surgery
DESCRIPTION
Surgery a short introTRANSCRIPT
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SURGERY
Dr Fahim Akbar
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Balance
SocietyWork Family
Self
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Personal relationship
Scientific
research
professional skill
Teaching ability
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Theory basis surgical skill Sympathy and love Scientist Engineer Artist Make correct decisions
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The Anatomy
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The Surgical Technique
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Grey’s Anatomy
The Emergency Room
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The HistoryPresent illness, previous history, family history
1. Correct Diagnosis2. Therapy schedule3. Good relationship
The physical examinationInspection, palpation, percussion, auscultation
The laboratory examinationLaboratory examination, imaging exams
Other examinationAll kinds of endoscopes, angiography
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Medical Record
Chief complains Present illness Past history Review of systems Personal history Bearing history Family history
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The history——how to begin
Gain confidence Give confidence Establish relationship Effective communication
gentle Considerate Sympathy Understanding Personal charm
The way is different Follow your rhythm , not the patient’s What the patient said maybe unreliability Avoid: Leading questions, wanted , wrong answers
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Building the history
Detective work: respect the facts Realize the critical problem Follow some rules Patient may tell a lie, Why? Believe your eye and mind but not your ear
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Building the history—Pain The International Association for the Pain Study "Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described in terms of such damage
The progress of pain
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Why pay attention to Pain motivates the individual to withdraw from
damaging situations protect a damaged body part while it heals to avoid similar experiences in the future
Most pain resolves promptly once the painful stimulus is removed and the body has healed
sometimes pain persists despite removal of the stimulus and apparent healing of the body
sometimes pain arises in the absence of any detectable stimulus, damage or disease
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Building the history—Pain
How to evaluate/rate pain
Wong—Baker face
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Pain: What can we learn
How the pain begin Position Characteristics:
○ Explosive ( rupture ) or Rapid or Gradual○ Precise ( trunk ) or obscure ( viscera)○ Constant ( structural ) or intermittent ( functional)
How to relieve: naturally or medication
Associations: intermittent claudication: vasculitis or Spinal Stenosis extremity deformity: bone fracture
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Pain: reaction
Purpose : To find the cause Do not believe all patients saying Overreactor:
Mild pain: Mosquito BitesModerate pain: gastric ulcerSevere pain: vascular pain, renal or biliary colic
Restore confidence Anagelsia
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Vomiting
What How much How often Smell Color Projectile:
○ Intracranial hypertension
Pathogeny
diagnosis
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Bowel Habits
Habits change: common but easy to ignore
The shape and size: maybe changed with alter of diet or travel
Intermittent alternations of constipation or diarrhea
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Hematemesis or Hematochezia
Hematemesis From throat\mouth Character of blood Clot Bright or dark red Coffee-ground
Hematochezia From rectum Character of blood Clot Bright or dark red Tarry stool hemorrhoids
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Trauma Get the detals as precisely as possible, find
important clues○ When○ Where○ How○ Patients position○ Consciousness○ Retrograde amnesia○ Check the wounds○ Blood lose○ Get what therapy
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Trauma
Car/vehicle accident injury
Sport injury
Gun shot
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Past history
Never overlooked important histories Do not expend to much time Do with the physical examination Accord to different systems System review
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System review
Respiratory system no pharyngalgia; no chromic cough or hemoptysis; no dyspnea and
thoracalgia;no afternoon fever or night sweats.
Circulatory system no palpitation and breathlessness on exertion: no precordial pain,
dizziness and persistent headache; no syncope and hypertension.
Digestive system no sour regurgitation and dysphagia: no chronic abdominal ache,
diarrhea and vomiting: no jaundice, hematemesis and melena
Urinary system no past history of edema and proteinuria; no pollakiuria; no urgency
and painful micturition; no visible hematuria and hypertension.
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System review Hematopoietic system
pale shin, dizziness, blurred vision and tinnitus; impairment of memory; petechia and jaundic; lymph node, liver and spleen enlargement; abnormal bony pain.
Endocrine and metabolic system no irritability, hidrosis or profound fatigue and headache; no impaired vision, exceeding
thirsty and polyuria; no excessive hairiness or hair loss; no pigmentation and sexuality change.
Muscle, bone and joint system no unusual pain, redness and swelling of the joints; no deformity of joints; no
limbs and trunk limitation on motion; no myoasthenia and myoatrophy. Nervous system
no persistent headache and syncope; no memorial impairment or speaking obstacle; no insomnia and consciousness obstacle; no paresthesia of skin; no paralysis and convulsion. Mental status: no hallucination, delirium and orientation obstacle; no abnormal emotion
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Family history
Many disease are familial hereditaryfamilial adenomatous polyposis FAPHypertensionHeart diseasediabetes mellitusColon cancers
Have the same genesHave the similar enviroment
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Patients emotional background
Patient Depressed Nerves Fear and be afraid of the surgery Do not have confident
Amputation , ileostomy, colostomy
Psychiatric consultation is seldom need
Surgeon is important: Explain enough Patient Professional Trustworthy
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Examination
Physical examination Laboratory examination X-ray CT scan MRI ( Magnatic Resonance Imaging)
Endoscopy○ Gastroscopy○ Esophagoscopy
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Remember
Necessary examination
Painful and inconvenient examination
No excessive examination
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Physical examination
In a certain sequence Elective examination Complete later Be courteous and relax Suitable enviroment Let patient collaborate and at ease
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Physical examination
Ordinary systemInspectionPalpationPercussionAuscultation
locomotor systemMovementmeasurement
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Inspection
Observe by purpose Compare with the normal side
Facial features Expression position Pupil Consciousness Steps Droop eyelid Breast disease
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Palpation
Gentle and skillful Careful, gentle and precise Fingertip is most sensitive
Mass (benign, malignant)Boundary, tenderness, size, pain, movements
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Auscultation
Important in both medicine and surgery Pneumothorax Great vessels disease Ileus Vascular lesions Heart disease
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Movement and measurement
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Emergency
Alter to fit circumstances Make the changes History must be short and to the point Make certain the primary considerations Physical exams must be specific
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Emergency
Primary consideration:consciousnessBreathingAirway openPalpable pulseHeart beating
CPR?
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How to deal with
Airway obstruction Massive bleeding Tension pneumothorax Cardiac tamponade Bone fracture Blunt trauma to the brain/ head
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Emergency physical exam
Life sign is stable Make a rapid survey examination 2-3minuts to evaluate:
○ Head○ Throat○ Abdomen○ Extremities○ Genitalia○ Cervical: turn the patient
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Laboratory exam
Screening for asymptomatic disease Appraisal of disease contraindicate elective
surgery emergency, deadline , elective surgery
interstinal rupture, great vessels rupture
gastric cancer, liver cancer
thyroid adenoma, inguinal hernia
Diagnosis of disorders Evaluate the paitents condition
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Imaging studies—X ray
Chest radiograph○ Pneumonia○ lung cancer○ Tuberculosis○ Rib fracture○ Pneumothorax
- (lung marking)
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Imaging studies—X ray
Abdominal X-RayRupture
Obstruction
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Imaging studies—X rayBone Fracture
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Imaging studies——CT Why do a CT
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Imaging studies——CT
CT will show the nidus more specific than X ray
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Imaging studies——MRI
Why do a MRI
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Imaging studies——MRI
MRI can display Softtissue
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Basic exams
Complete blood test Stool examination Urine examination Chest X-ray ECG: electrocardiograph Old patient ( >60):
○ Ultrasonic cardiography○ blood gas analysis
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Medical consultation
Why
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Thank You!