liver cirrhosis in the context of an abdominal examination OSCE station. Oedema: typically presents as swelling of the limbs (e.g.Hyperpigmentation: a bronzing of the skin associated with haemochromatosis.acute hepatitis, liver cirrhosis, cholangitis, pancreatic cancer). Jaundice: a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels (e.g.It should be noted that healthy individuals may have a pale complexion that mimics pallor. gastrointestinal bleeding or malnutrition). Pallor: a pale colour of the skin that can suggest underlying anaemia (e.g.Abdominal distention: may suggest the presence of ascites or underlying bowel obstruction and/or organomegaly.Obvious scars: may provide clues regarding previous abdominal surgery.Pain: if the patient appears uncomfortable, ask where the pain is and whether they are still happy for you to examine them.Confusion: often a feature of end-stage liver disease, known as hepatic encephalopathy.Age: the patient’s approximate age is helpful when considering the most likely underlying pathology, with younger patients more likely to have diagnoses such as inflammatory bowel disease (IBD) and older patients more likely to have chronic liver disease and malignancy.Inspect the patient from the end of the bed whilst at rest, looking for clinical signs suggestive of underlying pathology: You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.
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