Macleod's Gastrointestinal Examination

Sample of DVD content available with Macleod's Clinical Examination 12th edition. A further 24 DVD quality clinical examinations available with the textbook and on student consult.

Category:

Education

Tags:

• macleod's
• osce
• clinical examination
• medical finals
• exam
• abdominal exam
• abdominal examination

[drhjhulsebos]

inspect, auscultate, percuss, palpate...FAIL

[iainhennessey]

@drhjhulsebos I refer you to the previous (multiple) discussions. If you are sitting your exams in britain do it like the video. If you are sitting them in the US then auscultate first. From a clinical point of view it really doesn't matter (cue howls of protest). I defy anyone to create or cure obstructive bowel sounds by palpation alone, the same for a paralytic ileus. Discuss.

[iainhennessey]

@iainhennessey. Now just so that we are clear - when I auscultate someones abdomen I gently place the stethoscope on their abdomen. Now if this action was to cause pain then the patient has severe peritonitis (unlikely in an exam situation). I am highly likely to have deduced that the patient has severe peritonitis either from the end of the bed or on my initial light palpation - therefore the exact character of the bowel sounds would become largely irrelevant.

[iainhennessey]

Trust me it is possible - see previous discussion for rationale. Essentially a difference between UK and US practice.

[iainhennessey]

Yes I would feel for a AAA. (it is actually in a different video that we have not posted for the vascular examination).

[hketsun]

The doctor's technique in percussion is incorrect. He is percussing by flexing his elbow joint instead of flexing his wrist joint.

[iainhennessey]

@hketsun I agree that this action should be from the wrist not the elbow (otherwise you do not create the desired sound). Reviewing this video I feel that the movement is predominantly at the wrist and I can vouch for the fact that he was creating an extremely clear percussion note as I could hear it very well from the other side of the room. I take your point that there is some movement at the elbow and while percussing the liver from above he has not used his wrist correctly.

[wiccc1]

The sexual tension is palpable here.

[iainhennessey]

@dk1070 @dk1070 Ok I have done a quick survey of clinical examination books for you. I have 7 textbooks that examine IPPA and 3 that examine IAPP. The theme appears to be (but not exclusively) that US textbooks favour the ausc before palp. I think an interesting book for you to read would be Evidence based physical signs by Steven Mcgee (Prof of medicine in washington) there is a really good chapter on the clinical significance of bowel sounds. In short US exam IAPP, UK exam IPPA.

[azmanhakim]

hello dr ben! grrr

[pratyushpppppp]

what if the patient is fat

[kickitupify]

Dr. Ben can examine me any time.

[TheSquareRing]

@drhjhulsebos

I don't think this is an issue. You are meant to auscultate for at least one minute so any sounds produced by previous palpation/percussion are not likely to persist for such a long period. More to the point to diagnose absent bowel sounds you MUST listen for TWO minutes- again any bowel movements generated previously are unlikely to persist for this length of period. Feel free to correct me if I'm wrong.

[JamesCAMH]

doctor's face suggests he found an anomaly at 6:34

[rageagaintstheNWO]

So the Highlander developed this procedure?

[redman476]

so what is your method here? inspect, palpate, auscultate, percuss, follow this and consider your self a fail in your exam.

[YourLifeIsForever]

Now try doing this with a fat person!