1
6
th
stage
Surgery
lec.1
د.عبدالكريم
Session notes
General Examination:
Includes the following points (mental state +position of pt + JACCOL)
1-Mental state
2-position of pt
3-JACCOL
: J : jaundice: site where can be seen:- sclera
Points consider in checking it :
1-ask pt to gaze downward
2-daylight
3- ------
Types of jaundice ((according to site (prehepatic-hepatic-post-hepatic))
Anemia :sites where it can be seen in:
1-conjuctiva
2-lip mucosa
3-palm
4-soft palate
Clubbing:-
how to check it
-common causes of it
-Clubbing, particularly the congenital variety, may also involve
the feet .
Common causes of clubbing are carcinoma and purulent conditions of the
lung
(bronchiectasis , lung abscess, empyema), congenital heart disease and
infective
Endocarditis . Less common conditions are pulmonary fibrosis,
fibrosing alveolitis, pulmonary tuberculosis, pleural mesothelioma, cystic
fibrosis, coeliac and
2
inflammatory bowel disease, cirrhosis , malabsorption, thyrotoxicosis and
bronchial
arteriovenous malformations
Beau’s lines-stressful conditions such as fever, measles, pneumonia, DM.
etc.
Cyanosis:
types :central& peripheral
Edema: types :
1- pitting(causes of it ):HF -RF-LF-Nephrotic syndrome
2-Non-pitting:
Causes; -lymphatic obstruction: also has causes:
a-as sign & post.op
complication of tumor(in upper limb*breast ca*-----in lower limb *pelvic
mass*)
B-elephantiasis
*normal mass=gravid uterus
LN for LAP
Vital signs :
1-pulse
2-blood pressure
3-respiration :male :
thoracic-abdominal
Female: Abdominal-thoracic
pregnancy so abdominal first
4-Tempreture:
Abdominal examination
1-how to divide abdominal region
*what is the difference b/w mid inguinal point & mid
inguinal ligament point
3
-mid inguinal ligament point lie b/t Sup. Ant. Iliac spine
&pubic tubercle & used for determination of Inguinal
ring
While mid inguinal point b/t AIS& pubic symphysis
used for femoral artery landmark
Ex General
1-general look (ABOPE)
Middle age man ,has average building ,oriented to the time &place
&person ,in supine position, he looks
sad, uncomfortable.
2-general sign(JACCOL)
3-Examination of head , neck , hand & foot.
A-head:1-skin 2-hair 3-orifices
B-neck: 1-thyroid 2-neck veins 3-any mass
C-hand & foot : skin &nail &muscle & edema
4-vital signs :pulse
Temp.
Respiratory rate
Blood pressure
Abdominal Ex.
*inspection :
1-From the foot of the bed((symmetry &shape)} the pt abdomen looks
symmetrical ,scaphoid shaped,
Moving w/t respiration ,there is visible pulse.
No dilated vein, no scar, umbilicus located in
Centre, inverted, no discharge ,I should ask pt to
cough
2-kneeling from side of the bed
Movements; move with respiration
Visible pulsation
Visible peristalsis
3-from the side of the bed looks for any
4
A-Skin;;dilated vein
Scar
Umbilicus
* Palpation
a. Superficial and deep
b. palpation for tenderness or masses
c. palpation for organomegaly ( for any organomegaly look for
span, edge , surface , consistency)
Percussion
Tympanic (Normal)
Dull(fluid , Mass)
Auscultation
For aortic bruit
For renal artery bruit
For bowel sound
Then
Inspect the abdomen from behind and do renal angle
tenderness
then
Examine
1. The genitalia
2. Supra claviclar lymph node(Virchow’s node-troisier sign )
3. Do PR examination
4. do succession splash) A characteristic sloshing sound
(succession splash) over the stomach may be heard with sudden movement
of the patient seen in
`acute gastric dilatation)