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Vascular Surgery for Final Medical
Vascular Surgery UnitVascular Surgery Unit
AMNCHAMNCHwww.perfuse.net
Introduction
Scope
Occlusive Vascular disease
Aortic aneurysm
Carotid disease
Varicose veins
Occlusive venousdisease
Lymphoedema
Visceral arterial occlusion
Peripheral aneurysms
Arterial Trauma
Diabetic FootHyperhidrosis
Venous access
Topics
Occlusive Vascular disease
Aortic aneurysm
Carotid disease
Varicose veins
Occlusive venousdisease
Lymphoedema
Visceral arterial occlusion
Peripheral aneurysms
Arterial Trauma
Diabetic FootHyperhidrosis
Venous access
Lecture topics
• Introduction– History– Physical examination– Differential diagnosis– Presentation
• Leg Ulcers– clinical description– clinical reasoning– differential diagnosis– Bayesian approach to
diagnosis
• Peripheral arterial occlusive disease– systemic disease– differing end organ
manifestation– holistic approach to therapy– Indications for surgery
• Aortic aneurysms– preparing patients for
complex surgery– clinical decision making
Lecture topics
• Carotid disease– evidence based medicine– randomised trials in surgery– choosing therapy
• Varicose veins– relationship between
symptoms & conditions
– Risk/benefits in surgery– Informed consent
• Diabetic foot– systemic disease– Warning signs– Interventions– Preventing amputations
Perfuse.net
Perfuse.net
Elements
• Theoretical knowledge– anatomy
– physiology– pathology– pharmacology
– medicine– surgery etc.
Normal & disease
Clinical skills
• History
• Physical examination
• Diagnosis
• Investigation
• Treatment
Patients present with symptoms and signs rather than disease
Patients present with symptoms and signs rather than disease
History
• Presenting problem
• Context– personal
• age• sex• occupation
– social• domestic
arrangements
• lifestyle
– medical• chronic
illness
• medications• previous
surgery
Process of communicationProcess of communication
History - II
• Obtain information from the patient – listen
– identify precise symptoms
– avoid leading questions initially– ask questions to fill in the gaps
• Collateral history– trauma, confused, paediatric etc
All the information that cannot be obtained by examining the patient
All the information that cannot be obtained by examining the patient
Art of History Taking
Translate
Common language
• Standard formula
• Common among clinicians
• Precise terminology vs– “haemorrhoids”– “can’t breathe”– “trouble passing water”
Physical examination
Differential diagnosis
• Consider all the possibilities
• Weight them
Diagnosis
• Test the hypothesis
• Re prioritise
Diagnosis
• Treat
• Evaluate response