Sriram Bhat M MS (General Surgery)
Additional Professor, Department of Surgery Kasturba Medical College, Mangalore (Karnataka)
and
Honorary Surgeon Government District Wenlock Hospital
Mangalore, Dakshina Kannada, India
Jitendar P Vij
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SRB's Clinical Methods in Surgery
© 2010, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2010
9788184489255
Typeset at JPBMP typesetting unit
Printed at
5Dedicated to
College where I had my undergraduation, postgraduation and surgical professional career till date, i.e.
KASTURBA MEDICAL COLLEGE AND DISTRICT WENLOCK HOSPITAL MANGALORE, KARNATAKA, INDIA
6Foreword
Dr Sriram Bhat, Additional Professor of Surgery, KMC, Mangalore is a very popular teacher and I have known him for more than three decades. He has always been interested in teaching and his emphasis was on the fundamentals of good clinical examination. At a time when imaging and other methods of investigations are becoming popular than methodical and a well-executed clinical examination, a well-written book SRB's Clinical Methods in Surgery is most welcome. Dr Bhat has tried to emphasize a very systemic examination so that one could arrive at a working diagnosis at the end of a good history and physical examination. The value of this book has been enhanced by a very large number of highly illustrative pictorial descriptions. Unfortunately, the number and the variety of patients in many teaching hospitals across the country are unfavourable as far as undergraduates and postgraduates are concerned. I am sure this book will find a place in the armamentarium of all the students.
Dr Bhat is already the author of a popular textbook SRB's Manual of Surgery. I have no hesitation to believe that this book SRB's Clinical Methods in Surgery will be equally popular. Dr Bhat needs to write a book on operative surgery to complete that trilogy needed for medical students.
Dr CR Ballal
Professor Emeritus
Mangalore
7Preface
It was my long time dream to bring out a good surgical clinical book for undergraduates, postgraduates and practicing surgeons. Even though I have written surgical manual for students of MBBS, Dental and Nursing category, I had an aspiration to write an adequate sufficient clinical book which can cover all category of students who need to learn clinical surgery properly. I have covered every aspect of clinical surgery with good illustrations in all chapters. This contains methods of basic clinical surgery for medical students. Clinical approaches, clinical analysis and clinical diagnosis with differential diagnosis are discussed in each chapter. However, therapeutic aspects, controversies and recent advances are not a part of this book. Students who want to learn in detail in these aspects are requested to refer to my textbook SRB's Manual of Surgery, 3rd edition or any other surgical books of their choice. I have taken enough care to discuss different clinical methods and signs. I have also referred standard clinical books and surgery books prior to writing this book. Many methods and signs which are old are well accepted but still many methods are controversial. But whatever given in this are commonly followed one; individual opinions and controversies not highlighted here.
I hope this book will be useful for all those who are keen to learn clinical surgery.
I sincerely appreciate everyone who has helped me. I thank Jaypee Brothers Medical Publishers, New Delhi for their support to bring out this book.
Any constructive criticisms are most welcome.
Sriram Bhat M
8Acknowledgements
I am happy to bring out first edition of Clinical Methods in Surgery. This is due to constant help and support of many.
I thank our Chancellor, Dr Ramdas M Pai; Pro-Chancellor, Dr HS Ballal; Vice-Chancellor of MAHE, Dr Professor Rajashekaran, Warrior; our beloved Dean, Professor (Major General Retd) Rajagopal MCh; our Vice-Deans, Professor Venkatraya Prabhu and Professor Urmila Kadilkar for their academic support.
I thank my beloved teacher, a great clinician and senior surgeon Dr Professor CR Ballal, Mangalore for accepting to give Foreword to this clinical book. I owe a lot to him.
I thank the Head of Department of Surgery, KMC, Mangalore, and Professor Thangam Varghese for her constant encouragement in academic work and progress.
I always remember my senior teachers, Professor CR Ballal and Professor Suresh Kamath for their constant help.
Our senior faculty in the department, Dr Professor K Prakash Rao who is a guide and encourager to everybody will be remembered as a special person by me always.
Surgical unit heads in our college Dr BM Nayak, Dr Anand Kni MCh, Dr Jayaram Shenoy, Dr Jayaprakash Rao, Dr Harish Rao, Dr Ramachandra Pai, Dr Alfred Augustine and Dr Shivananda Prabhu are always supportive for my work and are worth to be remembered always.
I am grateful to all my teachers and colleagues in surgery department who directly or indirectly helped me to bring out this book.
I appreciate District Medical Officer and Resident Medical Officer of Government Wenlock Hospital, Mangalore for their kind help.
I sincerely thank Professor Navinchandra Shetty, Head of Radiology Department, KMC, Mangalore and also other faculty of the department for their help in providing and guiding me in X-rays, CT scans and imaging methods.
I acknowledge Dr Professor Kishore Chandra Prasad, Head of Department of ENT for his help, guidance and encouragement in bringing out this book.
I thank Dr Shivaprasad Rai; Dr Yogish Kumar; Dr Ramesh; Dr Ashfaque Mohammed; Dr Kalpana Sridhar; Dr K Akbar; Dr Keshava Prasad; Dr Kishore Reddy; Dr Achaleshwar Dayal; Dr Raghav Pandey; Dr Rupen Shah; Dr Ashwin Mallya; Dr Praveen; Dr Ashok Hegde; Dr Rajesh Ballal; Dr Devidas Shetty; Dr Venkatesh Sanjeeva; Dr Sunil; Dr Shanbogh; Dr Harish Nayak; Dr Subraya Kamath; Dr Venkatesh Shanbogh; Dr Shubanshu; Dr Chaithanya; Dr Nandakishore; Dr Shrishail; and Dr Sampath for their help in various aspects.
I sincerely appreciate Dr Raghavendra Bhat and Dr Ravichandra, Consultants in Radiology Department, Yenepoya Medical College, Mangalore for their contribution and affectionate help.
I thank Dr Ganesh Pai MCh (Paediatric Surgery); Dr Suresh Pai MCh; Dr Ashok Shetty (Cardiothoracic Surgery); Dr Muralidhar Pai MCh (Neurosurgery); Dr Sadashiva Rao, Paediatric Surgeon; and Dr Narayana Bhat, Paediatric Surgeon for their help and contributions.9
I will never forget my close associates Dr Ganapathy MD, Mangala Hospital, Kadri, Mangalore and Dr Ashok Pandith MCh, Urologist for their affectionate help and encouragement in all my endeavours. They always stood with me in my difficulties.
I thank my friends Dr Manjunath Shetty, Urologist and Dr Jagadish MDS for their contributions to photos and X-rays and opinion on dental and maxillofaciallary topics. I thank Dr Balasaraswathy, Consultant Dermatologist, Mangalore for providing rare photographs.
My wife Dr Meera Karanth helped me day and night in editing this new book and without her help this could not have been possible. My beloved daughter Ananya helped me in drawing diagrams artistically. I enjoy her love and affection towards me.
I thank all my postgraduate students of Surgery Department (especially Dr Abhishek, Dr Ranjit, Dr Laxman, Dr Mahesh, Dr Adithya, Dr Nishyesh, Dr Solomon, Dr Sachin) who were helping regularly in bringing out this new book.
Words are not sufficient to remember all my patients who are the main material for the book. I pray for their good health always.
I appreciate Shri Jitendar P Vij, Chairman and Managing Director, Mr Tarun Duneja, Director (Publishing) and all staff of the Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, for doing appreciable work in their respective field of printing and publishing. I also thank Mr V Venugopal, Branch Manager and staff of Bengaluru branch.