SRB's Clinical Methods in SURGERY
SRB's Clinical Methods in SURGERY
SECOND EDITION
Sriram Bhat M MS (General Surgery)
Professor Department of Surgery Kasturba Medical College Mangaluru, Karnataka, India
Honorary Surgeon Government Wenlock Hospital Mangaluru, Dakshina Kannada, Karnataka, India e-mail: meera_sriram2003@yahoo.com
Forewords
CR Ballal
Narayanaswamy Srinivasan
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SRB's Clinical Methods in Surgery
First Edition : 2010
Second Edition : 2015
9789351525264
Printed at
- GG Laxman Prabhu MS MCh
- Urologist
- Kasturba Medical College
- Mangaluru, Karnataka, India
- He has contributed ‘Examination of Back ’ in Chapter 40—Examinations in Spine Injuries and Diseases
- Meera Karanth P (Meera Sriram) MD
- Gynecologist
- Light House Poly Clinic
- Mangaluru, Karnataka, India
- She has contributed Chapter 23—Examination in Rectal and Vaginal Problems
- Narayanaswamy Srinivasan MS FRCS (Glasgow)
- Medical Superintendent
- Fathima Institute of Medical Sciences
- Kadapa, Andhra Pradesh, India
- Former Dean and Director
- Bangalore Medical College and Research Institute
- Bengaluru, Karnataka, India
- His innovative invention—'Srinivasan costal sign’ is published in this book
- Sribatsa Kumar Mohapatra MS FRCS DNB
- Veer Surendra Sai Medical College
- Burla, Sambalpur, Odisha, India
- He has contributed his new approaches in breast and abdomen examination—an innovative triple ABC technique (Sribatsa Mohapatra Clinical Technique) for clinical breast examination (CBE) for breast disorders and a cricketing approach to the abdomen
Dr Sriram Bhat M, Professor of Surgery, Kasturba Medical College (KMC), Mangaluru, Karnataka, India, 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 on clinical surgery is most welcome. Dr Bhat has tried to emphasize as 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 unfavorable 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 of surgery. I have no hesitation to believe that this book on clinical surgery will be equally popular.
CR Ballal MS
Professor Emeritus
Department of Surgery
Mangaluru, Karnataka, India
Foreword
When Professor Sriram Bhat M, from Kasturba Medical College (KMC), Mangaluru, Karnataka, India, has requested me to write a foreword for the second edition of his clinical book SRB's Clinical Methods in Surgery, I readily accepted it because I know him since few years if not personally because of his popular well-known book SRB's Manual of Surgery and SRB's Clinical Methods in Surgery, first edition and regular communications through phone and e-mail.
This book carries its own merit by lucid presentation, detailed methods of clinical examinations with excellent clinical photographs and illustrations. Even though present era is of imaging, this book stresses the need for proper clinical examination to clinch the proper diagnosis, treatment plans and during follow up. This book has covered all topics including clinical examination in orthopedics. As by his request, I have given permission to publish the sign which I have invented, i.e. ‘Srinivasan costal sign’ and I also felt it is my honor to get the sign published in SRB's Clinical Methods in Surgery, second edition.
This book will become probably an essential one to all undergraduates and postgraduates to get a clear idea of clinical methods. It carries an Interactive DVD which contains clinical examinations of all important topics with background voice explanation of the author.
This is also very useful to practicing clinicians and surgeons worldwide to understand the surgical conditions and to achieve proper clinical diagnosis.
I appreciate dedication and determination of Professor Sriram Bhat M in bringing out the second edition of SRB's Clinical Methods in Surgery and wish him a grand success and also recommend this clinical book to all undergraduates, postgraduates and clinicians to make use of it in clinical practice or learning or in examinations.
Narayanaswamy Srinivasan MS FRCS (Glasgow)
Medical Superintendent
Fathima Institute of Medical Sciences
Kadapa, Andhra Pradesh, India
Former Dean and Director
Bangalore Medical College and Research Institute
Bengaluru, Karnataka, India
Preface to the Second Edition
It is more than 4 years since I have brought out the first edition of SRB's Clinical Methods in Surgery with clinical video. Even though the book is successful, it is time to make changes in many ideas of the clinical surgery hence thought of bringing the second edition. I have entirely changed the script of the Chapter 1—Introduction on Clinical Examination, Chapter 2—Investigations and clinical orthopedics. I have done proper necessary corrections in all other chapters including photographs. The present second edition is self-sufficient as a clinical book to both undergraduates and postgraduates in their learning period; it is also a useful clinical book for all practicing clinicians. I have covered every aspect of clinical surgery with good illustrations in all chapters. This contains methods of basic clinical surgery for undergraduates and postgraduates of medical, dental, nursing and allied medicines (Ayurveda, Homeopathy). Clinical approaches, clinical analysis and clinical diagnosis with differential diagnoses 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, fourth edition or any other surgical books of their choice. I have taken enough care to discuss different clinical methods and signs. 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 are not highlighted here.
Newer innovations by few of the consultants are placed in this book with their prior permission. ‘Srinivasan costal sign’ in abdominal distension by Professor Narayanaswamy Srinivasan, MS, FRCS, Bengaluru, Karnataka and ‘A cricketing approach to the abdomen’ and an innovative triple ABC technique (Sribatsa Kumar Mohapatra Clinical Technique) for clinical breast examination by Professor Dr Sribatsa Kumar Mohapatra, MS, FRCS, DNB, Veer Surendra Sai Medical College, Burla, Sambalpur, Odisha and subchapter ‘Examination of the back’ by Professor Dr GG Laxman Prabhu, MS, MCh, DNB, Professor of Urology, KMC, Mangaluru. Many consultants all over the country have given suggestions including rare clinical photographs. I thank them wholeheartedly for their help and encouragement. My wife Dr Meera Sriram has contributed the Chapter 23 on ‘Examination of Rectal and Vaginal Problems’ and she also helped me in most of the spelling, language and proof corrections, without her help this book would not have been possible.
I thank my beloved teacher Professor CR Ballal, for writing foreword.
I hope this book will be useful for all those who learn clinical surgery.
I am ever grateful to Shri Jitendar P Vij (Group Chairman) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi India, for his wholehearted encouragement in my work.
I sincerely appreciate everyone who has helped me. I thank M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, for their support to bring out this book.
Any constructive criticisms are most welcome.
Sriram Bhat M
Preface to the First Edition
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 are 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 M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, for their support to bring out this book.
Any constructive criticisms are most welcome.
Sriram Bhat M
Acknowledgments
I am happy to bring out the second edition of SRB's 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 Manipal Academy of Higher Education (MAHE) Professor Dr Ramnarayan; Pro Vice-Chancellor Dr Vinod Bhat, Dr Surendra Shetty, and our beloved Dean Professor Dr Venkatraya Prabhu. I thank Vice-Deans Dr Vivian D'Souza and Dr Chakrapani.
I thank my beloved teacher, a great clinician and Senior Surgeon Dr Professor CR Ballal, Mangaluru, Karnataka, India, for accepting to give foreword to this clinical book. I owe a lot to him.
I thank Professor Narayanaswamy Srinivasan MS, FRCS (Glasgow), Former Dean and Director, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India; presently, Medical Superintendent, Fathima Institute of Medical Sciences, Kadapa, Andhra Pradesh, India, for writing foreword to this book and contributing to the book with ‘Srinivasan costal sign’.
I thank the Head, Department of Surgery, Kasturba Medical College (KMC), Mangaluru, and Professor Alfred Augustine, for his constant encouragement in academic work and progress.
I always remember my senior teachers, Professor Suresh Kamath and Professor K Prakash Rao and Dr Jayaprakash Rao, for their constant help.
I thank Professor GG Laxman Prabhu, Urologist, KMC, Mangaluru. He has contributed ‘Examination of Back’ of Chapter 40—Examinations in Spine Injuries and Diseases.
I thank Professor Dr Sribatsa Kumar Mohapatra MS, FRCS, DNB, Veer Surendra Sai Medical College, Burla, Sambalpur, Odisha, India, contributed his new approaches in breast and abdomen examination—an innovative triple ABC technique (Sribatsa Mohapatra Clinical Technique) for clinical breast examination (CBE) for breast disorders and a cricketing approach to the abdomen.
I thank Professor Ramlingam, Kamineni Institute of Medical Sciences, Narketpalli, Karnataka, for contributing with many photographs. I thank many other senior consultants and professors in different medical colleges across the country for contributing towards this in the form of opinions, photographs and corrections.
I thank many professors and teachers, who guided, corrected, helped me and contributed in different forms like clinical photographs towards this edition of the book.
Professors, Department Surgery, Kasturba Medical College, Mangaluru namely—Dr BM Nayak, Dr Thangam Varghese, Dr Jayaram Shenoy, Dr Anand Kini (MCh), Dr Harish Rao, Dr Ramachandra Pai, Dr SP Rai, Dr Yogish Kumar, and Dr Shivananda Prabhu H, 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 the book.
I appreciate District Medical Officer and Resident Medical Officer of Government Wenlock Hospital, Mangaluru, for their kind help.
I will never forget my close associates Dr Ganapathy, MD, Director, Mangala Hospital, Kadri, Mangaluru, and Dr Ashok Pandith, MCh, Urologist, for their affectionate help and encouragement in all my endeavors. They always stood with me in my difficulties.
I thank DR Manohar Pai, Dr Ashfaque Mohammed, Dr Poornachandra Tejashri, Dr Shibumon MM, Dr Rahul Bhat, Dr Bharath Kumar Bhat, Dr Kalpana Sridhar, Dr Keshava Prasad, Dr Sunilkumar Shetty, Dr Ranjith Rao, Dr Ventakesh Shanbogh, Dr Vivek MA, Dr Aromal Chakavar, Dr Guruprasad Reddy, Dr Sunil Matt, Dr Anand, Dr Aravindan R, Dr Jawahar BK, Dr Shushruth Shetty, 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 Harish Nayak, Dr Subraya Kamath, 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, Department of Radiology, Mangaluru, for their contribution and affectionate help.
I thank Dr Ganesh Pai, MCh (Pediatric Surgery); Dr Suresh Pai, MCh; Dr Ashok Shetty (Cardiothoracic Surgery); Dr Muralidhar Pai, MCh (Neurosurgery); Dr Sadashiva Rao, Pediatric Surgeon, and Dr Narayana Bhat, Pediatric Surgeon, for their help and contributions.
I thank my friends Dr Manjunath Shenoy, Urologist and Dr Jagadish, MDS, for their contributions to photographs and X-rays, and opinion on dental and faciomaxillary topics; Dr Harsharaj, Orthopedician, Mangaluru, and Dr Ishwarakeerthi, Spine Specialist, Mangaluru, for their help. I thank Dr Balasaraswathy, Consultant Dermatologist, Mangaluru, for providing rare photographs.
My wife Dr Meera Karanth P 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 students especially postgraduates of surgery department, who were helping regularly in bringing out this second edition.
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 (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing) and all the working staff in Delhi office of M/s Japyee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their unmatchful dedication, hard work and responsibility, namely Ms Sunita Katla (Publishing Manager), Mr KK Raman (Production Manager), Mr Rajesh Sharma (Production Coordinator), Ms Seema Dogra (Cover Designer), Mr Laxmidhar Padhiary (Proofreader), Mr Sumit Kumar (Graphic Designer) and Mr Rajkumar (DTP Operator). I also thank manager and staff of Bengaluru branch of M/s Jaypee Brothers Medical Publishers (P) Ltd.