Arriving at a Surgical Diagnosis

1043 Pages·2013·80.37 MB·English

by  Pramod Shrikrishna Bapat

Arriving at a
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Arriving at a
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Pramod Shrikrishna Bapat
a
consultant general Surgeon
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Shree Harneshwar cslinic
Talegaon (Dabhade), Pune, Maharashtra, india
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Formeerly
registrar
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rajawadi Hospital, Mumbai, Maharashtra, india
.lecturer
lokamanya Tpilak Municipal Medical college
and general Hospital, Mumbai, Maharashtra, india
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Professor of general Surgery
People’s colleg/e of Medical Sciences, Bhopal, Madhya Pradesh, india
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consultant general Surgeon
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pcolonial War Memorial Hospital, Suva, Fiji islands
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© 2013, Jaypee Brothers Medical Publishers
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All rights reserved. no ptart of this book may be reproduced in any form or by any means without the prior permission of the
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This book has been published in good faith that the contents provided by the author contained herein are original, and is
intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the
author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of
the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the
readers should consult with a specialist or contact the manufacturer of the drug or device.
Arriving at a Surgical Diagnosis
First Edition: 2013
iSBn 978-93-5025-810-1
Printed at
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Dedicated to
infinite patience of /
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my daughter Anuprita and wife Vaishali
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for tolerating me, always .
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Preface
‘clinical diagnosis is an art’—I DISAGREE. clinical diagnosis is a science. ‘Art’ is a faculty, which
can be mastered only by few having an inborn aptitude in a particular field of art. Clinical medicine
cannot afford to be an art! Every clinician must be a master with the greatest level of competence
in arriving at the clinical diagnosis; and the mastery will be achieved with a scientific approach.
What was the need for yet another book on ‘clinical surgery’? Well, most of the existing books
explain clinical methods, and then describe ‘differential diagnoses’. There is hardly any book which
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explains how to analyze clinical data systematically and arrive at a clinical driagnosis by using
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logical thinking in stepwise manner. operative surgery books describe procedures in stepwise
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manner. Why not have a clinical surgery book which explains the method osf arriving at the diagnosis
in the same manner? s
in the present era of technological advent, clinicians seem to be requesting a battery of
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investigations even in straightforward cases. Such a practice tends to blunt the thinking aptitude
very fast, and decay the clinical approach. unfortunately, junioar students in surgical training seem
to be adopting this approach from the beginning of their apiprenticeship. Hence, i thought of writing
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this book, which will guide them to make a clinical diagnosis with confidence, without having to
rely on too many unnecessary investigations. r
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The contents, including the steps in arriving at the diagnosis in each chapter, are generally
ordered in the same sequence unless special cpircumstances dictate otherwise. However, systems
and organs naturally possess a remarkable degree of individuality with respect to anatomy,
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physiology and pathology; and it follows pthat the techniques for history-taking and examining one
anatomical region / system may have to be varied when it comes to look at another. in spite of this
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fact, i have tried to derive a commovn sequence as best as possible.
i do not claim originality in all the facts presented in this book; most of these have been derived
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from various authentic books/ existing on the subject. However, some of the facts have been
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derived from the knowledge imparted to me by my teachers, and observations from my own clinical
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experience.
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I am conscious of deficiencies as a single author, but I hope that this fact has helped in maintaining
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coherence and chontinuity of the methods and subject. nevertheless, there is a possibility for
inadequacies and errors to have occurred. i invite the readers to share their critical reviews and
positive ideas for improvement of future editions of this book.
Pramod Shrikrishna Bapat
E-mail: [email protected]
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Layout of the Book
By and large, titles given to the chapters are none other than the chief complaints with which
patients present. This book focuses on history-taking in a readymade questionnaire format, and
systematic step-by-step analysis of the clinical data to arrive at the diagnosis. Each chapter on
individual problem is written in a standard format:
(a) Definition/s.
(b) general remarks.
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(c) History-taking. r
(d) Physical examination. i
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(e) Arriving at the diagnosis s
• Principles and pitfalls s
• Stepwise analysis of clinical data.
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(f) Differential diagnosis.
(g) residual problem, if any. a
clinical tests are described in a uniform format all throughoiut the book:
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(a) Title of the test.
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(b) Aim.
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(c) Principle.
(d) Precaution to be observed, if any, while perpforming the test.
(e) Prerequisite. .
(f) Procedure (clinical method). p
(g) observation and inference. i
(h) causes of false +ve and false –vve results.
(i) controversy, if any. /
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(j) Therapeutic application, if any.
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Justification of the diagnosis is discussed in ‘to-the-point’ form:
• Basic point. t
• Differentiating potints.
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• Supporting points.
in addition, variations in clinical presentation and important relevant short notes on various
conditions are also described.
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