Professional Documents
Culture Documents
Medicine Practical
Medicine Practical
Chişinău 2012
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Intoduction
The prezent note are destinated for students of stomatology faculty and content the
main practical skills that is necesary to be known by a future doctor in his own
practical work, not just a dentist but as a general doctor. The doctor, in general,
must to have knwledge not only from it future occupation but also from another
fields of medical activities.
The more important things it is the practical implimentation of the knowledge that
students have accumulated during their practoical clasis and lessons. We hope that
prezent practical note will be usefill not only for passing the practical part of the
exam in surgical desease but also in his future work in general.
The publication content the illustration informations about main surgical sign and
symptoms in emergency surgical and same planic surgical desease. The publication
writing according with surgical analitic programme for students of stomatological
faculty.
GOOD LUCK!!!
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ACUTE APPENDICITIS
1. Delafoua triade - cutaneous hyperesthesia often overlies the region of
maximal tenderness and pain. (figure N. 1 and 2.)
Figure N. 1
Figure N. 2.
2.The Rovsing’s sign Continuous deep palpation starting from the left iliac fossa
upwards (anti clockwise along the colon) may cause pain in the right iliac fossa, by
pushing bowel contents towards the ileocaecal valve and thus increasing pressure
around the appendix. (Figures N. 3 and N. 4.)
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Figure N. 3.
Figure N. 4.
Figure Nr. 5
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Figure Nr. 6.
4. Obturator sign or Coupe 2 sign. With the patient supine, passive internally
rotation of the flexed right hip causes hypogastric pain. (mean the pelvic position
of the inflanated appendix). (Figures Nr. 7 and Nr.8.)
Figure Nr. 7.
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Figures Nr. 8.
5. Kocher (Kosher)’s sign. The classic history - The appearance of pain in the
epigastric region and migrating or subsequent shift to the right iliac region occurs in
only 50 percent of patients. Figures Nr. 9. and Nr. 10)
6. Sitkovskiy’s sign Increased pain in the right iliac region as patient lies on his/her
left side. (Figures Nr. 11.)
Figures Nr. 11.)
8.Voscresenshi’s sign —increased pain in the right ileac area during the slipering
with the hand on the shirt. (Figures Nr. 13.)
ACUTE PANCREATITIS
9 Grey Turner's sign. - flanks ecchymoses (indicative of hemorrhagic
pancreatitis.) (Figure Nr. 14.)
12.Meio – Robson sign – the pain in the left costo-vertebral ungle. (Figure Nr.
17.)
ACUTE CHOLECYSTITIS
14. Murphy's sign - consisting of inspiratory arrest and pain during deep palpation
of the right upper quadrant. (Figure Nr. 20.)
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Figure Nr.20.
15.Ortner's sign - tenderness when hand taps the edge of right costal arch.
(Figure Nr.21.)
16. Georgievskiy-Myussi's sign (phrenic nerve sign) - pain when press between
edges of sternocleidomastoid muscle. (Figure Nr.22.)
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Figure Nr. 22.
17. Kher symptom - increasing of the pain during deep breath and palpation of the
anterior abdominal wall. (Figure Nr. 23.)
19. Determination of the X- ray sign of choledocholithiasis. (Figures Nr. 24; 25;
26. 27.)
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Figure Nr. 24. RCPG
Stone in the enlarge choledochus.
PERITONITIS
20. Diffuse abdominal rigidity ("washboard abdomen") is often present,
especially in generalized peritonitis
21. Blumberg sign - deep palpation of the viscera over the suspected inflamed
organs followed by sudden release of the pressure causes the severe pain in the
abdomen.
22. Mondor sign – absens of the intestinal peristaltic during auscultation.
Auscultation reveals a silent abdomen or minimal peristalsis.
INTESTINAL OBSTRUCTION
Figure Nr. 28. Irigoscopic investigation of the colon, contrast mass inserted inside
PERFORATED ULCER
30. Delafoua sign - a perforated peptic ulcer usually present with a sudden onset of
severe, sharp, intense and steady epigastrical pain, like knife heat.
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31. Eleken sign – the pain irradiated toward clavicula.
32. Mondore triade – ulcer history, the epigastrical pain that beginning like knife
heat , muscule tenderness.
33. The Klark sign – the ,,absens,, of the liver tisuie during percution.( Figure Nr.
31.)
Figure Nr. 31
34.Mandel sign – the increasing of the abdominal pan during perecution in the
proiection of the perforation.
35. Shlange sign – sign of abdominal silent, the absens of the intestinal peristaltic
36.Kulenkamf sign – the presens of painfull pelvic swelling during rectal
examination.
37. X-RAYS EXAM. Look for a thin linear gas shadow between his diaphragm
and his liver or stomach. (Figure Nr. 32.) If he cannot sit or stand, take a lateral
decubitus film and look for air under his anterior abdominal wall.CAUTION ! (1)
An ulcer can perforate almost silently in the very old, or in the course of another
disease. (2) The absence of gas does not exclude the presence of a perforated ulcer.
(Figure Nr. 33.)(3) Gas can also come from a ruptured diverticulum or an
appendix (uncommon).
Figure Nr. 32. Linear gas shadow between diaphragma and liver
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Figure Nr. 33. Petresu test is negative, after the insertion of the air inside the
stomach, the aer don,t pass into peritoneal cavity
Acute hemorrhage
39. The using of the puls, arterial blood presure, Hb, Ht, RBC levels in the
determination of the peptic ulcer bleeding degree.
Figure Nr.45.
Umbilical hernia, umbilical ring palpation.
Figure Nr.46.
Right inghinal hernia. Palpation of the right external inghinal ring.
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Figure Nr.47.
Ventral hernia, general view.
Figure Nr.50.
Determination of the puls in the proection of the arteria dorsalis pedis
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Figure Nr.51.
Determination of the puls in the proection of the arteria tibialis posterior
Figure Nr.52.
Determination of the puls in the proection of the arteria poplitea
48. Arterial function test (Opel sign of plantar ischemia, finger compres sign,
Pancenco sign).
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Figure Nr.52.
Opel sign the paleness of the leg in the high position of the foot.
]
49. Disorder of the venosis system
Figure Nr.53.
Varicouses deases of the right inferior extremity, general veiw
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Figure Nr.54.
The retrograde -feeling test described by Trendelenburg The patient in the supine
position, the leg to be examined is elevated 30 to 45 ° to ensure maximal
venous emptying. An elastic tourniquet is adjusted around the thigh just below the
inguinal area
Figure Nr.55.
If after the tourniquet was removed the vein become rapidly full with blood that
remark the failure of the ostial valve.
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Perthe’s first test
Perthe’s first test has been used to assess deep venous patency. Superficial
varicose are compressed by tourniqet in the upper 1/3 of the thigh. Upon exercise,
the development of increasingly severe crampy leg pain suggests a deep venous
obstruction.(figures Nr.56, 57)
Figure Nr.56.
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Figure Nr.57.
The Prate test (Figures Nr. 58, 59. 60. 61, 62)
Figure Nr.58.
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Figure Nr.59.
Figure Nr.60.
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Figure Nr.61.
Figure Nr.62.
Figure Nr.63.
Stelvage sign – rare blink, or wolf look