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1. INTRODUCTION TO
GENERAL SURGERY
Dr.Abdirahman
Adan

2. GENERAL OBJECTIVES
1. To upgrade and enforce scattered
surgical clinical experience obtained
during the study, so that the students can
now take proper history, do proper clinical
examination to reach a provisional
diagnosis, obtain an adequate differential
order and obtain the required amount and
variety of investigations and be able to
reach a reasonable diagnosis of the
surgical problem at hand and to be able to

3. CONT..
2. To acquire the knowledge and develop skills to do
all physical examinations needed to diagnose surgical
problems
3. The students must be made to realize the wide
scope of surgery as a discipline and must develop his
or her abilities for self learning
4. The student must develop the right attitude in
dealing with patients by understanding the effects of
surgical affections and surgical intervention taking
into consideration the family background and the
socio-economic condition of the patient in plan for
surgical therapy

4. SPECIFIC OBJECTIVES
At the end of the course the students will be able to:
1. Take a careful history, perform a good clinical examination,
reach a provisional diagnosis and use the relevant
investigations (Lab and image) reach a logical diagnosis of a
surgical problem.
2. Discuss pathology and pathophysiology of surgical problem
and outline the rationale investigation ordered.
3. Discuss the basic principles in surgery concerning metabolic
response to trauma, shock, fluid, electrolyte and acid-base
balance and use of blood and blood components in surgery.
4. Discuss tissue healing, surgical infections, use of antibiotics,
cancer spread and its management.
5. Outline hazards of surgery in diabetic patients and their
management.

5. COURSE REQUIRMENT
Assessment type percenta
ge
Mid Exam
Attendance And Assignments
Class Activity, And
Presentations
Final Exam
Reference: Baily & Love's Short Practice of
Surgery , kasrel ain surgical book ,
SRB_s_Clinical_Methods_in_Surgery.pdf
30
marks
5 marks
5 marks
60
marks

6. AIMS
By the end of this lesson, you should be able to:
1. Describe how to take and perform a systemic
history and physical examination of surgical
patients
2. Interpret common surgical pts symptoms and sign
into a diagnosis
3. Classify type of surgery
4. Describe the importance of investigations in
confirming diagnoses of surgical patients

7. DEFINITION
Surgery is the branch of medicine that deals with
physical manipulation of a bodily structure to
diagnosis, prevent, or cure an ailment.
Surgery is procedure that involves cutting of apt
tissue or closure of previous sustained wound or as
the treatment of injuries or disorders of the body by
incision or manipulation, especially with instruments.
It also refers to performance of such procedures by
surgeons
Surgery word is derived from Greek (Hand working)

8. WHY DO WE NEED TO PERFORM TO
SURGERY?
In 16 th century, a French surgeon named
Ambroise pare, stated that there were five
reasons to perform surgery. These are
1.Eliminate that which is superfluous
2.Restore that which has been dislocated
3.Separate that which has been united
4.Join that which has been divided
5.Repair the defect of nature

9. 3 MAJOR OBSTACLES IN SURGERY
Up until the industrial revolution , surgeons were incapable of
overcoming three principal obstacles which had plagued the medical
profession from its infancy ,
these obstacles are:
1. Pain
2. Bleeding
3. Infection
Advances in these fields have transformed surgery from a risky “art’
into a scientific discipline capable of treating many diseases and
conditions.

10. HISTORY OF SURGERY
The first surgical techniques were developed to treat
injuries and traumas.
It involved suturing lacerations, amputating in
salvageable limbs, and draining and cauterizing open
wounds.
Oldest surgery that is evidenced is trepanation (burr
holes or craniotomy) – BC
Setting bones and splinting, intramedullary fixation
with wooden splints is reported in early Spanish texts
Anesthesia using alcohol or opium is one of the oldest
surgical techniques reported

11. Bleeding
Cauterization(numb)
Ligatures
Infection
Spread through contamination
Washing hands - aseptic techniques
Antibiotics
Pain
Anesthesia –
Ether, chloroform –
Muscle relaxants e.g. curare

12. CLASSIFICATION
Divisions of Surgery – very many
General
Orthopaedic
Peadiatric
Cardiothoracic and Vascular
Plastic or reconstructive
Maxillofacial
Gastroenteric
Neurosurgery
Urology

13. CONT…
Types of surgeries
Diagnostic, exploratory,
 reconstructive, curative,
pariative, transplant,
elective, urgent, emergency
According to magnitude
Major,
medium,
minor

14. TYPES OF SURGERY :.
SURGICAL PROCEDURES ARE CLASSIFIED BASED ON
1.Urgency
2.Risk
3.Purpose
SURGERY BASED ON URGENCY
A. Elective surgery
B. Urgent surgery
C. Emergency surgery

15. ELECTIVE SURGERY
• It is a procedure that is pre planned and based on
patients choice and availability of scheduling for the
patient, surgeon and the facility.
• Delay of surgery has no ill effects.
Examples are:
Hernia repair
Cataract extraction
Tonsillectomy
Hip prosthesis

16. URGENT SURGERY
Must be done with in a reasonably short time frame to
preserve health. Usually done with in 24 – 48 hours.
 Examples are
Removal of gall bladder
Amputation
Appendectomy
EMERGENCE SURGERY
Must be done immediately to preserve life, a body part or
function
 Examples are:
Control of hemorrhage, Repair of trauma, perforated
ulcers, fasciotomy OR intestinal obstruction.

17. SURGERY BASED ON DEGREE OF
RISK
MAJOR SURGERY
Major surgery requires hospitalization and specialized care, is
usually prolonged, has a higher degree of risk, involves major
body organs or life threatening situations, and has a greater
risk for postoperative complications.
Examples are:
Open Cholecystectomy
 Nephrectomy
Hysterectomy
Radical mastectomy
Laparotomy

18. CONT…
MINOR SURGERY
Minor surgery is usually brief, carries a low risk
and results in few complications.
Minor surgeries are mostly elective.
Examples are:
Teeth extraction
Cataract extraction

19. SURGERIES BASED ON PURPOSE
1.Diagnostic
2.Ablative
3.Palliative (Intestinal Obstruction)
4.Reconstructive
5.Transplantation
6.Constructive

20. CONT…
DIAGNOSTIC SURGERY:
Surgeries to make or confirm a diagnosis,
Examples are: Biopsy, Bronchoscopy, Endoscopy
ABLATIVE SURGERY:
To remove a diseased body part.
Examples are: Appendectomy, Amputation
PALLIATIVE SURGERY:
Surgeries to relieve or reduce intensity of an illness. It is not
curative.
Examples are: Colostomy, Nerve root resection

21. CONT…
 RECONSTRUCTIVE SURGERY:
Surgeries to restore function to traumatized or malfunctioning tissue
or to improve self concept.
Examples are: Scar revision, Plastic surgery, Internal fixation of a
fracture, Breast reconstruction
TRANSPLANTATION SURGERY:
Surgeries to replace organs or structures that are diseased or
malfunctioning
Examples are: Kidney, liver, heart transplantation.
CONSTRUCTIVE SURGERY:
Surgeries To restore functions in congenital anomalies.
Examples are: Cleft lip Repair, Closure of Atrial Septal Defect

22. SURGICAL HISTORY
1) Demographics/Bio-data – name, age, gender,
occupation
2) Presenting complaint(s) (C/O)+ duration
3) History of presenting complaints or present illness
4) Systemic inquiry
5) Past medical History – chronic dxs, op, accidents,
admission
6) Family and Social History – alcohol, smoking, mobility,
accommodation
7) Obstetric and gynaecological history
8) Drug and allergy History

23. APPROACH TO PHYSICAL
EXAMINATION
1.General Examination
2.Local Examination
Inspection
Palpation
Percussion
Auscultation
Special tests

24. IMPORTANT SURGICAL SYMPTOMS
1. Pain
2. Swelling
3. Vomiting
4. Cough
5. Bleeding or wound
6. Dysphagia
7. Change in bowel habits
8. Abdominal distension
9. Difficult in micturition
10.Joint stiffness

25. DEFINITION OF PAIN
Unpleasant sensory and emotional experience associated with actual
or potential tissue damage.
Can be classified into somatic or autonomic depending on organ of
origin
Site
Onset
Character – stabbing, sharp, dull, burning, aching, colic, etc
Radiation or referral
Aggravating or relieving factor
Timing
Severity

26. SWELLING
1. History of swelling
Onset, course, duration?
Painful or painless?
Other lumps?
Effect on general condition?
Cause?
Does the lump disappear?

27. 2. EXAMINATION OF A SWELLING
Inspection –
Site, size, Shape, Symmetry, surface, skin overlying, scars
special signs e.g. pulsations, cough impulse, movements,
association with swallowing
Palpation –
Tenderness, skin temperature, size, surface (smooth,
irregular, nodular), edges (well defined, ill defined),
consistency (cystic or solid, soft or hard),
Relationship to surrounding structures (skin, muscle,
arteries, nerves), draining lymph nodes, special signs

28. CONSISTENCY OF THE SWELLING
Cystic – Fluctuation,
Paget’s test (a solid tumour
is most hard in the center,
where as a cyst is least hard
at its center)
 Solid – soft, firm,
indurated, hard

29. A LUMP’S RELATIONSHIP TO SKIN
Is the lump separate from the surrounding skin? –
Pinch the skin over the lump
Is the lump tethered or fixed to the skin? – move the
lump andd see what happens
A lump’s relationship with muscle
Feel the swelling before and after muscle contraction
Is the swelling superficial, within, or deep to the
muscle

30. OTHER SPECIFIC DIAGNOSTIC
SIGNS OF LUMPS
Pulsations – expansile or transmitted
Transillumination – e.g. in hydrocele or cystic
hygroma
Neck lumps – thyroid gland/thyroglossal cyst, lymph
nodes
Hernias – cough impulse, reducibility
Percussion and Auscultation
Percussion – dull or resonant
Auscultation – Essentially over arteries and pulsating
masses – listen for bruit

31. ANY DISCHARGE
Amount
Color
Consistent (serous, sanguineous,
serosanguineous, and purulent)
Odor or smell
Relations (causing)

32. INVESTIGATIONS
Basic labs
Blood serum or culture
Fluid or discharge
Tissue biopsy or needle aspiration
Images
X-ray
Ultrasound
Ct scan
MRI

33. WHEN
Sadness fill your
heart
And tears flow in your eyes
Always remember three
things
Allah is with you
 Still with you