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Published byMarlene Harrison Modified over 8 years ago
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“Introduction to surgery” Prof. Saadallah M. Al-Zacko, FRCS (Ed.), Consultant Plastic Surgeon. Member of British Association of Plastic Surgeon (BAPS). In-Charge, Burns & Plastic unit-Mosul teaching hospital In-Charge, Mosul postgraduate center in plastic surgery. Head- dept. of surgery
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Surgical diagnosis is based on sound knowledge of anatomy, physiology & pathology, a specific history & exam with confirmation by imaging & operative surgery. No matter how good the operation, if it is performed for wrong diagnosis, the benefit for the patient will be limited.
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In other patient presented with severe illness & present as a surgical emergency, a skilled preop. resuscitation & management can turn a high risk procedure into a routine operation. Similarly, the very ill patient can be saved by expert post-op. management.
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The skill of op. surgery are primarily taught in the op. theatre & by supervised practice aided by specific texts of op. surgery.
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Too little attention has been paid by the surgeon to the ancillary process of investigation. Just as the stethoscope is helpful in diagnosis, so the U/S, endoscopy & other forms of imaging will confirm the clinical finding the clinical findings: U/S-gall stone, sigmoidoscopy- rectal carcinoma, X-Ray- fracture (#) bones.
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We have to consider the benefit of the patient from the op. for the disease & the mortality & morbidity if left untreated.
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Surgical history: History of the complaint is the key in surgical diagnosis. History of 2 types: 1-outpatient ( emergency) history: where specific complaint of the patient is pinpointed. The object is to obtain diagnosis & assess treatment planned. 2-history for elective surger.
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Clinical exam.: 1- general. 2-local
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Diagnosis of lump: 1- anatomical plain: skin, muscle, tendon. 2- physical characteristic : tender, round, regular, consistency ( cystic, soft, firm, hard, stony hard).
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Importance of specific signs: Thrill: percussion of middle finger & feel by 2 fingers. Compression sign: decrease size after compression means vascular lesion. Indentation sign: can be moulded, mean fecal impaction. Pulsation: in aneurysm.
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Ulcer: Size,shape, edge, floor, base, surrounding tissue, lymph node, vessels.
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Terminology: Fistula: tunnel connecting 2 epithelial surfaces. Sinus: blind tract open on skin or mucosa. Lymphangitis: inflammation of lymph vessels shows red line leading to lymph node.
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Phlebitis: inflamed vein. Cellulitis: inflammation of tissue ( skin & subcutaneous tissue). Inflammation: redness, swelling, tender, hot, loss of function. Crepitus: bone #, joint arthritis Translucency: clear fluid collection. Fluctuation: presence of fluid.(2directions)
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