I am so sick of seeing cocky medical students criticizing the video. Clinical examinations may defer slightly in many parts of the world. To me, this examination is perfect and this is how it is taught to us. There is no 'RIGHT' way. So if you are a medical student with the ability to rationalize things you should know this. Really disappointing to see some 'close-minded' medical students.
In regards to SurrealSteven, I agree with you in one perspective. Medical students should not assume that just because a particular lecture/teacher taught them a certain method of examination, then other types are incorrect. Indeed when I learn how to do examinations I think in the back of my mind if I were to follow exactly the textbook on how to examine patients then me and my patients would be screwed. We need guidance along with flexibility.
great video! but just a suggestion...you guys should think about changing the text color in your videos to something darker. It is a bit hard to read when it is white.
in right heart failure, venous congestion can occur. JVP is a visible indicator of increased central venous pressure that often occurs during right heart failure. Right heart failure can also lead to portal hypertension by causing posthepatic obstruction (as opposed to pre- or intrahepatic). Pulmonary hypertension/edema is d/t LEFT heart failure usually
@dredgurevich usually palpation is done first before the auscultation because the auscultation will help we to be more specific if there is any clinical finding
@jonchuadeusvult It can be done either way. But personally I find it easier to percuss away from myself as you say. However I believe the clinical sign can be elicited just as well either way. Thanks for the feedback :)
This was a great video, but I do have a slight correction. For abdominal exam, auscultation should always come before palpation. I have seen many videos start with palpation. It is not the correct form. Palpating creates abnormal sounds that are truly not there, which are later heard when auscultating.
Really nice and clear presentation . Very helpful as i am doing my PLAB 2 soon . Your website is also helpful, though i was hoping to see videos as those on youtube covering all possible area . I am being greedy :) . I Saw lots of videos on UA-cam , yours is exceptional . Big Thanks
@dredgurevich if that the case,before doing the clinical examination,the history of illness & chief complaint of the patient we need to take first so that we can rule out any aneurysm sign can happen..but if the aneurysm suspected i also agreed to do the auscultation first.
I would assume however that plasma oncontic pressure (via albumin) is a larger driving factor than the RAAS system in maintaining adequate volume. For instance, RAAS will work to vasconstrict & retain water (ADH) - so RAAS yes would work to maintain fluid pressure, however, elevated JVP is a result of fluid overload (or RH failure) . RAAS because its under homeostatic control would correct hypovolemia, but not cause hypervolemia. Portal HTN would back up fluid in shunt system - not systemic.
It wouldn't. however the etiology of JVP (ie cardiac overload, right heart failure) could also backlog to the hepatic vein and then the portal venous system in a later stage of the pathology. So with portal hypertension of cardiac origin, there would like already be raised JVP present.
I think the 'small scar' noted on his abdomen may represent a supernumerary nipple as it occurs along the milk line. It is atypical for a laproscopic surgical scar and is in an unusual spot for a traumatic scar but I may be wrong.
+Oliver Froud I agree with your diagnosis. It looks like an accessory nipple he also has some hair in the same area on the right which strengthens your argument.
tricuspid regurge that lead to hepatic congestion and portal hypertension . He should say assess fluid status as elevated JVP indicate heart failure as a cause of ascites .
Auscultation should be performed before percussion or palpation because these maneuvers may alter the frequency of bowel sounds according to Bates' guide to physical examination.
If I lay on hand flat on my stomach and tap on it with my other hand when laying on my back, the noise on the left side of my stomach is different from my right. the rightside sound more hollow than the left. should i be concerned about this? I did have my gullbadder removed a few months ago. thanks.
Thanks for sharing I've got a question. If we do the auscultation after percussion and deep palpation, the bowel sound might change? Shouldn't do it before percussion and deep palpation??
is it possible for portal hypertension to cause hepatic congestion, leading to back flow through the inferior vena cava, raising intra-atrial pressue leading to a raised JVP?
Only in the US do they auscultate before palpation because it would stir up bowel sounds. They do it differently in other parts of the world for whatever reason.
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i like the fact that you put pictures of the conditions there.
Yes, super helpful!
Miliray J me too
I am so sick of seeing cocky medical students criticizing the video.
Clinical examinations may defer slightly in many parts of the world.
To me, this examination is perfect and this is how it is taught to us.
There is no 'RIGHT' way.
So if you are a medical student with the ability to rationalize things you should know this.
Really disappointing to see some 'close-minded' medical students.
couldnt agree more steven
Agreed bro.
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I'm a paramedic student and loving these videos to help me with my assessments. Thank you so much!!!
Dr Adam kibirige is now a grown up
Thank you so much for such good information 🙂ℹ️
In regards to SurrealSteven, I agree with you in one perspective. Medical students should not assume that just because a particular lecture/teacher taught them a certain method of examination, then other types are incorrect. Indeed when I learn how to do examinations I think in the back of my mind if I were to follow exactly the textbook on how to examine patients then me and my patients would be screwed. We need guidance along with flexibility.
great video! but just a suggestion...you guys should think about changing the text color in your videos to something darker. It is a bit hard to read when it is white.
you guys are my absolute favorites. I'm probably acing ,my exam maneuvers because of you.
+Sana Yousif Thanks Sana :) Hope the exams are going well! Always great to hear about fellow Geeky Medics acing exams!
in right heart failure, venous congestion can occur. JVP is a visible indicator of increased central venous pressure that often occurs during right heart failure. Right heart failure can also lead to portal hypertension by causing posthepatic obstruction (as opposed to pre- or intrahepatic).
Pulmonary hypertension/edema is d/t LEFT heart failure usually
Very helpful, all the videos our Uni provides are what to do in a normal abdominal exam not an "OSCE abdominal exam". With all the showy bits.
Assuming that portal HTN is not the primary pathology but cirrhosis:
1. Cirrhosis --> portal HTN
2. Cirrhosis --> decreased plasma protein synthesis --> decrease in plasma oncotic pressure --> edema --> decreased renal perfusion --> RAAS activation --> fluid retention and thus raised JVP
@dredgurevich usually palpation is done first before the auscultation because the auscultation will help we to be more specific if there is any clinical finding
@jonchuadeusvult It can be done either way. But personally I find it easier to percuss away from myself as you say. However I believe the clinical sign can be elicited just as well either way. Thanks for the feedback :)
Would that all Doctors took the time for such a great exam ❤
one of the best abdominal examination videos, thank you alot.
but the pitting edema examined usually by your thump on the shin.
Excellent and concise, perfect for 7 min osce stations, thank you! :)
This was a great video, but I do have a slight correction. For abdominal exam, auscultation should always come before palpation. I have seen many videos start with palpation. It is not the correct form. Palpating creates abnormal sounds that are truly not there, which are later heard when auscultating.
GeekyMedics, you guys are certainly doing an awesome job!!! :) Helps me a lot!
thank you for sharing this..i hope i can do well tomorrow since i have clinical test..hope this video can help me a bit =)
Really nice and clear presentation . Very helpful as i am doing my PLAB 2 soon . Your website is also helpful, though i was hoping to see videos as those on youtube covering all possible area . I am being greedy :) . I Saw lots of videos on UA-cam , yours is exceptional .
Big Thanks
@dredgurevich if that the case,before doing the clinical examination,the history of illness & chief complaint of the patient we need to take first so that we can rule out any aneurysm sign can happen..but if the aneurysm suspected i also agreed to do the auscultation first.
I think this is an excellent video - everything is just as I learnt ...
You should read books also and compare
I would assume however that plasma oncontic pressure (via albumin) is a larger driving factor than the RAAS system in maintaining adequate volume. For instance, RAAS will work to vasconstrict & retain water (ADH) - so RAAS yes would work to maintain fluid pressure, however, elevated JVP is a result of fluid overload (or RH failure) . RAAS because its under homeostatic control would correct hypovolemia, but not cause hypervolemia. Portal HTN would back up fluid in shunt system - not systemic.
It wouldn't. however the etiology of JVP (ie cardiac overload, right heart failure) could also backlog to the hepatic vein and then the portal venous system in a later stage of the pathology. So with portal hypertension of cardiac origin, there would like already be raised JVP present.
its help me a lot to correctly examine the abdomen...😊
Thank u so much for your video. Its really useful for my osce
thank you geeky medics....
please, abdominal examination must also include back examination for renal angle tenderness, with palpation for sacral odema and thank you
Thank You geekymedics
more system pleaseee . thanks geekymedics :)
I think the 'small scar' noted on his abdomen may represent a supernumerary nipple as it occurs along the milk line. It is atypical for a laproscopic surgical scar and is in an unusual spot for a traumatic scar but I may be wrong.
+Oliver Froud dude really?? did u actually say its unusual for Trauma scar?? I fail you.
+Oliver Froud I agree with your diagnosis. It looks like an accessory nipple he also has some hair in the same area on the right which strengthens your argument.
tricuspid regurge that lead to hepatic congestion and portal hypertension . He should say assess fluid status as elevated JVP indicate heart failure as a cause of ascites .
Auscultation should be performed before percussion or palpation because these maneuvers may alter the frequency of bowel sounds according to Bates' guide to physical examination.
Thank you so much for this video!!!!!!
great video &so helpful .. thank u so much
great video...u guys rock!!
thank you sooo much
amazing , Thank you
Thank you for the video
very good video fluent exam
If I lay on hand flat on my stomach and tap on it with my other hand when laying on my back, the noise on the left side of my stomach is different from my right. the rightside sound more hollow than the left. should i be concerned about this? I did have my gullbadder removed a few months ago. thanks.
damn. i find myself here every year lmao our curriculum is so repetitive
+LOLsaudi i have no words.......
+LOLsaudi toraleno hits again !!
white fonts are not visible on white background n appear to b very vague.
great work ...keep up guys :)))
Thanks for sharing
I've got a question. If we do the auscultation after percussion and deep palpation, the bowel sound might change?
Shouldn't do it before percussion and deep palpation??
should we do auscultation before palpation? because the palpation may alter the bowel sound..
is it possible for portal hypertension to cause hepatic congestion, leading to back flow through the inferior vena cava, raising intra-atrial pressue leading to a raised JVP?
Auscultation comes first before palpation!
I like it!
408k future doctors ! :)
Only in the US do they auscultate before palpation because it would stir up bowel sounds. They do it differently in other parts of the world for whatever reason.
Great Video with everything covered. A bit more of a technique needed on the palpation. But great revision aid.
I think he meant pulmonary hypertension because no way portal hypertesnion would cause raised jvp
i was about to write the same thing.
M.S >> pulmonary HTN >> RSHF >> raised JVP ;)
palpation and cervical lymph node examination wasn't palpated properly. need to be more firm and cover the whole area.
I love the accents:)
what year are you in now ??
OSCE is just 5 minutes, so we have to rush through the steps. Gosh
should n`t we auscultate before palpation?!
how on earth would portal hypertension give you a raised JVP?
Thank you Very useful! but auscultation comes before palpation
This varies between countries and medical schools. Use the technique that your local medical school recommends. Thanks for watching :)
Abdomen perfecto!!
hepato-jugular reflux.
The order is all wrong!!! Palpation and percussion should never be done on the abdomen before auscultation. Otherwise you guys are awesome.