Ascites Examination - Shifting Dullness & Fluid Thrill - Clinical Skills Revision - Dr Gill
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- เผยแพร่เมื่อ 4 ก.ค. 2024
- Ascites Examination - Shifting Dullness & Fluid Thrill - Clinical Skills Revision - Dr Gill
NB original paper on the scorpion and pancreatitis
pubmed.ncbi.nlm.nih.gov/5443968/
Shifting dullness and fluid thrill for ascites is often one of the last parts of the abdominal examination, but it is often something students can become confused over when they first start clinical skills at medical school
In this video, we will look at what ascites is, how it is clinically relevant, what ascites means for the body, how to assess ascites, what causes ascites and crucially what steps we can implement to treat it
Watch further abdominal examinations for your OSCE revision:
Abdominal Examination
• Abdominal Clinical Exa...
Understanding the abdominal examination
• Abdominal Examination ...
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Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.
However during OSCE assessments. Different medical schools, nursing colleges and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.
The examination demonstrated here is derived from Macleods Clinical Examination - a recognised standard textbook for clinical skills.
Some people viewing this medical examination video may experience an ASMR effect
#clinicalskills #ascites #DrGill
You can now consult via video or in person with Dr Gill at Dr Finlay’s Private Practice - www.drfinlays.co.uk/services/...
00:00 - Overview of Ascites
01:04 - Ascites Fluid Composition
02:00 - Serum Ascites Albumin Gradient (SAAG) Explanation
02:28 - High vs. Low SAAG
04:12 - Paracentesis for Ascites
05:05 - Clinical Examination for Ascites
05:54 - Shifting Dullness Technique Demonstration
07:59 - Fluid Thrill Technique Demonstration
09:40 - Additional Investigations for Ascites
10:48 - Treatment Approaches for Ascites
14:54 - Recap and Final Thoughts
Can't wait for the cloning techniques to evolve so that finally we can have at least 1 dr Gill per 100 hundred people worldwide. This would be the biggest stress relief ever.
That's interesting, as speculation. But, really, any of us is valuable, as an individual, only as long as we ARE individual and singular.
As someone that has watched you for many years, I've always appreciated your gentlemanly approach to your patients and the respect you show to your subscribers in the comments.
Thank you - I find life much easier that way 😊
Dr Gill, you are an excellent teacher and it is because of you and your videos that I passed my minor illness OSCEs. I can't thank you enough! I will definitely continue to enjoy your lessons 😊
I didn’t mean to watch it to the end. Couldn’t help but made it to the end and other videos of this channel! What a marvelous professionalism and soothing calm voice of the teacher. Your teachings get to the point straight!
Amazing how many signs and symptoms can be linked back to the liver! I can remember the first time I held one in anatomy lab and was struck by its sheer size, among everything else. It truly is an amazing organ :)
It’s really impressive, esp it’s regenerative ability
And there's another reason this channel is amazing. Imagine this sort of comment on any other creator's thread.
You are a consummate professional. I so appreciate your transcendent respect for the patient and gentleness.
Excellent video, thank you for taking the time to teach everyone. Medicine is evolving faster and faster and I look forward to seeing what will be taught 10-20 years from now.
I think it is Dr. gill’s soft spoken masculine voice, his articulation' and his command of his subject, that draws one in. I would like to be examined by Dr. gill, more than by anyone else..
I really love these videos that combine clinical skills with indepth explanations
Excellent Doctor/teacher, Dr James Gill
Dr. Gill in the multiverse of madness where he meets Dr. Berry and Dr. Michael.
And Dr Kelly (although Dr Kelly is fairly old by now)
on a mission to defeat Dr. Saul Shaye
Thank You Very Much Dr Gill for Sharing This message.
this is quite informative, as I have a big belly, and it really is annoying. This is something for me to bring up with my GP, that I have been only seeing via online meetings!
I’m 1.5 years post liver transplant right now and the ascites was one of if the not the worst thing I had to deal with when I was sick. Went from about 190 lbs to 250 lbs because of it and it made everything exponentially harder. I had to get a paracentesis weekly just to be able to sit and breathe somewhat comfortably. Wouldn’t wish it on my worst enemy.
I’m really sorry to hear you went through that.
I hope things have gone well since the transplant?
@@DrJamesGill it’s so cool you answered haha but thank you and yes I’ve been very lucky and haven’t had any serious complications. My bilirubin was still very high for about a month after my transplant but other than that I’ve been in the clear.
That’s wonderful to hear. I think it’s brilliant that patients can share they experiences - especially publicly, as it can really help others, who might be worried, or waiting to go through the same thing
So thank YOU 😊
Wow, I’m a 2yr post liver transplant 🥹. Feels good to know that I’m not alone. Take care 💜
@@highfeelz you’re definitely not! Best of luck to you💚
your the best dr gill!
Hello Dr. Gill! I’m a medical student watching your videos from the US, and I’m interested in going into pediatrics. If you could upload some videos illustrating physical exam techniques with children and infants, that would be terrific. Thank you so much!
I’ll see what I can do about that, not the easiest thing however.
I wonder if there are any training dummies available?
Thank you so much 🙂 Dr.James Gill
I'm a recovering alcoholic and last year got diagnosed with pancreatitis,after loads of trips to hospital.Ive thankfully been in detox since.I still have alot of health issues.
I am a nurse of 30 years experience, although I am not an M D I try to teach my nursing students asusultation of bowel sounds. And simple percussion and palpation. This video was excellent...I knew about fluid wave but never saw it explained or demonstrated. Thank you!!!!
Glad it was helpful. Are there any other areas we could look to help you with?
@@DrJamesGill What a welcomed and thoughtful question! I would need to give it some thought. As you know nurses do not diagnose disease, but I do teach them as much as I can to recognize abnormalities that can contribute to assessments and of course when pathophysiology is well understood they have a very real role in patient education about disease, treatments, psychosocial challenges and coping skills. Thank you!
Great video, very educational. Thanks Dr Gill.
👍
i have an OSCE exam tomorrow and tell me WHYYYY i have just found about your channel?!!! i’m stunned honestly
Good luck! What are you being examined for?
@@DrJamesGill thank you!! everything basically😂 i’m taking plab 2- gmc’s registration exam for doctors outside of uk. there’s a number of practical stations for each exam
Thank you very much, the video
was useful.
My God, I love your work, style and relaxing manner. If you were my GP I'd end up a complete hypochondriac if it meant spending more time in your care. 😁
Thank you Dr. Gill. This video was perfect to help me refresh my technique!
You're very welcome! - any other areas we can help with?
Thank you so much Dr James. It is really helpful for my PACES Exam. I really like the way you explain and show the clinical examinations step by step thoroughly. Please keep teaching to us. I should have watched your videos sooner :)
You're very welcome! Any other areas we could help with?
We had a patient recently. He had major liver problems (alcoholism and drug abuse). He came to us with ascites and unbelievable edema (4+/4+) on his legs and arms. Also, his feet and fingers were completely ischaemic (the feet had no circulation at all) and each day it seemed to worsen. the docs called it phlegmasia cerulea dolens. He died in less than a week.
Great video! Very educational!❤️❤️ and by the way, i love your accent!
Thanks
Hope it was useful!
@@DrJamesGill yes it was!
You are the best
Very helpful, Thank you
Great information
Awesome, thanks for the video! Perfecting timing I just began learning about the peritoneal cavity and conditions involved!
What course at you studying on?
@@DrJamesGill currently general anatomy and physiology as a pre req for a medical laboratory scientist program :) watching your videos after reading relevant portions of my textbook helps me understand your content but also remember what I just learned, I appreciate your work!
@@GetBennidover ooh you're lucky to have Dr Gill's videos to help you!
I'm studying psychology and I *wish* I had a psychology equivalent to Dr Gill to help me memorise my studies!
I am about to start as an FY2 in emergency Medicine in scotland and i am using ur vids to prepare well for the job 😍 they give me so much confidence
Best of luck!
Thank U for this video🙏. I have exams next week and I have learnt alot from you😊. Praying that I pass my exams 🙏
Hi, how did it go ? ☺️
Can you imagine a Dr J Gill and Dr J Kelly collab
shouldnt it be low oncotic pressure for low SAAG? as if it's hypoalbuminemia for example means less protien in blood so lower oncotic pressure and so albumin can seep through the blood vessels to the peritoneal cavity?
This is something I'd really like to have done to me, I've been having a really serious issue with nausea, diarrhea, non stop vomiting, etc, and I believe it may be stomach acid related. My doctor has been no help, and trying to get a new doctor in the usa is practically impossible without waiting multiple months
excellent video
I’m quite happy with the animations I managed to put together for this one 😊
Nice examination demonstration
Thank you
Grande dott gill bravissimo professionista 🇮🇹🇮🇹🇮🇹👍👍👍👍
will there be any more uploads onto Spotify? I love listening to them!
Yes, I simply need to pull the audio, I’d forgotten to do it for a while actually !
Thanks for the reminder
@@DrJamesGill ah amazing! I can't wait 🥰
Super interesting video, much love ❤️
👍👍
5:49 This is the name I will use from now on when I go for a beer
Excellent doc
the video provided useful tips especially with the causes of Pancreatitis.
I GET SMASHED your subscribe button 😂😂😂
By the way please I’ll would appreciate if you become more audible next time.
Thanks Doc❤️
A question, will said tests work well on an obese patient?
Will there be any other methods of checking?
They should still work. But the ultrasound that will be requested to assess the liver anyway will also quantify the volume of ascites
@@DrJamesGill thank you!
3 ads at the start that can't be skipped. Go youtube!
Detroit in the building!!
It seems this test is mostly performed when the condition has become visible?
Are there instances where you would anticipate this condition before it was visible and obvious?
If for example someone had deranged liver function tests, it would be appropriate to do an USS to assess the liver.
That may detect early ascites for example
Now that was ascites for sore eyes...
Har har
I've seen this condition in young kittens --- caused by Feline Infectious Peritonitis. Sadly, it's nearly always lethal.
Oh dear. That’s such a shame
My kitty died because of that. FIP
@@sammiekara7631 We've lost kittens to it, also. Still hurts.❤️
not any more - there's an antiviral, GS-441524, which cures it completely some 90% of the time. unfortunately the patent holder refuses to license it for veterinary use so it's only available through... back channels.
had a young cat die of FIP some years ago, within a month of initial symptoms. a friend's cat was diagnosed with it earlier this year, they got ahold of the drug, and their cat is perfectly healthy many months later. very upsetting that this is the situation but at least there's something
Well this video plus Google image search has me scared and grossed out. Glad I don't drink.
Learning is learning I guess 😊
@@DrJamesGill yup and I went for the most messed up things like looking up to see if they can drain it.
Medical procedures don't actually gross me out, I looked up the way they do the back surgery I had done and watched videos of them doing it.
I just know I don't wanna go through this and now I understand how some people have that belly
Where is the promised paper about the pankreatits causing scorpion venom?
Ah sorry, I’ll add that now
Added now.
I *THINK* I’ve listed the paper that started it all / made the connection between the two
@@DrJamesGill Thank you very much
👍
wish the volume could get louder..
It's called lennyism doc!
Jim Harper after 2 weeks in Hungary
Dr. House?? That are you?😹
Learn how to examine for ascites on an abdomen with absolutely no ascites or other abdominal pathology.... Great video 😅
That’s first year medicine for you. Understand the process, and later on learn to
Examine on the pathology
@DrJamesGill If you made a video about general palpation and assessment of abdomen then yes - but for a specific thing such as shifting dullness and fluid thrill choosing a slim sixpacked abdomen and "telling how it sounds and looks" is not very valuable. I would much rather look for a video with positive findings generally. Also in joint examinations, just my opinion :)
*falls asleep to British Bob Ross*
Just for giggles, I wonder about doing an Warhammer painting video 🤣
@@DrJamesGill dude....doit.
I'm sure my husband has this. However, every doctor says his liver is fine. But he throws everything he eats up. I wish I could find someone who would take it seriously!
Vomiting can be a sign of many things, not just a liver issue
Has he had a camera test - an OGD - to look at his throat and stomach?
@@DrJamesGill no, his health group doesn't want to do it. He's getting better insurance through his new job so I hope the docs will be more keen. Thank you for answering!
Could be gastroparesis
Shirt removal: 2/10
Bad form. Could really use some coaching on that.
shirt removal: 2/10 🤣🤣🤣 love it!
Top form Doc thank you 😘
Shall I get one of the others to have a word?
@@DrJamesGill yessir. Absolutely. Definitely needs some coaching. 🤣🤣🤣
As someone described it recently - Yeeting
Which was a new one to me
the most british doctor ever?
Hipryi
6:33 - 6:45 Too much music theory for me to understand, sorry.
Which part it is that is difficult? Perhaps we can help?
@@DrJamesGill it was a joke. I'm a guitarist, and the greatest fear of every guitarist is music theory 😂
@@PishPishoto ahhh -that makes sense, Music is one of those things I've never been able to create :)
@@DrJamesGill I was sure it would be a topic of interest for you, though :)
Why is he whispering?
Cheee a sound a very very silimar a game Cotton tree.