Nill

1. History Taking
In Surgery
Dr Brima m sesay

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

3. The Surgical History and Examination
• Give the patient your complete attention and never take
short cuts.
• Tell the patient your name and explain why you are seeing
them. It is particularly important for medical student to do
this.
• Let the patient talk to you. Guide the conversation but do
not dictate it.
• Try to be explicit.
• Fluency problems. Keep your question short and simple
and have your ans translated one at a time
• Avoid leading questions.

4. How to take the history ?
Do not write and talk to the patient at the sametime
but drug history maybe difficult to remember after
examination.
Also record
Names, Age, Date of Birth, Sex, Marital status,
Occupation, Ethnic group, Hospital or practice
record number.

5. History should be taken
in the following order:
 the present complaint (c/o).
 History of present complaint.
 Elaboration on the system involved.
 Systemic enquiry.

6. History should be taken
in the following order:
e. Past history ? surgical, medical
f. Drug history
g. Family history
h. Social history
e. Habits

7. 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

8. Commonest complains in
Surgery
 Pain
 Lump

9. 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.

10. The history OF A LUMP
 Duration
 How discovered
 Symptoms ? pain
 Changes ? ?in size
 Other lumps
 Any cause ? Trauma

11. Physical Examination
 General Examination:
- First part ? during taking history ? posture,
speech,etc…
- vital signs ? pulse, BP, temp

12. Examination of the Head and
neck
Eyes
 Pupil reaction to light
 Sclera  jaundice
 Conjuction  paller
 Movement 
 Exophthalmos
 Fundoscopy

13. Examination of the Head and neck (cont’d)
Ears and Nose
 Usually forgotten on ex:
 External auditory canal
 Eardrum
 Nostrils

14. Examination of the Head and neck (cont’d)
Neck
 Jugular veins
 Trachea
 Lymph nodes
 Thyroid

15. Examination of A LUMP
 Position
 Colour and texture of skin
 Temperature
 Tenderness
 Shape
 Size
 Surface
 Edge
 Consistency
 Pulsatile, compressibility (venous malformations)
 Reducibility

16. 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

17. FIG. 16.6
THE NAMES OF THE REGIONS OF THE
ABDOMEN

18. THE STEPS OF Examination
 Inspection
 Palpation
 Percussion
 Auscultation

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

20. THE STEPS OF Examination
PALPATION:
 Superficial :
 Tenderness
 Rebound
 Ganding
 Deep palpation:
 Masses
 Organs

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

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