Browse's Introduction to the Symptoms & Signs of Surgical Disease 4th Edition PDF
Preview Browse's Introduction to the Symptoms & Signs of Surgical Disease 4th Edition
Browse-Power-Prelims.qxd 12/17/10 5:49 PM Page i Browse’s Introduction to The Symptoms and Signs of Surgical Disease Fourth edition NORMAN L.BROWSE Kt,MD,FRCS,FRCP Professor ofSurgery,Emeritus,University ofLondon,UK Honorary Consulting Surgeon,St Thomas’Hospital,London,UK Formerly,Chairman,London University MBBSand MSExaminers Formerly,Member ofCourt ofExaminers,Royal College ofSurgeons ofEngland,UK Formerly,Member ofCouncil and Chairman ofExaminations Committee and Academic Board,Royal College ofSurgeons ofEngland,UK Past President,Royal College ofSurgeons ofEngland,UK JOHN BLACK MD,FRCS Consultant Surgeon,Worcestershire Royal Hospital,UK Member ofCouncil,Royal College ofSurgeons ofEngland,UK Examiner,Intercollegiate Board in General Surgery,UK KEVIN G.BURNAND MS,FRCS,MBBS Professor ofVascular Surgery and Chairman ofthe Academic Department ofSurgery and Anaesthesia in the Cardiovascular Divison ofKing’s College at the St Thomas’Campus, University ofLondon,UK Honorary Consultant Surgeon to Guy’s and St Thomas’Foundation Trust,London,UK WILLIAM E.G.THOMAS MS,FRCS Consultant Surgeon and Clinical Director,Sheffield Teaching Hospitals Trust Member ofCouncil,Royal College ofSurgeons ofEngland,UK Formerly,Member ofCourt ofExaminers,Royal College ofSurgeons ofEngland and Panel ofExaminers for the Intercollegiate Board in General Surgery,UK with Hodder Arnold Sponsored by AstraZeneca PLC CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2005 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper Version Date: 20140805 International Standard Book Number-13: 978-0-340-81571-7 (Pack - Book and Ebook) 978-0-340-81579-3 (Paperback) This book contains information obtained from authentic and highly regarded sources. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Browse-Power-Prelims.qxd 12/17/10 5:49 PM Page iii BookPower (formerly ELST) is a registered charity which makes available low-priced, unabridged editions ofBritish publishers’textbooks to students in developing countries. BookPower is grateful to the many individuals,trusts and organisations which have provided funding to cover the costs ofits operation.These include: The Arimathea Charitable Trust The PJK Charitable Trust The Peter Courtauld Charitable Trust The Rolfe Charitable Trust The Ros Pilcher Charitable Trust The Tanner Trust Below is a list ofsome other medical books published under the BookPower imprint: Crook Clinical Chemistry and Metabolic Medicine Hodder Arnold Holt and Kumar ABC ofDiabetes Wiley Blackwell Houghton and Gray Chamberlain’s Symptoms and Signs in Clinical Medicine Hodder Arnold Leppard An Atlas ofAfrican Dermatology Radcliffe Medical Press McMinn The Concise Handbook ofHuman Anatomy Manson Pallister and Watson Haematology Scion Publishing Rogstad ABC ofSexually Transmitted Infections Wiley Blackwell Strobel et al The Great Ormond Street Colour Handbook ofPaediatrics and Child Health Manson Publishing Truswell ABC of Nutrition BMJ Books Browse-Power-Prelims.qxd 12/17/10 5:49 PM Page iv We dedicate this book to all those who have supported us thoughout our clinical careers: Our wives, families, consultant colleagues, registrars and house officers, nurses in the wards,outpatients and operating rooms, secretaries and laboratory staff, but,above all, our patients. Without the support of everyone mentioned above,it would have been impossible to write this book. Acknowledgements The advice and contributions of many surgical four editors themselves,at home,but we are most colleagues throughout the UK to previous editions grateful for the secretarial assistance of Elizabeth have already been acknowledged but they are Webb and Patricia Webb of the Academic Depart- still part of the substance of this edition.Added to ment ofSurgery at St Thomas’Hospital. this group must be Dr Jane Terris, Consultant in Over the past 2 years we have received and A&E Medicine,Dr Elizabeth Graham,Consultant in are most grateful for the constant support given by Medical Ophthalmology and Mr Kieran Healey, all the editorial team of Hodder Arnold led by Consultant Plastic Surgeon,all ofSt Thomas’Hospi- Georgina Bentliff. tal,who gave valuable advice on Chapters 2 and 3, Last,but by no means least,we thank our wives and Mr David Douglas, Consultant Orthopaedic and families for accepting the disruptions to family Surgeon,Sheffield Teaching Hospitals NHS Founda- life that the preparation of this fourth edition has tion Trust,who advised on Chapter 4. imposed upon them. In these days ofword processors and computers, much of the secretarial work has been done by the Browse-Power-Prelims.qxd 12/17/10 5:49 PM Page v Contents Preface to the First Edition viii Soft tissues 106 Preface to the Third Edition ix Muscles and muscle disease 106 Preface to the Fourth Edition x Fibrous tissue 110 Tendons and tendon sheaths 112 Bones and bone irregularities 114 1 History taking and clinical Examination ofbones 114 examination 1 Fractures 117 How to take the history 2 Bone diseases and deformities 118 History ofpain 7 Benign tumours ofbone 122 The clinical examination 11 Malignant tumours ofbone 123 History and examination ofa lump 29 Joints 127 History and examination ofan ulcer 32 Examination ofa joint 127 Examination ofthe spine 134 2 The symptoms,signs and emergency Diseases ofjoints 136 management of major injuries 36 5 Conditions peculiar to the hands 143 The primary survey and management at the site ofthe event:first-aid 36 A plan for the examination ofthe hand 143 The primary survey in the accident and Recording data about the hand 148 emergency department 38 Abnormalities and lesions ofthe hand 149 The secondary survey 41 The nails 160 Infections in the hand 162 3 The skin and subcutaneous tissues 47 6 Conditions peculiar to the feet 165 The diagnosis ofskin conditions 47 Congenital skin disorders 50 Congenital and acquired deformities Genetic skin disorders 50 ofthe foot and ankle 165 Non-genetic skin disorders 51 The toe nails 170 Haemangiomata/lymphangiomata 53 7 The arteries,veins and lymphatics 175 Acquired dermatological conditions 57 Conditions ofthe skin caused by trauma 57 The arteries 175 Infections ofthe skin 66 Clinical assessment ofthe arterial Benign tumours and benign skin lumps 71 circulation ofthe lower limb 175 Pigmented naevi 75 Symptoms produced by arterial Benign subcutaneous swellings 78 insufficiency 179 Tumours ofthe skin appendages 86 Haemorrhage 190 Pre-malignant skin lesions 87 Transient and permanent weakness, Malignant diseases ofthe skin 89 paralysis and blindness 190 Other common skin conditions Cold,blue digits,hands and feet 192 often seen in surgical patients 99 Hypertension 196 Subcutaneous infections 100 Intestinal ischaemia 196 The veins 196 4 Muscles,tendons,bones and joints 104 Clinical assessment ofthe venous A general plan for examining the circulation ofthe lower limb 196 muscles,bones and joints ofa limb 104 The lymphatics 209 Browse-Power-Prelims.qxd 12/17/10 5:49 PM Page vi vi Contents 8 General and facial appearance 214 The nipple 326 Breast abscess 328 Colour 214 Pregnancy 329 General appearance 217 The male breast 329 Diseases affecting facial appearance 224 Carcinoma ofthe male breast 330 The eyes 226 The nose 230 13 The external genitalia 331 Shape ofthe skull 230 The ears 232 Examination ofthe male genitalia 331 Meningocele 234 The penis 334 The chest wall 234 The scrotal skin 342 The testes 343 9 The salivary glands 239 The female external genitalia 357 The submandibular salivary gland 239 The parotid gland 242 14 The abdominal wall,herniae and the Autoimmune disease 248 umbilicus 359 10 The mouth 250 Abdominal herniae 360 Inguinal hernia 361 Congenital abnormalities ofthe lips Femoral hernia 373 and palate 250 Umbilical hernia 375 The lips,buccal mucosa and tongue 251 Epigastric hernia 378 Other conditions ofthe tongue 261 Incisional hernia 378 The palate 261 Divarication ofthe recti 379 The tonsils 263 Rare abdominal herniae 381 The floor ofthe mouth 263 The umbilicus 381 The gums 266 Swellings ofthe jaw 267 15 The abdomen 386 The jaw 268 The examination ofthe abdomen 386 11 The neck 270 Abdominal pain 391 The history and examination of Upper abdominal pain – acute and/or swellings in the neck 270 chronic – caused by inflammatory and Cervical lymphadenopathy and other malignant conditions 393 neck swellings 271 Central abdominal pain – acute The thyroid gland 288 and/or chronic 401 Symptoms ofthyroid disease 288 General abdominal pain – acute Examination ofthe thyroid gland 290 and/or chronic 403 Different forms ofgoitre 295 Lower abdominal pain – acute and/or Thyrotoxicosis and myxoedema 299 chronic – caused by inflammatory Carcinoma ofthe thyroid gland 303 and/or malignant conditions 405 Thyroiditis 307 Symptoms and signs resulting from the perforation ofa viscus 411 12 The breast 312 Symptoms and signs caused by an History and examination of obstructed viscus 412 breast disease 312 Infarction ofa viscus causing Presentation ofbreast disease 318 abdominal pain 414 Carcinoma ofthe female breast 318 Abdominal pain caused by intra- Benign breast tumours 322 abdominal or retroperitoneal Benign breast disease 323 haemorrhage 415 Browse-Power-Prelims.qxd 12/17/10 5:49 PM Page vii Contents vii Extra-abdominal and medical conditions Retention ofurine 441 causing acute abdominal pain 418 The prostate gland 443 Alimentary conditions presenting The urethra 445 with dysphagia or vomiting 419 17 The rectum and anal canal 447 Conditions presenting with diarrhoea 420 The abdominal mass:causes and signs 421 Symptoms ofano-rectal disease 447 Causes ofa mass in the right iliac fossa 427 Technique for ano-rectal examination 448 Causes ofa mass in the left iliac fossa 430 Sigmoidoscopy and proctoscopy 451 Causes ofa lump in the groin 430 Conditions presenting with rectal Abdominal distension 431 bleeding 454 Conditions presenting with anal pain 459 16 The kidneys,urinary tract and Conditions presenting as an anal lump prostate 435 with or without pain 465 Symptoms ofrenal and urinary tract disease 435 Index 471 Diseases ofthe urinary tract 437 INSTRUCTIONS FOR COMPANION WEBSITE This book has a companion website available at: http://www.hodderplus.com/browsesintroductions To access the image library included on the website,please register using the following access details: Serial number:jxpz475ak9wr Once you have registered,you will not need the serial number but can log in using the username and password that 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Browse-Power-Prelims.qxd 12/17/10 5:49 PM Page viii Preface to the First Edition I believe that the main object ofbasic medical edu- site, shape and surface are constantly repeated in cation is to train the student to talk to and to exam- an unobtrusive way.I hope that when you have fin- ine a patient in such a way that he can discover the ished reading the book you will have these headings full history of the patient’s illness,elicit the abnor- so deeply imprinted in your mind that you will mal physical signs,make a differential diagnosis and never forget them.Ifso,I will consider that the book suggest likely methods of treatment.The object of has succeeded,for you will always take a proper history further medical training is to amplify these capabil- and perform a correct and complete examination. ities in range and depth through practical experi- Because the main object ofthe book is to empha- ence and specialist training. size the proper techniques of history taking and It is surprising, but a fact, that some students clinical examination,I have described only the com- present themselves for their qualifying examination mon conditions that you are likely to see in a surgi- unable to take a history or to conduct a physical cal clinic.Indeed the whole book is presented in a examination in a way that is likely to detect all the manner similar to that used by most teachers when abnormal symptoms and signs. Even more are they are in the presence ofthe patient.Special inves- unable to interpret and integrate the facts they do tigations and treatment are completely excluded elicit. I think there are two reasons for these defi- because neither can be applied sensibly if you get ciencies.First,and most important,students do not the history and physical signs wrong. spend enough time seeing patients and practising To make the book useful for revision,I have put the art ofhistory taking and clinical examination.It a number of the lists and classifications in special is essential for them to realize at the beginning of Revision Panels. The photographs are close to the their training that the major part ofmedical educa- relevant text but their legends contain enough tion is an apprenticeship, an old but well-proven information to make the picture-plus-legend a use- system whereby the apprentice watches and listens ful revision piece. to someone more experienced than himself and I hope this book will be more of a teach-book then tries it himselfunder supervision.The second than a text-book, which will be read many times reason is the lack of books which describe how to during your basic and higher medical training. examine a patient and explain how the presence or There is a well-known saying ‘A bad workman absence of particular symptoms and signs lead the always blames his tools’. The doctor cannot make clinician to the correct diagnosis. this excuse because his basic tools are his five senses. In this book I have attempted to describe,in detail, Ifhe has not trained his senses properly in the man- the relevant features ofthe history and physical signs ner described in this book and kept them finely of the common surgical diseases in a way which honed by constant practice, he will practise bad emphasizes the importance ofthe routine application medicine but he will have only himselfto blame. ofthe techniques ofhistory taking and examining. The details ofthese techniques are fully described, Norman Browse and headings such as age,sex,symptoms,position, 1978 Browse-Power-Prelims.qxd 12/17/10 5:49 PM Page ix Preface to the Third Edition The diseases and abnormalities described in this difficult to obtain.Unfortunately,the current trend book have not changed for many thousands of is for patients to be unwilling to be photographed years,nor have their symptoms and signs.Why then for illustrations to be used in books for teaching, produce a third edition? The main reason is to thus making the compilation of a comprehensive improve and modernize the presentation of the library of clinical photographs far more difficult information within the book in the beliefthat better than it used to be. presentation facilitates and improves learning. I have also added a considerable number ofnew Whereas the symptoms and signs of surgical dis- Revision panels,now on a blue background,as stu- ease have not changed in the past 20 years,methods dents find them particularly helpful. of printing and publishing have.Computer graphics To remind students of their importance, the and colour printing now enable publishers to produce illustrations of methods of clinical examination books of superb design, with infinite varieties of (mostly black-and-white photographs) are outlined colour,at acceptable costs.The main changes in this in Revision Panel blue. new edition are therefore the introduction of colour I hope this revised presentation will give the into the general presentation and design,and the con- book a new modern appearance and that it will con- version of all ‘blackboard-style’ line drawings into tinue to be attractive to new readers in the same way coloured illustrations – still simple – but giving them that it has been to the gratifyingly large number of the added impact on the memory provided by colour. students who have acquired it for their libraries over At the same time I have tried to illustrate all the past 20 years. the clinical conditions with colour photographs – except for the few rare conditions, worthy of pre- Sir Norman Browse sentation,for which modern colour photographs are 1997
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