General Surgery Flashcards
What should presenting complaint of a pt be made of?
Pt own words
No medical terms or diagnosis
As short as possible
What is hernia?
Protrusion of an organ or part of an organ through the wall that contains it
It is most common surgical situation
Can be emergency or not ( if in bowel-emergancy!)
How do you take history of a swelling?
Onset, course, duration
Painful or painless
Other lumps
Effects on general condition
Cause
Does the lump disappear
Onset of a lump? Important features
If gradual-benign
Rapid-inflammatory
Acute- bleeding into cyst of trauma
Accidental - most lumps. Doesn’t mean it is acute, it means it was only found by the PT at that time. Can be easily gradual onset
Incidental -means during the examination by the doctor
Accidental - found by the pt
Course of a lump
Regarding the size- is it increasing, decreasing, stationary
Progressive- benign, malignant, inflammatory
Regressive- resolving inflammation, unlikely to be a tumour
Duration of a lump/swelling
Malignancy is unlikely with long duration, probably would be benign
But, recent change in a size with long-standing swelling can indicate malignant change!
If lump is painful or painless?
Most lumps are painless
If painful- trauma, inflammatory, or late sign of malignancy (when tumour infiltrated local nerves or surrounding structures)
*Onset of pain in a previously painless lump could indicate onset of complications
Effect on general conditions?
Benign or early malignant lumps have no effect on general health
Inflammatory lumps do-sepsis, fever, malaise, night sweats
Malignant lumps - signs of metastasis: weight loss, loss of appetite
Over activity can be sign of increased thyroid gland activity- weight loss, sweating, palpitations
If lump disappear?
Definitely a hernia
Examination.of a lump
General examination (BP, temp…)
Local examination ( inspection-size site, shape, surface, overlying skin, palpation, percussion, auscultation)
Why are thyroglossal cysts removed?
Can get infected
1%chance to become malignant
Aesthetic reasons
What to look at in palpation on examination?
Tenderness ( check if painful before touching)
Skin temperature- if worm( increased vascularity -inflammation)
Size
Surface
Edge-ill or well defined
Consistently -cystic (containing fluid, need to be positive in 2perpendicular directions)or solid (soft, firm, hard, indurated)
Relation to surrounding structures
Draining lymph nodes
Special signs
Relation of a lump to the surrounding structures?
Fixed- lump and skin move together -malignant
Tethered-lump can move within the range
Lump separated from the overlying skin
Relation to the muscle
Superficial to the muscle-becomes more prominent when muscle contracts
Deep into the muscle- not felt on muscle contraction, it is more significant due to lymph nodes
Inside the muscle - less prominent and fixed
Illeostomy vs colostomy
Illeostomy is when small bowel is attached to the skin, needs to be changed 3-4 a day and it is raised from the skin
Colostomy is large bowel connected to the skin, needs to be emptied once a day, more flat.on the skin
Nasogastric tube
Ng tube is used when there is decompression of stomach and small bowel
It is used to prevent vomiting and aspiration
