Surgical sieve

Surgical sieve

The "surgical sieve" is a nickname for a type of thought process in the medical profession. It has several purposes. Firstly, it is a typical example of how to organise a structured examination answer for medical students and doctors when they are challenged with a question [ [http://student.bmj.com/back_issues/0602/education/ed6.html sBMJ ] ] . It is also a way of constructing answers to questions from patients and their relatives in a logical manner, and structuring articles and reference texts in medicine. Some text books put emphasis on using the "surgical sieve" as a basic structure of diagnosis and management of illnesses [Oral diagnosis - the clinician's guide, W. Birnbaum, S. M. Dunne] [The New Aird's Companion in Surgical Studies (3rd edn). K. Burnand, A. Young, J. Lucas. ] [Surgical Talk: Revision In Surgery, A. Goldberg, G. Stansby] [Medicine and Surgery: a concise textbook, G. Kendall, K.Y. Shiu, S. L. Johnston] .

The 'Sieve'

Although there are several versions around the world with slight variations, the "surgical sieve" usually consist of the following types of process in the human body in any particular order:

1. Congenital
2. Acquired:
Neoplastic
Metabolic
Infective
Traumatic
Autoimmune
Vascular
Inflammatory
Degenerative
Idiopathic

Example 1

Question: What are the causes of an acute confusional state in a patient?

Answer: The causes can be divided into:

1. Neoplastic: brain tumour, carcinomatosis
2. Metabolic: electrolyte imbalance, DKA, hypoglycaemia, SIADH
2. Infective: sepsis, local infection
3. Traumatic: head injury, intra-cerebral haemorrhage, shock
4. Autoimmune: thyroid disease
5. Vascular: CVA, TIA, vascular dementia
6. Inflammatory: infection, systemic inflammatory response syndrome
7. Degenerative: Alzheimer's Disease, dementia
8. Idiopathic

Example 2

Question: What are the causes of splenomegaly?

Answer: The causes can be divided into:

1. Neoplastic: CML, metastases, myeloproliferative disorders
2. Metabolic: Gaucher's disease, mucopolysaccharidoses, amyloidosis, Tangier disease
2. Infective: AIDS, mononucleosis, septicaemia, TB, brucellosis, malaria
3. Traumatic: haematoma, rupture
4. Autoimmune: rheumatoid arthritis, SLE
5. Vascular: portal vein obstruction, Budd-Chiari syndrome, haemoglobinopathies (sickle cell, thalassemia)
6. Inflammatory: sarcoidosis
7. Degenerative: nil
8. Idiopathic

Example 3

Robbins "Pathologic Basis Of Disease [Robbins Pathologic Basis of Disease, R. S. Cotran, V. Kumar, T. Collins] " is an internationally used reference textbook in pathology. Its chapters under the heading 'General Pathology' can be considered to be a version of the "surgical sieve":

3. Acute and chronic "inflammation"
4. Tissue Repair
5. "Hemodynamic" Disorders
6. "Genetic" Disorders
7. Diseases of "Immunity"
8. "Neoplasia"
9. "Infectious Diseases"
10. "Environmental and Nutritional" Pathology

Use in popular culture

The surgical sieve is frequently used by "House MD", who is a doctor in the TV series "House" [ [http://www.fox.com/house/ FOX Broadcasting Company: House ] ] in order to diagnose the diseases that his patients are suffering from. In some episodes various forms of the surgical sieve are scribbled onto House's whiteboard while his team struggle to diagnose difficult cases.

References


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