SECTION 1: EXAMINATION IN GENERAL SURGERY

Transcription

1 Contents SECTION 1: EXAMINATION IN GENERAL SURGERY 1. Introduction on Clinical Examination... 1 Clinical methods 1 Symptoms and signs 2 History taking 3 Chief complaints 5 History of present illness 5 Past history 5 Personal history 6 Family history and genetic history 8 Other relevant history 8 Assessment of specific symptoms and signs 8 Physical examination 15 Examination of skin and mucous membrane 22 Examination of nails 26 Skin changes and eruptions 29 Texture of the skin 33 Pigmented lesions in the skin 33 Hair 33 Edema 35 Visible veins 36 Examination of pulse 39 Blood pressure (BP) 40 Respiration 42 Eyes 42 Nose 44 Ears 45 Fever/rise in temperature 45 Tongue 47 Crepitus 48 Local examination 49 Systemic examination 50 Final diagnosis 50 Levels of evidences 51

2 xx SRB S CLINICAL METHODS IN SURGERY Ecog performance status (eastern cooperative oncology group) 52 Karnofsky performance status (KPS) Investigations Introduction 53 Types of investigation 54 Cellular study 54 Biopsy 55 Endoscopic examination 57 X-ray and imaging 57 Examination by exploration 64 Preanesthetic assessment (check up for fitness for surgery) 64 Examination of feces 67 Examination of urine Examination of an Ulcer Definition 70 Parts of an ulcer 70 Life history of an ulcer 71 Causes of ulcer becoming chronic in the skin 73 History 74 General examination 76 Local examination of an ulcer Examination of a Swelling/Lump History 98 General examination 102 Local examination 102 Relevant systemic examination 119 Proper clinical diagnosis 120 Relevant investigations 120 Differential diagnosis Examination of Sinus and Fistula History 154 General examination 155 Local examination 155 Investigations 157 Classification of sinus 158 Classification of fistula 158 Sequestrum 159 Median mental sinus 159 Actinomycosis 160 Madura foot (mycetoma pedis) Examination in Arterial Diseases History 162 Chief complaints 162 General examination 166 Local examination 166 Systemic examination 177

3 CONTENTS xxi Intermittent claudication 177 Rest pain 179 Limb ischemia 179 Investigations for arterial diseases 181 Diseases of the arteries Examination in Venous Diseases History 198 General examination 200 Local examination 200 Investigations for varicose veins 211 Surgical anatomy of lower limb veins 214 Venous pathology Examination of Lymphatic System Surgical anatomy 222 Chief complaints 226 General examination 227 Local examination 228 Investigations 235 Pathology of lymphatic systems Examination of Peripheral Nervous System History 247 Examination 248 Local examination 248 Relevant investigations 256 Peripheral nerve injuries 257 Brachial plexus injury 258 Median nerve injury 259 Ulnar nerve injury 261 Radial nerve lesions 262 Common peroneal nerve 263 Medial popliteal nerve 264 Axillary nerve injury 264 Long thoracic nerve injury (nerve of bell) 265 Accessory nerve injury 265 Hypoglossal nerve injury Examination in Diseases of Muscles, Tendons and Fasciae History 268 General examination 268 Local examination (look/feel/measure/move) Examination of Oral Cavity History 274 General examination 276 Local examination 276 Examination of cervical lymph nodes 290 Systemic examination 290 Investigations 291

4 xxii SRB S CLINICAL METHODS IN SURGERY 12. Examination of Jaw History 304 General examination 304 Local examination of jaw 304 Investigations for jaw disease 307 Maxillary tumors 308 Jaw tumors 309 Diseases of the palate 314 Maxillofacial injuries Examination of Salivary Gland History 318 General examination 320 Local examination 320 Investigations for salivary diseases 329 Salivary neoplasms Examination of Neck History 340 General examination 341 Local examination 341 Systemic examination 351 Investigations 352 Classification of neck swellings Examinations of Pharynx, Larynx, Nasal Cavities and Paranasal Sinuses Examination of pharynx 364 Examination of larynx 366 Examination of nasal cavities and paranasal air sinuses Examination of Thyroid General examination 375 Local examination 380 Systemic examination Examination of Breast History 406 General examination 408 Local examination of breasts 408 Investigations in carcinoma breast/breast lump 424 Differential diagnosis Examination of Hernia History 443 General examination 445 Local examination 445 Investigations 452 Hernia 452 Groin hernia 453 Parts of inguinal hernia 453

5 CONTENTS xxiii Boundaries and anatomy of the inguinal canal 453 Newer anatomical considerations 454 Clinical classification of hernia 455 Newer classifications of groin hernias 456 Types of indirect inguinal hernia 456 Direct hernia 457 Differences between indirect inguinal and direct inguinal hernias 458 Differential diagnoses for groin swelling 459 Recurrent hernia 460 Incisional hernia 460 Epigastric hernia 462 Paraumbilical hernia 462 Umbilical hernia 462 Ventral hernia 462 Richter s hernia 463 Sliding hernia 463 Pantaloon hernia 463 Strangulated hernia 463 Femoral hernia Examination of Inguinoscrotal and Scrotal Swelling History 469 General examination 471 Local examination 471 Investigations Examination of Male External Genitalia History 491 General examination 492 Local examination 492 Disorders of penis 495 SECTION 2: EXAMINATION IN ABDOMINAL AND RELATED CONDITIONS 21. Examinations in Chronic Abdominal Conditions History 501 General examination 506 Local examination 506 Systemic examinations 517 Investigations Examination of Mass Abdomen History 530 General examination 531 Local abdominal examination 531 Differential diagnosis 543 Diseases of the umbilicus and abdominal wall 560

6 xxiv SRB S CLINICAL METHODS IN SURGERY 23. Examination in Rectal and Vaginal Problems History 564 Examination of the anorectum 566 Vaginal examination Examination of Acute Abdomen History 585 General examination 588 Local examination of abdomen 589 Systemic examination 593 Investigations 594 Acute appendicitis 595 Acute cholecystitis 596 Acute pancreatitis 597 Acute peritonitis 598 Subphrenic spaces and subphrenic abscess 599 Amebic liver abscess 600 Perforated duodenal ulcer 601 Perforation of typhoid ulcer 602 Meckel s diverticulum 602 Intestinal obstruction 603 Adhesions and bands 604 Acute intussusception 605 Volvulus 605 Bolus obstruction 606 Acute salpingitis 606 Acute nonspecific mesenteric lymphadenitis 606 Ruptured ectopic gestation 607 Ruptured aortic aneurysm 607 Munchausen s syndrome 607 History Examination in Dysphagia General examination 609 Dysphagia 610 Foreign body in the esophagus 613 Gastroesophageal reflux disease (gord gerd) 613 Barrett s esophagus 613 Barrett s ulcer 614 Hiatus hernia 614 Boerhaave s syndrome 614 Mallory weiss syndrome 614 Tracheoesophageal fistula (TEF) 614 Achalasia cardia 615 Corrosive stricture of Esophagus 615 Plummer vinson syndrome (paterson kelly syndrome) 616 Reflux esophagitis 616 Schatzki rings 616 Carcinoma of esophagus 616

7 CONTENTS xxv SECTION 3: EXAMINATION IN SPECIALIZED AREAS 26. Examination in Urinary Diseases Hematuria 619 Retention of urine 620 Increased urinary frequency 621 Definitions of various terms 621 History 622 General examination 625 Local examination 625 Systemic examination 628 Examination of urine 628 Plain x-ray kub (kidney, ureter bladder) 629 Ultrasound abdomen 630 Intravenous urogram (IVU) 630 Retrograde pyelography (RGP) 630 Antegrade pyelogram/urogram 631 Renal angiogram 631 Micturating cystourethrography (MCU) 632 Ascending urethrogram 632 Isotope renography 632 Cystoscopy 632 Urethroscopy 633 Ct scan 633 Horseshoe kidney 633 Polycystic kidney disease 634 Solitary renal cyst 634 Duplication of renal pelvis 634 Retrocaval ureter 634 Ureterocele 634 Perinephric abscess 635 Renal tuberculosis 635 Hydronephrosis (HN) 636 Pyonephrosis 637 Carbuncle of kidney (renal carbuncle) 637 Renal calculus 638 Ureteric calculi 639 Staghorn calculus 639 Wilms tumor (nephroblastoma) 639 Renal cell carcinoma (RCC) 640 Ectopia vesicae (exstrophy of the bladder) 641 Vesical calculus 642 Cystitis 642 Interstitial cystitis (hunner s ulcer, elusive ulcer) 643 Schistosoma hematobium (endemic hematuria, urinary bilharziasis) 643 Thimble or systolic bladder 644 Bladder tumors 644 Residual urine 645

8 xxvi SRB S CLINICAL METHODS IN SURGERY Malakoplakia 645 Acid phosphatase 646 Prostate specific antigen (PSA) 646 Benign prostatic hyperplasia (BPH) 646 Carcinoma prostate 647 Prostatitis 648 Stricture urethra 648 Posterior urethral valve 649 Urethral calculi 649 Urethritis 650 Urinary fistulas Examination in Hand Diseases History 651 Examination 651 Investigations 654 Hand infections 655 Hand injuries 659 Syndactyly Examination in Foot Diseases History 660 Examination 660 Investigations Examination of Face and Head Introduction 664 Cleft lip and cleft palate 665 Hydrocephalous 668 Meningocele 668 Preauricular sinus 668 Problems of face and head trauma 668 Problems with infective lesions of face and head 669 Benign swellings of the face and head 670 Malignant conditions of face and head 670 Examination of cranial nerves Examination of Chest Diseases History 673 General examination 673 Local examination 673 Investigations 674 Empyema thoracis 675 Mediastinal tumors 676 Shock lung (stiff lung) 677 Pulmonary embolism (pe) 677 Carcinoma of lung 677 Pancoast tumor 678 Pulmonary complications during postoperative period 678 Pericarditis 678 Cardiac tamponade 679

9 CONTENTS xxvii Diaphragmatic hernia 679 Chest wall tumors Examination in Intracranial Diseases History 681 General examination 681 Nervous system examination 681 Examination of cranial nerves 682 Investigations 684 Intracranial abscess 684 Subarachnoid hemorrhage 685 Intracranial aneurysms 685 Intracranial tumors 686 Pituitary tumors 687 Craniopharyngiomas 688 SECTION 4: EXAMINATION IN TRAUMA 32. Examination in Head Injuries History 689 Examination 689 Local examination 690 Investigations 691 Mechanism of head injury 691 Adelaid coma scale 693 Indications for admission 693 Complications of head injuries 693 Extradural hematoma 693 Subdural hematoma 694 Depressed skull fracture Examination in Chest Injuries History 696 Examination 696 Investigations 697 Chest injuries 697 Flail chest and stove in chest 698 Pneumothorax 699 Tension pneumothorax 699 Hemothorax 699 Triage Examination in Abdominal Injuries General examination 701 Investigations 702 Liver injury 703 Splenic injury (rupture spleen) 703 Injuries to kidney 704 Pancreatic trauma 705

10 xxviii SRB S CLINICAL METHODS IN SURGERY Rupture bladder 705 Urethral injury 706 Abdominal compartment syndrome 707 SECTION 5: CLINICAL METHODS IN ORTHOPEDICS 35. Examinations of Bone and Joint Injuries History 709 Examination 710 Investigations 712 Fracture 713 Dislocation Examinations in Injuries of Various Joints Examination in injuries around shoulder joint and arm 716 Examination in injuries of elbow joint and forearm 720 Examination in injuries of wrist and hand 723 Examination in injuries to pelvis 726 Examination in injuries of hip and thigh 729 Examination in injuries of knee joint and leg bones 733 Examination in injuries of ankle joint and foot Examinations in Bone Diseases History 742 Examination 743 Investigations Examination of Pathological Joint History 753 Examination 754 Investigation Examinations in Pathologies of Individual Joints Examination of pathological shoulder joint 759 Examination of pathological elbow joint 763 Examination of pathological wrist and joints of hand 765 Examination of pathological hip joint 767 Examination in pathological knee joint 774 Examination of pathological ankle joint and foot Examinations in Spine Injuries and Diseases Spinal injuries 781 Fracture spine 783 Spinal cord injuries 784 Spinal diseases 785 Investigations 791 Examination of the back 795 Index...801