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History Taking In Surgery. Gamal Khairy FRCS,MS College of Medicine KKUH. History taking ? the key step in surgical diagnosis. Varies according to the complain ? specific histories ? surgical specialty. Two types of history in surgical practice:.

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History taking in surgery

History Taking In Surgery

Gamal Khairy FRCS,MS

College of Medicine KKUH


  • History taking

    ? the key step in surgical diagnosis.

  • Varies according to the complain

    ? specific histories

    ? surgical specialty


Two types of history in surgical practice
Two types of history in surgical practice:

  • Out-pt or emergency room history

    ?specific complaint is pinpointed ? diagnosis

  • Clerking of pt admitted for elective surgery object

    ?to assess that the treatment planned correctly indicated and pt is suitable for that operation.


How to take the history
How to take the history ?

  • Personal information : Age, sex, marital status, occupation, etc……


History should be taken in the following order
History should be taken in the following order:

  • the present complaint (c/o).

  • History of present complaint.

  • Elaboration on the system involved.

  • Systemic enquiry.


History should be taken in the following order1
History should be taken in the following order:

e. Past history ? surgical, medical

f. Drug history

g. Family history

h. Social history


Systemic enquiry
Systemic Enquiry

1. GIT: Appetite, Vomiting, Regurgitation, etc.

  • Respiratory System ? cough, haemoptysis, Dyspnea….

  • C.V.S: * Breathlessness, palpations, chest pain…

    * Peripheral vessels: Intermittent, claudication, rest pain.

  • Urogenital system: micturition, loin pain supropubic pain.

  • Nervous system: Tremor, fainting attacks, fits, weakness…

  • Musculor skeletal ? muscle pains, joint swelling



The history of pain
The history of pain

- Site.

- Onset.

- Severity ? wake him up, need analgesics

Rather than: mild, severe.

- Nature: Buring, stabing, coliky.

  • Progression ? - begin ç maximum, then remains steady.

    - steadily increase till maximum then gradual decline.

  • Duration.

  • Aggravating and releaving factors

  • Radiation.


The history of a lump
The history OF A LUMP

  • Duration

  • How discovered

  • Symptoms ? pain

  • Changes ? ?in size

  • Other lumps

  • Any cause ? Trauma


Physical examination
Physical Examination

  • General Examination:

    - First part ? during taking history ? posture, speech,etc…

    - vital signs ? pulse, BP, temp


Examination of the head and neck
Examination of the Head and neck

Eyes

  • Pupil reaction to light

  • Sclera à jaundice

  • Conjuction à paller

  • Movement à

  • Exophthalmos

  • Fundoscopy


Examination of the head and neck cont d
Examination of the Head and neck (cont’d)

Ears and Nose

  • Usually forgotten on ex:

  • External auditory canal

  • Eardrum

  • Nostrils


Examination of the head and neck cont d1
Examination of the Head and neck (cont’d)

Neck

  • Jugular veins

  • Trachea

  • Lymph nodes

  • Thyroid


Examination of a lump
Examination of A LUMP

  • Position

  • Colour and texture of skin

  • Temperature

  • Tenderness

  • Shape

  • Size

  • Surface

  • Edge

  • Consistency

  • Pulsatile, compressibility (venous malformations)

  • Reducibility


Examination of the abdomen
Examination of THE ABDOMEN

PREPARATION:

  • Warm and private room

  • Good light

  • Comfortable cough or bed

  • Exposure: nipple to knee

  • Get the patient to relax

  • The position of the examiner


Fig 16 6 the names of the regions of the abdomen
FIG. 16.6THE NAMES OF THE REGIONS OF THE ABDOMEN


The steps of examination
THE STEPS OF Examination

  • Inspection

  • Palpation

  • Percussion

  • Auscultation


The steps of examination1
THE STEPS OF Examination

INSPECTION:

  • Shape of abdomen

  • Scars, sinuses & fistulae

  • Distended veins

  • Lumps

  • Pigmentation

  • Movement


The steps of examination2
THE STEPS OF Examination

PALPATION:

  • Superficial :

    • Tenderness

    • Rebound

    • Ganding

  • Deep palpation:

    • Masses

    • Organs


The steps of examination3
THE STEPS OF Examination

PERCUSSION:

  • All abdomen à spec. over masses

  • Fluid thrill

  • Shifting dullness


The steps of examination4
THE STEPS OF Examination

AUSCULTATION:

  • Bowl sounds

  • Aorta and iliac anteries - Bruit

  • Succusion splash


THANK

YOU !!!!!


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