Clinical Medicine: General Surgery Complete Notes

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SURGERY
MODULE 1 SURGERY 1
It has three units:
1. General introduction to surgery
2. Soft tissue injuries
3. Chest conditions
UNIT 1.
Definition. A branch of medicine which treats diseases, deformities and injuries by manual or operative procedures
INTRODUCTION
The management of surgical problems includes the following;
- Application of technical skills
- Training in the basic sciences to the problems of diagnosis and treatment and
- Genuine sympathy and love for the patient.
The surgeon must be a doctor in the old fashioned sense, that is,
- An applied scientist
- An engineer
- An artist and
- A minister to his or her fellow human beings.

THE HISTORY
Introduction- At first contact, the surgeon must gain the pt’s confidence and give assurance that help is available and will be provided. He must demonstrate concern for the patient as a person who requires help and not just as a “case’ to be processed through the surgical ward. Most pts are eager to like and trust their doctors and respond gratefully to a sympathetic and understanding person. Generally what is needed is a conducive atmosphere for the patient.
A formal history must be structured. Do not ask leading questions because the cooperative pt gives the answer that seems to be wanted; and the interview concludes on a note of mutual satisfaction with the wrong answer thus developed.
Building a history; History is detective. Avoid preconceived ideas, snap judgments, and haste conclusions. First determine the facts and then search for essential clues. A pt may conceal the most important symptoms e.g passage of blood by the rectum hoping that if nothing is inquired about them nothing is serious. Special emphasis should be put on the more common surgical conditions. The symptoms include;
Pain –Analysis of the nature of pain is vital during hx taking.
- ascertain how the pain begun, was it explosive, rapid or gradual in onset?
- establish the character of the pain, whether so severe that it cannot be relieved by medications, is it constant or intermittent?
- Are there classic associations like rhythmic pattern of small bowel obstruction
- How does the pt react to the pain? Remember the overeater’s description of pain is usually inappropriate and is described as ‘excruciating’ in a casual or jovial manner.
Vomiting; -ask what the pt vomited
- How much
- How often
- What the vomitus looked like
- Was it projectile
- Is it necessary for the examiner to look at it?
Change in bowel habits; this is common and usually of no significance, however, a person who has always had a regular evacuation notices a distinct change particularly towards intermittent alterations of constipation and diarrhea, colon cancer is suspected. Emphasis is placed upon the size and shape of the stool.

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