~ Patron Date / / © i History “of Varicese Veins Sup vernous_syplers _ Seg TE threat saphenous meds Art hie) _wein. ull PostHbial vein ae Pepnecdvein— Femoral ss hd —— £ « Tttrece——$ — fan =o a unilaered eFfeed Common Tha persisdent ll E ee puto of heart = mone Flow! in vei ‘valves are 9 C72en} | \aluts = more in peritheral legs Ss IA middle keg and no in SVCeTVC eet vein = connec SUP: € deep Remeasys oni )ateral FJow Ee allow flow from sup: VeNos 5 Jen fo VENOSS Sty preraied he» more copac4 Reasan/ Cause -_ Thrombosis - Pat: immobile € calf compre yan hay 4 ho tagrontey -___ bbexit : es Frac 3p, gpa lokam preisure vse AN on = cari vein - Long” SToncNG gravity | effet * steqna agg" id eos JPS fs a result RBc’s breakdown Pp! nts release result I _Hjn. walls - Wore prone 4 leak — C2 = trepely dilated fovtous vein 19 tonitony of. qyecct < sho Ssaphenoys oilodaherg P > C3 - Leale phare — ping eens 2 cH Blood staces — Hermalysis ki _wajah se_jo pigment re)ene ts rhe haiy + pigmemahon lipo dermatoscleresls 4 CS SKIN thinin + Pg Or Flas Sie iv cis Scompressio7 of —sesse} supplying skin. 3 post vascular lead iq | Skin ischemic. ae? —Wiealeed—verousuleer __ then viter _ 4 cG - Achye Venous ulcer oozing )a Date \ ; © Patrongroup “Primary. sar varicose vein= Vasculay lox pathology _itelf Sec iad vanicase vein = Ave to lie clinic Hiriolegical cab Peatumnead Fathotegical History ee - eit long a WS Pain is no ; : SO, prolet a aires Pare usith a Dis fiqurrren| — PC Tf cAhnued For years _ Phen gl te \ 7 e > Re itendion sclerosis _ 2 Ulceration. re atc in Cocket above med.malels —_ Sapheno pepl ee sap! heno below Bsid above condyle ; hunter eo Bi Ewop val valves mo. bez Peer E xaminahon | _ Tornigue test AY points b ~ Elevak dpnios Hhej_enrphy vei _| Date : eC Patrongroup 401g quel while the leg is taised_ ) at tes b J _in- compl ine which valve comp tert By iat ‘Baring tank pal to Stand. Vodle isa fill ho rhe Na hai acess: feet 1 wale Walvein-- —ithrge wmplent aie os fen oe nigae s2 ace. Risa _dilak — pa eh one v palve a hand on dilahon ask patient aes cough felaHunship of DVT with varicose Veineee” SS—S”—S—“ Dull hojayeqvment . asses Surg erg Trip}es istoy In examinckiss Patrongroup pete Radivlogic Nergound % “History of breast lump Duration Wher you noticed t+ first Triple assesment > (tic & examinaho 4 Radic tcad Ultrasound & Mamegraphy > Histo ne __Prugression eo te —Kedvable ae _ Pain - Dischorqe Colour, Ebseta | Fine the > blsatl Fe __Ang other” er site ke emp? khitha Famil a ni ly hi __matinal si side hi at aoa ‘= lay —___examinatian Exposure — Examine normal breast first _ but if mn mentien then only examine lum p —tospechiga ——__ Symmetry (Lontaw- Pendutcity ) J isting the hans TT meer bc “Asses the patienr by ark her_ tiny pate ©OPatrongroup 4 Nipple areola comp kx (waaseerg» Pischarge , Retraction 5 eee | 2 _Infremamory Arca, uv ft up the bread _€ examine the ave, yw see (Mechor> redness wound etc. 2 overtying skin of +vtal breast Any a" Visible veins, redress. — rehness, ulkcratons § wound __ Palpathion : ~ Sta ae Stiri SGC a sh eqin from ea Qval ran} feb the _lemp “holel 1+ ot measure the size of | lump en the_ quadrant Be Shai _tunsisieneg + 5 Surface » Hob tthy _, Fixahoo fae — Pxila Ty amice Pee ; Put Pub—patients afm on your ow) = Hobetad orn —t € ank the potent am % locate ant-> post, je ae = Rpicad with the hand of same side Locate jeter) lymphnode with the opposite hond —Suplaclovjculay Fossa 7 : ee am Ask hey i cit Shrug. q examine the arte~ —> Bate in, — Ask saat headache = Paspate verebr e neste chest pehind then cume OpPatrongroup “Mal non 4 4 ‘haga spread fs bone 5 ver vin font S tpe causeultue fro Font _Dpclomen , examing Heo 4 1s Check liver Concert & accle)__ — > urgery Date / / ©atrongroup Sei 8 ee —ppenue dette How We de it Wren we shovid not do ty = ext ; mae t s Rule out kena hal if pahent prover} with BPR — Colonorectal carcinoma, = Haemorthoids - Colits = Fissure = Anagiodysplaria ag sui CH prostate - fistula XY _ Hist i In fissure no pinteseapy, - Fissure pahenk Prienawy complain constipahon Lui a pain Befure_evacuahun of Stud! Blood pas B)ood Will came in a tyne —Hecnentialds! Petar ceone Take P_periectt bleed Fist stool then blood will pass Bleed will Come jn drops blagel haces 1eS ‘Left _lalera_pasition _sdack night i Proper_deteuiled his of patent Gha pe~mon = wv Bales opart = #kIn Nash fur distostion Fissure 6Oclock IMOplock —Awti-be-_painfl — —___doan't jnsey} frnger ins; de— > Lubricate perineal ares, put fing er — on anus Ge push your _& ; inside 4 “4 q on ants side can paljpa le posta in mele { Examine tne finger Blood feces BR eS Mincscpee a obturator 3 . Sleeve is Sbturatur shad oq smug afy fit Basal ralyaeee B —Hold —ebhurcrty hand with henel — : —Lubricate He _pystoxope 5 —_ 2 ea ‘ Co inside. i Wiehe: iacside Yen ke ot by =pete i : CpPrtronsregs so Ritadh \ rgd ~€ exaineinside ; @ atta. fai uae take | , ae ~whtle_ Seeing —___"_ —Centerof ena canet should _ eo a ; — conke of ee eee ea Place ¢b —tanery.. ot wnat h eae Pod Bie k Poa ant exer check brlen; hax Ast deqree Only Aeegiag fet eee ~ Sane + “psredle wibtnhe Stop aH aie — epson pete 7 Tees “Clea - ee ee, § oom P: Date © Patrongroup ai History of inquinad scrotal hernia. iv Biodola e Be Name _ ae — (oe Résiden E F MoA, Boh | Presenting Complaint Er ec HOPL . 2 > Constipation bs ae . all St Duration not ‘site i | = Size : 3 = Reducible / Iryeduc ble |i Bilakrad /Uni lateral | =e Aga ie vah fieete cough ¢ paatendrs - ee vi tying on bed = b ; eee Tictpcingsl f > Mae a ¢ Side Ons® ChotackY Radiation il Eee Fee boy eNom TY * ar 7? Weakness in ahd. wall & abd Contesr © a oe it Date / i Nam a Nye 349 yCors Te Tadivect — Enguinah | pee ePrice roa ate ; argc (Scro tod swe Ling) - , Gypsic Pi SES MEY cariea.. Of Cord me biedenop hy. of ingeine yop in mphoma» £U Dette) : | = Sophenavanx | (s-_ Testicular mabignany as Xxroted sescliey | J Examinahon i — Exposure Frm “umbilicus to mid th qh = Position Standing of pat while examination CE ELE A DL | | | J Tospection ’ e oak Shape, Skil Ue sk pohent to Cou Cag) r Compare with other ch ie see & Hernicd hernia) ani fices ured & femora wing chong codgh % cons Bpa NV (cee ernicn VIC al gn Congenited bho skta hai, Abd +Date / ” _OPatronsroup —faipahon : stat if while _pabent is et aati aa ee And axle hi a iP tetes is separa tel « alee or not - IN-> co! im ulse wee olou a and yedyco tt eo ee 2D z = ask te aie fei ¥ Ge ai c. of rr a - Mahe" Cae He should be dpwn) = Ring occlusion Test m2) Pabpate superticial inGruinal ving wand ask patrent Cogf, cpain - eee a ret : Lon blocking supeytinal F tnFrunal vi ving vith Fragen E = x may auscultate pe ; - uU0]N __ fh eee z Direc] uw? poe from abdonim walle don’! divecto> P te, a Ca6 f bay Ff © Patrongroup Date Z / ed ret EH ENT to pneite —_ Reducible ov Rott ie pe — bivect or Indirect _ © Inguinal or Inguinal sevetal a v] Visit OF _ > day hernig permet in which doo didturt shape of _umblias is_epigertrc hernia = omentee > = Paraumbilical > crcale deformity et ony ide of umblicus sup-,tnF, lat = Spigarian hernia ;— = Thasionol hemia chs Previous suf icad 907 kK thr bn jye se tehe_ hain il = Tf ingsinal hernia ki Sieger Best FaeeVGIICMEOSE UEC HT ~ main _hemia bn\ge 2a How 4 Psent Mass ; farts of hernia : A Fundus 1 neck a body ; fernitonead Ubi 4 y N&e Ghrowhich ten Ri) > Tight 7}, tonal hacia _ Tv eel Merrie Wec4 Merrie ATOR Umbh cedhermianDate t ¥ Surg a eC Patrongroup wer 9 ‘ q - site Where ‘is winen it Star v Seven't v Charac v onset Radiat va a Ts thi “Redominal pats ain __Locertion”” ed 2 “purahon How bad FIs. ain “Si ° sk palt.._ Nhat Sper ay Haus | 4 Starktd ? Bur ni [Non- radiating ka m4 factor x Geleavang, Fac — re symptory = Pain Fst hme ov ho this pain rage befure Pahent’s thought/ serge _ Dpatronszour roup Date 2 ~ Presers| ae vistt 7 __ ump € BumP Tyredvei ble ee aa “ Reducible — Al preentin oPD lump Treaycinated_ Adhesions « Phere sCan™t weduce 1 76S ED — obshyckd When lumenis occluded - Strang vied Bat a a ao aes —& Vaso ni < also 0 impale ~ Tschemic changer _oCevy “T+ ras 5_susgicad he aera —4es his cus pigitian herria. —sagasap infioration —tenden, edness , WT 1erp jPain, be Loss of function = Ten & iyredudble hemic Shoutd ced. mic should he tealed Irg’ Fern Tae fersislect absorrh abdyrnine! vein tenet below ene : wilicas , Gemacross band | las} ee spiqnian = a Ye Semilunan's | ine nt te fora | 4 Fechsakd join te Ex Bae ansaidOued SS Date ae OPatrongrouy . lite Thavinal hernia 1995 @ Symptons Fesernhy fe: ical hernics Mare commen in feral & ‘an 7 - Fernorall hernie HESS Teredecthle ber neck shove tratrsion of cxhepenturcall fey ee _ S8mmon_io_ fermoles ; | faints swedbiry iz | No pulse 0 ; Paydal sVangulah un —Riters emia exni def. Enukle bs Ath hax _Apnorme) _prebusion of | ViscosK OY pat Ang wall “along cu of Viscous with ib coven) Athieles— Inquinal hemia : Went lifters é Fost balers Fan vermic. Sa, neck , feric dy © one? (on iteDate / / — sae - or epleeg Biisd ees) = In _hemorthoge pulse hiti - = Tachy cardia _usi l occur aa ats Radial Pulse -Fech at héad of radius ‘ ___Sermi_prone_,sxami flexed posifion - Brachial py se - Carohd Feel with thumb Ef fe check par yt Side check af right side with “4humb of opposite hand at an}. ber _ Femored = In Midline p(w iliac spine © pubic Aberhe - Psd Hbia) - below media) mallec ly - Pup liteol aaa Pop lite FU5Sa Rate ~ 7 Br __ Rela} candio = Rhy shen conhachony aftey requles A or _InPAulany Fg th en