31 Abdominal distension
Checklist
Appropriate introduction
Confirms patient’s name and age
Explain reason for consultation
Obtains consent
Open question to elicit presenting complaint
Allows patient to open up, listens carefully, remains silent and
does not interrupt the patient
Signposts: e.g. ‘Mr Gregory, thank you for telling me about this
problem. I would like to ask a few more detailed questions. Is
that all right?’
History of presenting complaint:
• Site:
• Generalised
• Localised
• Onset (how it started):
• How did the patient first notice it?
• Sudden
• Gradual
• Character:
• Soft fluctuant/fluid swelling
• Hard, mass-like swelling
• Radiation:
• To testicles/groin (hernia)
• Time:
• Duration
• Intermittent/continuous/progressive
• Correlation with menstrual periods
• Alleviating factors:
• Dietary factors
• Opening bowels
• Exacerbating factors:
• Dietary factors/meals
• Position (e.g. worse on lying down/standing – hernia),
coughing (hernia)
• Worse at the end of the day (oedema)
• Pain/tenderness
• Bloating/discomfort
• Local compression-related symptoms (e.g. urge incontinence)
• Asks if patient is suffering from any other symptoms
• Asks about any recent illnesses
• Previous episodes of abdominal distension
• Family members/contacts with similar symptoms
Associated symptoms:
• Gastrointestinal/colorectal symptoms:
P
MP
F
Checklist
•
•
•
•
Abdominal pain
Flatulence
Nausea/vomiting
Bowel habit/diarrhoea/constipation: any correlation of distension with opening bowels?
• Dysphagia/dyspepsia
Ascites:
• Facial swelling
• Ankle swelling
• Shortness of breath/orthopnoea
Liver/hepatobiliary symptoms: right upper quadrant pain, jaundice, dark stools, pale urine
Renal symptoms: urinary symptoms, frothy urine (nephrotic
syndrome), lethargy, pruritus
Heart failure symptoms: chest pain
Hypothyroidism
Females: gynaecological symptoms:
• Correlation with menstrual periods
• Irregular/painful periods
• Intermenstrual/postcoital bleeding
• Pelvic pain
Females: obstetric symptoms:
• Possibility of patient being pregnant
• Last menstrual period
• Unprotected sexual intercourse: must signpost before taking sexual history
• Contraception
‘Red flags’:
• Bleeding (rectal, melaena, vaginal)
• Weight loss, loss of appetite, night sweats (malignancy)
Review of systems
Past medical history:
• Constipation
• Abdominal surgery –especially laparoscopic surgery
• Gynaecological history: fibroids, ovarian cysts
• Heart failure
Family history:
• Colorectal cancer
• Ovarian cancer
• Polycystic kidney disease
• Hernia
• Fibroids
Drug history:
• Laxative history: any recent changes, stopped taking
• Oral contraceptive pill (OCP, if patient female)
• Over-the-counter medication
Allergies
Social history:
P
MP
F
Checklist
P
MP
F
• Alcohol (peptic ulcer disease, gastritis)
• Smoking
• Illicit drug use (especially intravenous drug abuse for hepatitis
B/C)
• Diet:
• Intake of fibre
• Recent change in diet
• Occupation
• Activities of daily living
Use of non-verbal cues, e.g. good eye contact, nodding head
and good body posture
Systematic approach
Explores and responds to ICE:
• Ideas
• Concerns
• Expectations
Shows empathy
Non-verbal skills
Avoids technical jargon
Devises holistic management plan and addresses psychosocial
issues as well as medical problems
Summarises
Offers to answer any questions
Thanks patient
OSCEs for Medical Finals, First Edition. Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and Sathiji Nageshwaran.
© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.