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History Taking In Surgery - PowerPoint

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					History Taking
In Surgery
  Dr.Ghazi Qasaimeh FRCS
   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
   GIT:
    Appetite, Vomiting, Regurgitation,
    Flatulence, Haematemesis, Abdominal
    pain, Abdominal Distension, Defecation,
    Rectal bleeding, Prolapse incontinence,
    Tenesmsus
   Respiratory System:
    Cough, Haemoptysis, Dyspnea, Orthopnea,
    Praxysmal nocturnal dyspnea, Chest pain.
Systemic Enquiry (Cont.)
   C.V.S:
 Breathlessness, palpations, chest pain, Orthopnea,
  Praxysmal nocturnal dyspnea.
 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  jaundice

   Conjuction  paller

   Movement 

   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
THE 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  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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