history taking in surgery

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History Taking In Surgery: 

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

Slide 2: 

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 order:: 

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

Commonest complains in Surgery: 

Commonest complains in Surgery Pain Lump

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’d): 

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. 16.6 THE NAMES OF THE REGIONS OF THE ABDOMEN

THE STEPS OF Examination : 

THE STEPS OF Examination Inspection Palpation Percussion Auscultation

THE STEPS OF Examination : 

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

THE STEPS OF Examination : 

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

THE STEPS OF Examination : 

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

THE STEPS OF Examination : 

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

THANK YOU !!!!!