History Taking In Surgery

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History Taking In Surgery

• Gamal Khairy FRCS,MS
• College of Medicine KKUH

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

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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.

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How to take the history ?

• Personal information Age, sex, marital status,
  occupation, etc

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History should be taken in the following order

• the present complaint (c/o).
• History of present complaint.
• Elaboration on the system involved.
• Systemic enquiry.

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History should be taken in the following order

• e. Past history ? surgical, medical
• f. Drug history
• g. Family history
• h. Social history

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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
  

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Commonest complains in Surgery

• Pain
• Lump

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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.

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The history OF A LUMP

• Duration
• How discovered
• Symptoms ? pain
• Changes ? ?in size
• Other lumps
• Any cause ? Trauma

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Physical Examination

• General Examination
• - First part ? during taking history ? posture,
  speech,etc
• - vital signs ? pulse, BP, temp

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Examination of the Head and neck

• Eyes
• Pupil reaction to light
• Sclera à jaundice
• Conjuction à paller
• Movement à
• Exophthalmos
• Fundoscopy

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Examination of the Head and neck (contd)

• Ears and Nose
• Usually forgotten on ex
• External auditory canal
• Eardrum
• Nostrils

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Examination of the Head and neck (contd)

• Neck
• Jugular veins
• Trachea
• Lymph nodes
• Thyroid

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Examination of A LUMP

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

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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

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FIG. 16.6 THE NAMES OF THE REGIONS OF THE
ABDOMEN

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THE STEPS OF Examination

• Inspection
• Palpation
• Percussion
• Auscultation

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THE STEPS OF Examination

• INSPECTION
• Shape of abdomen
• Scars, sinuses fistulae
• Distended veins
• Lumps
• Pigmentation
• Movement

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THE STEPS OF Examination

• PALPATION
• Superficial
• Tenderness
• Rebound
• Ganding
• Deep palpation
• Masses
• Organs

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THE STEPS OF Examination

• PERCUSSION
• All abdomen à spec. over masses
• Fluid thrill
• Shifting dullness

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THE STEPS OF Examination

• AUSCULTATION
• Bowl sounds
• Aorta and iliac anteries - Bruit
• Succusion splash

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• THANK
• YOU !!!!!