Systematic Systematic approachapproach

Simon AliSimon Ali

1313thth September 2007 September 2007

OverviewOverview

What is a systematic approachWhat is a systematic approach Why should you use itWhy should you use it What systems are usedWhat systems are used ExamplesExamples SummarySummary

What is a systematic What is a systematic approach?approach?

A method of classificationA method of classification Based primarily on body systems & Based primarily on body systems &

‘sieves’‘sieves’ PathologicalPathological AnatomicalAnatomical AetiologicalAetiological SurgicalSurgical

Think logicallyThink logically Common things first, rare things lastCommon things first, rare things last

Why should you use it?Why should you use it?

Provides a framework for differential Provides a framework for differential diagnosisdiagnosis

Provides a rationale for investigationsProvides a rationale for investigations Stops you ‘pulling answers out of mid Stops you ‘pulling answers out of mid

air’air’ Traditionally used by surgeonsTraditionally used by surgeons Can be used for anythingCan be used for anything Gets you out of a hole in finals, esp Gets you out of a hole in finals, esp

LOCAS…LOCAS…

Body SystemsBody Systems

Cardiovascular Cardiovascular & Blood& Blood

Gastro-intestinalGastro-intestinal NeurologicalNeurological RespiratoryRespiratory

Genitourinary & Genitourinary & ReproductiveReproductive

EndocrineEndocrine Musculoskeletal Musculoskeletal

& Skin& Skin

Up to you to create your own listUp to you to create your own list For example:For example:

The Pathological SieveThe Pathological Sieve

DefinitionDefinition HistologyHistology Clinical FeaturesClinical Features Differential Differential

DiagnosisDiagnosis Ix / Rx / MgmntIx / Rx / Mgmnt PrognosisPrognosis

AetiologyAetiology EpidemiologyEpidemiology Risk FactorsRisk Factors

Clinical StagingClinical Staging ComplicationsComplications OtherOther

In essence, this is the disease frameworkIn essence, this is the disease framework

The Anatomical SieveThe Anatomical Sieve

Requires a bit of thought and some Requires a bit of thought and some anatomy…anatomy…

For example, causes of obstructionFor example, causes of obstruction LuminalLuminal e.g. FB, impacted faecese.g. FB, impacted faeces IntramuralIntramural e.g tumours, inflammatione.g tumours, inflammation ExtramuralExtramural e.g. volvulus, adhesionse.g. volvulus, adhesions

The Aetiological SieveThe Aetiological Sieve

Differentiate based on disease processesDifferentiate based on disease processes 1st Point: is it Congenital or Acquired?1st Point: is it Congenital or Acquired? If congenital, you have your answerIf congenital, you have your answer If acquired, consider making up a rhyme If acquired, consider making up a rhyme

along the basis of the followingalong the basis of the following

TIN CAN MED DIPTIN CAN MED DIP This is the ‘textbook’ version…This is the ‘textbook’ version…

The Aetiological SieveThe Aetiological Sieve

TraumaTrauma InflammatoryInflammatory NeoplasticNeoplastic CirculatoryCirculatory Auto-immuneAuto-immune NutritionalNutritional

MetabolicMetabolic EndocrineEndocrine DegenerativeDegenerative DrugsDrugs IatrogenicIatrogenic PsychosomaticPsychosomatic

Surgical SievesSurgical Sieves

Type of complicationType of complication Are they general or specificAre they general or specific

GeneralGeneral Risks of anaesthesia, risks of surgeryRisks of anaesthesia, risks of surgery

SpecificSpecific What can go wrong with specific tissues What can go wrong with specific tissues

/ procedures/ procedures Timescale of complicationTimescale of complication

Immediate, early or lateImmediate, early or late

Example 1Example 1

What are the causes of aortic What are the causes of aortic stenosis?stenosis?

Example 2Example 2

What are the immediate injuries that What are the immediate injuries that may result from a fall from height?may result from a fall from height?

Example 3Example 3

What are the possible complications What are the possible complications of TURP?of TURP?

Limitations of this Limitations of this approachapproach

Not a substitute for learning your Not a substitute for learning your stuffstuff

It is only an aid memoiréIt is only an aid memoiré Common problems should be known Common problems should be known

inside outinside out Emergencies should be known inside Emergencies should be known inside

outout This does not appeal to everyoneThis does not appeal to everyone

SummarySummary Sieves can provide useful frameworksSieves can provide useful frameworks Based on anatomy and disease processes Based on anatomy and disease processes To be used in conjunction with To be used in conjunction with

knowledgeknowledge

Turn up to everythingTurn up to everything Read up on everything you don’t knowRead up on everything you don’t know Avoid revising ‘comfortable’ areasAvoid revising ‘comfortable’ areas You should pass!You should pass!