M Alhashash GENERAL SURGERY FOR DENTAL STUDENTS
Approach to the Surgical Patient: The management of surgical disorders requires not only the application of technical skills and training in the basic sciences to the problems of diagnosis and treatment but also a sympathy and indeed love for the patient. The surgeon must be a doctor, an applied scientist, an engineer, an artist. Because life or death often depends upon the validity of surgical decisions, the surgeon's judgment must be matched by courage in action and by a high degree of technical proficiency
Approach to the Surgical Patient: • History- • physical Examination - • Investigations- • Pre-operative preparation - • operation - • post-operative treatment- • management of complications.
Approach to the Surgical Patient: • The History : At their first contact, the surgeon must gain the patient's confidence and convey the assurance that help is available and will be provided. The surgeon must demonstrate concern for the patient as a person who needs help and not just as a "case" to be processed. This is not always easy to do, and there are no rules of conduct except to be gentle and considerate.
History • Basic (personal) data: • Name • Age • Sex • Occupation • Residence • Marital status • Date of admission Should be written in a sentence.
History name • Identification • Religion. • Calling by name----------friendly
History age • At birth: cleft palate • Infancy: cystic hygroma • Childhood: osteomyelitis, TB, rickets • Adolescence: infections • Young adults: thyrotoxicosis, peptic ulcer • Middle age: carcinoma • Old age: cancer , degenerative diseases
History • sex • GIT Tumours • Cholecystitis • Marital status: • Married or not • Children
History • Occupation • Farmers • Contact with dogs • Asbestos • Residency • Endemic diseases
The History I- The chief complaint: what is the problem that brings (forces) the patient to the doctor& its duration . Arrange in chronological order and in patient words. Exam: swelling in the neck since 1 year hoarseness of voice since 5 months difficulty in swallowing since 3 months
History II- The present history: in full detail: 1- when the complaint start exactly ? (day , hour). 2- how it starts? onset (sudden, acute, chronic) 3-its course ? (increasing progressive, the same stationary or decreasing regressive ). 4- any associated symptoms? (pain vomiting ,fever ,drowsiness ,change in vision ,giturinary, respiratory) .
History (present) 5- the provoking factors: what increase the complaint? 6- the releasing factors;what decrease the complaint ? 7- relieved by medication or not ? 8- constant or intermittent ,its duration & for how long ?
The History e.g. The pain: • The site : • The onset :gradual ,sudden or explosive • The character: burning ,colicky, vague ,heaviness,….. • The severity: mild ,moderate or sever . • constant or intermittent . • relieved by medication or not & what medication ? • Factors increase it :movement ,eating, standing ,…. • Factors decrease it :movement ,eating, standing ,… • Radiation to other site ? • Associated symptoms: vomiting ,fever …..
The History E.g.: vomiting : • What did the patient vomit? Food ,fluid ,…… • Nausia • How much? • How often? • What did the color of the vomitus ? yellow ,green, brown,…. • Was vomiting projectile? • The taste of the vomitus ?acidic , bitter ,…..
The History III- The past history; • Any same complain before ? How it started & how ended? • Any other complain before? Related to the complaint or not related ? • Any other medical diseases? hypertension. ,diabetes mellitus , cardiac problem,… • Allergy –The drug history :aspirin ,anticoagulant ,contraceptive pills ,chemotherapy . - The surgical history :any operation before, type of anesthesia ,any complication?
The History - Nutritional history :dehydration . Loss of electrolyte ,protein deficiency. IV- Menstrual history :regularity ,duration , amount,.. V-Family history: known disease in the family ,same disease in the family ,hereditary diseases? . Genetic , environmental NB: congenital, familial, herditary. VI- Habbit history :smoking, alcohol ,drug abuse .