1. History Taking In Surgery Gamal Khairy FRCS,MS College of Medicine KKUH

2. History taking ? the key step in surgical diagnosis. • Varies according to the complain ? specific histories ? surgical specialty

3. 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.

4. How to take the history ? • Personal information : Age, sex, marital status, occupation, etc……

5. History should be taken in the following order: • the present complaint (c/o). • History of present complaint. • Elaboration on the system involved. • Systemic enquiry.

6. History should be taken in the following order: e. Past history ? surgical, medical f. Drug history g. Family history h. Social history

7. 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

8. Commonest complains in Surgery • Pain • Lump

9. 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.

10. The history OF A LUMP • Duration • How discovered • Symptoms ? pain • Changes ? ?in size • Other lumps • Any cause ? Trauma

13. Physical Examination • General Examination: - First part ? during taking history ? posture, speech,etc… - vital signs ? pulse, BP, temp

14. Examination of the Head and neck Eyes • Pupil reaction to light • Sclera à jaundice • Conjuction à paller • Movement à • Exophthalmos • Fundoscopy

15. Examination of the Head and neck (cont’d) Ears and Nose • Usually forgotten on ex: • External auditory canal • Eardrum • Nostrils

16. Examination of the Head and neck (cont’d) Neck • Jugular veins • Trachea • Lymph nodes • Thyroid

17. Examination of A LUMP • Position • Colour and texture of skin • Temperature • Tenderness • Shape • Size • Surface • Edge • Consistency • Pulsatile, compressibility (venous malformations) • Reducibility

18. 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

19. FIG. 16.6THE NAMES OF THE REGIONS OF THE ABDOMEN

20. THE STEPS OF Examination • Inspection • Palpation • Percussion • Auscultation

21. THE STEPS OF Examination INSPECTION: • Shape of abdomen • Scars, sinuses & fistulae • Distended veins • Lumps • Pigmentation • Movement

22. THE STEPS OF Examination PALPATION: • Superficial : • Tenderness • Rebound • Ganding • Deep palpation: • Masses • Organs

23. THE STEPS OF Examination PERCUSSION: • All abdomen à spec. over masses • Fluid thrill • Shifting dullness

24. THE STEPS OF Examination AUSCULTATION: • Bowl sounds • Aorta and iliac anteries - Bruit • Succusion splash

25. THANK YOU !!!!!