History taking in surgery
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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

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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:

  • 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 ?

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


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 order:

e. Past history ? surgical, medical

f. Drug history

g. Family history

h. Social history


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


Commonest complains in Surgery

  • Pain

  • Lump


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

  • Duration

  • How discovered

  • Symptoms ? pain

  • Changes ? ?in size

  • Other lumps

  • Any cause ? Trauma


Physical Examination

  • General Examination:

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

    -vital signs ? pulse, BP, temp


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)

Ears and Nose

  • Usually forgotten on ex:

  • External auditory canal

  • Eardrum

  • Nostrils


Examination of the Head and neck (cont’d)

Neck

  • Jugular veins

  • Trachea

  • Lymph nodes

  • Thyroid


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

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. 16.6THE NAMES OF THE REGIONS OF THE ABDOMEN


THE STEPS OF Examination

  • Inspection

  • Palpation

  • Percussion

  • Auscultation


THE STEPS OF Examination

INSPECTION:

  • Shape of abdomen

  • Scars, sinuses & fistulae

  • Distended veins

  • Lumps

  • Pigmentation

  • Movement


THE STEPS OF Examination

PALPATION:

  • Superficial :

    • Tenderness

    • Rebound

    • Ganding

  • Deep palpation:

    • Masses

    • Organs


THE STEPS OF Examination

PERCUSSION:

  • All abdomen à spec. over masses

  • Fluid thrill

  • Shifting dullness


THE STEPS OF Examination

AUSCULTATION:

  • Bowl sounds

  • Aorta and iliac anteries - Bruit

  • Succusion splash


THANK

YOU !!!!!


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