General surgery Introduction to clinical surgery general

General surgery Introduction to clinical surgery & general principles of patient assessment Dr. Ziad H. Delemi B. D. S, F. I. B. M. S (M. F. ) Mosul university- College of dentistry-oral & maxillofacial surgery department

Category of Surgery Classification of Surgical Diseases: 1) Trauma: mechanical, thermal, chemical, war, electrical…… 2) Infection: abscess, sinus…. 3) Neoplasia: benign, malignant. 4) Anatomical abnormalities: congenital or acquired. Mosul university- College of dentistry-oral & maxillofacial surgery department

Category of Surgery 5) Metabolic & Hormonal disorder. 6) Infarction & Ischemia. 7) Others: Obstruction, Parasite diseases, Vein varicose. Mosul university- College of dentistry-oral & maxillofacial surgery department

Classification of Surgical Specialties 1) Characteristics Neoplastic surgery Emergency surgery Trauma surgery Burn surgery Mosul university- College of dentistry-oral & maxillofacial surgery department

Classification of Surgical Specialties 2) Operation Methods Plastic surgery Microsurgery Transplantation Minimally invasive surgery Mosul university- College of dentistry-oral & maxillofacial surgery department

Classification of Surgical Specialties 3) Age Pediatric Surgery Adult Surgery Mosul university- College of dentistry-oral & maxillofacial surgery department

Classification of Surgical Specialties 4) Specialty: General surgery Orthopedic Neurosurgery Gynecology Otolaryngology( ENT ) Ophthalmology Maxillofacial Mosul university- College of dentistry-oral & maxillofacial surgery department

Classification of Surgical Specialties Plastic Cardiovascular Mosul university- College of dentistry-oral & maxillofacial surgery department

Case history Case sheet Personal information: ( name, age, sex, occupation, residency, religion, date of admission, date of examination) Mosul university- College of dentistry-oral & maxillofacial surgery department

Case history History chief complain history of the present illness past medical history past surgical history drug allergy & sensitivity family history social history Mosul university- College of dentistry-oral & maxillofacial surgery department

General principles : 1 - Inspection. 2 - Palpation. 3 - Percussion. 4 - Auscultation. Mosul university- College of dentistry-oral & maxillofacial surgery department

Case examination First describe age ( child, young, middle age, old age) then describe sex, then condition status conscious or not comfortable or not, built either thin or fat or normal, Mosul university- College of dentistry-oral & maxillofacial surgery department

Case examination General examination: ( the patient either lying or sitting on bed ) q Vital signs (pulse rate, blood pressure, respiratory rate, temperature). q Color changes: jaundice, anemia, cyanosis q Shape changes: Leg edema, clubbing of fingers. q Obesity q Dehydration q Lymphadenopathy Mosul university- College of dentistry-oral & maxillofacial surgery department

Vital signs 1 -Pulse rate: arterial pulse radial in forearm (simple, superfacial, bone under it), brachial , carotid, femoral , popleteal, dorsalis peadis, posterior tibial arteries. Normally 60 -100 bpm if > 100 tachycardia , and if < 60 bradycardia Rhythm either regular or irregular Mosul university- College of dentistry-oral & maxillofacial surgery department

Vital signs 2 -Blood pressure: sphygmomanometer and stethoscope, the patient should be relaxed quite, not eating, not smoking, not with tight clothes, put the cuff at the level of the heart above the cubital fossa 1 inch inflate cuff till brachial pulse disappear add 30 degree (nearly to 200 mm. Hg) then hear by stethoscope & deflate, the first sound is systolic , when the sound disappear it means diastolic, normally 12080 mm. Hg. Mosul university- College of dentistry-oral & maxillofacial surgery department

Vital signs 3 -Respiratory rate: normally 14 -20 breath/ min. type ( acidotic air-hunger, chinystock) mode normally female with thoracic breathing & male with abdominal breathing. Mosul university- College of dentistry-oral & maxillofacial surgery department

Vital signs 4 - temperature: examined by using thermometer 35 -42 c, it should be kept in disinfectant solution such as detol then shaken well till return to zero then use orally( under the tongue) or auxillary or rectaly for about one min. normally 36. 6 - 37. 4 c if below 35 c hypothermia more than 37. 5 c pyrexia & if more than 40 c hyperpyrexia Mosul university- College of dentistry-oral & maxillofacial surgery department

Color changes 1 - jaundice: yellowish color of skin & sclera( ask the patient to look downward). 2 - anemia: pale color of skin & tongue & sclera ( ask the patient to look upward). 3 - cyanosis: bluish discoloration of skin & mucous membrane of tongue due to deoxygenated blood & it is of two types central if the tongue & hand & lip are bluish in color with warm hands , peripheral if tongue is not bluish & hand bluish & cold. Mosul university- College of dentistry-oral & maxillofacial surgery department

Case examination Cardiovascular system: Inspection : apex beat, epigastric pulsation Palpation : apex beat position, thrill palpable murmur, Percussion : limited value Auscultation : heart sound , murmur Mosul university- College of dentistry-oral & maxillofacial surgery department

Case examination Respiratory system: Inspection : chest shape barrel (emphysema), pigeon ( rickets), funnel (congenital ), movement or expansion, breathe rate & character, back of the chest kyphosis, lordosis, scoliosis Palpation : position of trachea, apex beat, expansion, tactile vocal fremitus. Percussion : clavicular & intercostal space Auscultation : breath sounds, add sounds ronchi (wheeze) cripitation , plural rub (friction), vocal resonance

Case examination The nervous system: A- Cranial nerves: 1 - olfactory 2 - optic 3 - occulomotor 4 - trochlear 5 - trigeminal 6 - abducent 7 - facial 8 - vestibulochoclear 9 - glossopharyngeal 10 - vagus 11 - accessory 12 - hypoglossal Mosul university- College of dentistry-oral & maxillofacial surgery department

Case examination The nervous system: B- Motor system: Inspection : size & symmetry of muscle, abnormal movement, (fasculation, termer), chorea, athetosis, dyskinasia, examination of tone, examination of power, examination of reflexes( biceps jerk, triceps jerk, ankle jerk, knee jerk, jaw jerk, Babaniski sign, coordination, examine gait, ( waddling, hemiplegic, parkinsonial, wide-base. Mosul university- College of dentistry-oral & maxillofacial surgery department

Case examination The nervous system: B- Sensory system: Pain , temperature , touch, joint position, vibration sense Mosul university- College of dentistry-oral & maxillofacial surgery department

Case examination Abdominal examination: Inspection : movement of abdomen shape of the umbilicus visible peristalsis visible vein distribution of hair scar of previous operations cuttary & tattoo Palpation : liver , spleen, kidney, ovaries, masses Percussion : for asitis shifting dullness & transmitted thrill Auscultation : bowel sound, renal art. Mosul university- College of dentistry-oral & maxillofacial surgery department

Case examination Head examination: 1 - scalp: density of hair if hair loss alopecia texture of hair thick silky distribution & presence of scales 2 - face: mooning facies Cushing syndrome adenoid facies infection of adenoid lion facies in leprosy myxedemous face in hypothyroidism thin face as in hyperthyroidism coarse features as in acromegaly malar flush as in mitral valve stenosis earthy paler face as in renal failure catchaxic face in chronic illness

Case examination Neck examination: 1 - lymph nodes: by using tips of the fingers starting with submental, submandibular, jugulodigastric, juguloomohyoid, supraclavicular, etc. . 2 - thyroid gland : by inspection of neck & ask the patient to swallow or drink water. 3 - neck pulsation : put patient in 45° & observe arterial or venous pulsation. Mosul university- College of dentistry-oral & maxillofacial surgery department

Case examination Neck examination: 1 - lymph nodes: by using tips of the fingers starting with submental, submandibular, jugulodigastric, juguloomohyoid, supraclavicular, etc. . 2 - thyroid gland : by inspection of neck & ask the patient to swallow or drink water. 3 - neck pulsation : put patient in 45° & observe arterial or venous pulsation. Mosul university- College of dentistry-oral & maxillofacial surgery department

Investigation Complete blood count ( CBC ) Erythrocyte sedimentation rate ( ESR ) Fast blood sugar ( FBS ) Renal function test ( RFT ) Liver function test ( LFT ) General urine examination ( GUE ) Serum electrolytes (Na+, K+, Ca+, Mg+, Cl-, ……) Chest x-ray ( CXR ) Blood group ( BG ) Electrocardiogram ( ECG ) Mosul university- College of dentistry-oral & maxillofacial surgery department

Investigation Radiologic evaluation(conventional, C. T. , MRI, PET scan. . ) Biopsy (incisional, excisional, punch, …. ) Fine needle aspiration cytology FNAC Diagnosis Treatment Follow up Mosul university- College of dentistry-oral & maxillofacial surgery department