Textbook “Surgery”: principles of making of the preliminary diagnosis

The textbook “Surgery” for English-speaking students includes information on methods and principles of preliminary diagnosis. The following methods of diagnostics are viewed: a) Analogy method, which is possible in case of typical (classical) manifestation of a disease (in uncomplicated external abdominal hernias and acute purulent surgical infection of soft tissues); b) Inductive method, which is based on the initial hypothetical generalization with the findings validation; c) Substantiated diagnosis, based on the doctor’s mentally synthetically activity, who sequentially analyses all the present symptoms and verifies their compliance with the disease d) Method of differential diagnosis (most reliable), which excludes all signs of other similar diseases. To establish a diagnosis, a thorough examination of a patient is required. The more signs of the disease manifestation are revealed, the more probable the accuracy of the diagnosis is. The methodology of the preliminary diagnosis is discussed. After the thorough questioning and physical examination of the patient the doctor has to make sampling of pathological symptoms in their both subjective and objective manifestations. Preliminary diagnosis is substantiated by referring to the complaints of the patient, using their successive presentation, starting with the most evident ones. Each complaint must include all various subjective shades of the pain manifestation in this patient (for example, localization of pain, its displacement, intensity, character, irradiation, and ways of the pain relief). After the sequential referring to each complaint, in order to justify the preliminary diagnosis, the anamnesis is used that shows the time when the disease arose, the nature of its course and the patient’s subjective evaluation of possible factors that led to occurrence of the disease. At prolonged or recurrent course, methods of previously performed examinations and their results, types and extent of the treatment and its efficiency are ascertained. If the factors that have etiopathogenetical impact on the disease occurrence are present in the anamnesis, they must be pointed out (the presence of stressful situations, type of nutrition, working conditions, etc.). Preliminary diagnosis is substantiated by objectively revealed pathological changes, starting with general changes and then using the local ones. Using objective manifestations, it is necessary to comply with the methodological scheme at first to carry out physical examination, then palpation, percussion, auscultation and, finally, to analyze the results of rectal and vaginal examinations