INTRODUCTION TO SURGERY DR NABIL ABDELBAKI PROF SURGERY

INTRODUCTION TO SURGERY DR NABIL ABDEL-BAKI PROF SURGERY AUFM HEAD OF HBP SURG. UNIT

GENERAL SCHEME OF CASE TAKING 1) Systemic recording of History, Pyhsical exam. , Treatment & progress 2) Use a definite order do not escape points. History-physical ex. provisional Diagnosis investigations clinical diagnosis treatment- progress- termination 3) This routine should become a habit. 4) Stethoscope, sphygmo. , measuring tape, pencil torch, hammer, skin marker, …

• Alert employ eyes, ears, hands, ? Comments of pt. • Give pt whole attention; never short cuts • See pt walk into the room (not undressed on couch) • Accompanying persons? ? • Pt likes to know to whom they are talking. • Let him talk, guide the conversation, treat as human being, no leading questions. • Explain what you are doing.

History • I. Particulars of the patient: -Name: -Age: -Sex: haemophylia M transm by F; Ca lip, tongue, larynx= M>F visceroptosis & mobile kidne > in F -Race & religion: phimosis & ca penis -Occupation: dust cheminey, footballer, bursae -Residence: Bilh. , Filariasis, -Marital status: Single, Married, widow, divorced

• II. Complaints: - What are you complaining of? - In order of severity, why is he concerned about one c/o > other. C/O, duration, in chronological order. ( were you perfectly alright before this illness).

• III. History of the presence illness: MOO - COURSE - TREATMENT -How did the problem start? -No leading questions; -ve symptoms -Remaining Questions about the abnormal system Systematic Direct questions: amplifying knowledge about the main c/o Reveal the presence of other disorders

• Alimentary • Respiratory • Cardio-vascular • Urogenital • Nervous • Musculo-skeletal • Metabolic:

• IV. Past History: Illness Accidents Operations • V. Personal History: Habits: Smoking, drinking, dietary habits Menstrual history/No & dates of pregnancies social leaisure travels

VI. Drug history: steroids, MAO, DM, hypertension, pills, allergy VII. Immunisation: DPT, polio, TB, … VIII. Family History: Similar diseases, Hereditary, PU, TB. .

Physical examinaion • A) General Survey: -General apperance build, anaemia, jaundice, healthy or sick, … -Facies (facial appearance): prominent eyes(toxic goitre), risus sardonicus(tetanus) -Attitude: helpless eversion of LL =Fr Femur -Decubitus(position in bed): cerebral irritation currled in bed Vital Signs: P T BP RR

• B) Local Examination: (examination of part affected) - Complete exposure of the area(compare with other) - Eyes first and much hands next and little tongue no at all. - Eyes do not see what the brain does not know.

-INSPECTION: Looking at the body. -PALPATION: feeling the various parts. -PERCUSSION: listen to sound produced by tapping. -AUSCULTATION: listen to sounds within body(stethoscope). Movs of different joints, measurements of different parts BETTER: INSPECTION – AUSCULTATION – PERCUSSION - PALPATION

• General Examination: Examin all other systems; examin pt as a whole. ( For D, DD, Prognosis, selection of anaes. , nature of operation, other diseases) • • • PROVISIONAL DIAGNOSIS SPECIAL INVESTIGATIONS CLINICAL DIAGNOSIS TREATMENT PROGRESS