The Mont Reid Surgical Handbook [7 ed.] 9780323529808, 2017041248
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Table of contents :
Front Cover
IFC
THE MONT REIDSURGICAL HANDBOOK
THE MONT REIDSURGICAL HANDBOOK
Copyright
FOREWORD
PREFACE
CONTENTS
THE MONT REIDSURGICAL HANDBOOK
I - Perioperative Care
1 - Surgical History and Physical Examination
I. INTRODUCTION AND INITIAL CONTACT
II. HISTORY
A. CHIEF COMPLAINT
B. HISTORY OF PRESENT ILLNESS
C. REVIEW OF SYSTEMS
D. ALLERGIES
E. MEDICATION
F. PAST MEDICAL HISTORY
G. PAST SURGICAL HISTORY
H. FAMILY HISTORY
I. SOCIAL HISTORY
III. PHYSICAL EXAMINATION
A. VITAL SIGNS
B. GENERAL APPEARANCE
C. HEAD AND NECK
D. CHEST
E. CARDIOVASCULAR
F. ABDOMEN
G. GENITOURINARY
H. SKIN
I. MUSCULOSKELETAL
J. LYMPHATICS
K. NEUROLOGIC
2 - Fluids and Electrolytes
I. BASIC PHYSIOLOGY
A. BODY FLUID COMPOSITION
B. SERUM OSMOLALITY AND TONICITY
C. FLUID AND ELECTROLYTE HOMEOSTASIS
II. ELECTROLYTE DISTURBANCES
A. SODIUM
B. POTASSIUM
C. CALCIUM
D. MAGNESIUM
E. PHOSPHORUS
III. PARENTERAL REPLACEMENT FLUID THERAPY
A. CRYSTALLOIDS
B. COLLOIDS
IV. ACID-BASE DISORDERS
A. PHYSIOLOGY
B. PRIMARY METABOLIC DISORDERS
C. PRIMARY RESPIRATORY DISORDERS
D. MIXED ACID-BASE DISORDERS
E. EVALUATION OF ACID-BASE DISORDERS (TABLE 2.3)
3 - Nutrition
I. NUTRITION BASICS
II. DETERMINATION OF CALORIC NEEDS
III. NUTRITIONAL ASSESSMENT
IV. PREOPERATIVE NUTRITIONAL SUPPLEMENTATION
V. POSTOPERATIVE NUTRITIONAL SUPPLEMENTATION
VI. ENTERAL NUTRITION
VII. SHORT-TERM SUPPLEMENTATION
VIII. LONG-TERM SUPPLEMENTATION (>6 WEEKS)
IX. PRODUCTS
X. COMPLICATIONS OF ENTERAL FEEDING
XI. PARENTERAL NUTRITION
XII. BASIC COMPOSITION OF FORMULATIONS (TABLES 3.1 AND 3.2)
XIII. CENTRAL FORMULAS
XIV. PERIPHERAL PARENTERAL NUTRITION
XV. INFUSION
XVI. MONITORING
XVII. COMPLICATIONS
XVIII. IMMUNONUTRITION
XIX. NUTRIENTS/MACROMINERALS/MICRONUTRIENTS/VITAMINS
4 - Wound Healing
I. PHASES OF WOUND HEALING
A. HEMOSTASIS (5–10 MINUTES POST INJURY)
C. PROLIFERATIVE (DAY 1–3 WEEKS POST INJURY)
II. FACTORS THAT AFFECT WOUND HEALING
A. OXYGENATION
B. INFECTION
C. NUTRITION
D. STEROIDS
E. SMOKING
F. AGE
G. FOREIGN BODIES
H. EDEMA
I. CHEMOTHERAPY
J. RADIATION
K. DIABETES MELLITUS
L. GENERAL HEALTH
III. WOUND PREPARATION
A. IRRIGATION
B. ANTIMICROBIALS
C. DÉBRIDEMENT
IV. TYPES OF WOUND CLOSURE
A. PRIMARY: CLOSURE OF WOUND BY DIRECT APPROXIMATION OF WOUND EDGES
B. SPONTANEOUS HEALING (SECONDARY INTENTION): SPONTANEOUS WOUND CONTRACTION AND EPITHELIALIZATION
C. TERTIARY HEALING
V. MANAGEMENT OF WOUND COMPLICATIONS
A. INFECTION
B. SEROMA
C. DEHISCENCE
VI. HYPERTROPHIC SCARS AND KELOIDS
A. HYPERTROPHIC SCARS
B. KELOIDS
5 - Surgical Risk Assessment
I. RISKS AND BENEFITS OF SURGERY
II. SURGICAL RISK ASSESSMENT
III. PREOPERATIVE PREPARATION
IV. POSTOPERATIVE CARE
6 - Suture Types, Needle Types, and Instruments
I. SUTURE MATERIAL
A. THE OPTIMAL SUTURE
B. SUTURE CHARACTERISTICS
C. ABSORBABLE SUTURE
D. NONABSORBABLE SUTURE
E. SUMMARY
II. NEEDLES
III. INSTRUMENTS
II - Anesthesia
7 - Local Anesthesia
I. INJECTABLE AGENTS
A. MECHANISM OF ACTION
B. CLASSES
C. TOXICITY
D. USE OF EPINEPHRINE
II. TECHNIQUES
A. BEFORE INJECTING LOCAL ANESTHETIC IN TRAUMATIC INJURIES, BE SURE TO PERFORM AND DOCUMENT A DETAILED SENSORY EXAMINATION, WHICH MAY BE SUBSEQUENTLY MASKED BY YOUR BLOCK
B. OPTIMAL TIMING BETWEEN INJECTION AND INCISION
C. GENERAL TECHNIQUES TO DECREASE PAIN
D. FIELD BLOCKS
E. NERVE BLOCKS FOR THE FACE
F. NERVE BLOCKS FOR THE UPPER EXTREMITY
III. TOPICAL AGENTS
A. TOPICAL ANESTHESIA CAN AVOID THE PAIN AND ANXIETY OF NEEDLE INJECTION AND IS ESPECIALLY USEFUL IN THE PEDIATRIC POPULATION. IT CAN ALSO BE USED AS AN ADJUNCT TO DECREASE SUPERFICIAL SKIN PAIN BEFORE PERFORMING MORE TARGETED NERVE BLOCK WITH AN INJECTABLE LOCAL ANESTHETIC AGENT.
B. SYSTEMIC BLOOD LEVELS OF THESE COMPOUNDED TOPICAL ANESTHETICS DEPEND ON THE ABSORPTION, PATIENT SIZE, RATE OF ELIMINATION, AN...
C. COMMONLY USED PRODUCTS (10)
8 - Conscious Sedation
I. INTRODUCTION
A. DEFINITION
B. APPLICATIONS (SELECTED)
II. PREPROCEDURAL EVALUATION
A. HISTORY
B. AIRWAY EXAMINATION
III. MONITORING
A. Best Achieved by Someone Other than Person Performing Procedure
B. PREPROCEDURE
C. CLINICAL ASSESSMENT
F. BLOOD PRESSURE
IV. AVAILABILITY OF EMERGENCY MEDICAL EQUIPMENT AND PERSONNEL
A. Immediate Access to Suction, Bag-Mask Ventilation, Intubation Materials, Defibrillator, and Emergency (Advanced Cardiac Life ...
B. Anesthesia or Other Trained Airway Staff in Close Proximity1397256787
V. TRAINING IN AIRWAY MANAGEMENT
A. GENERAL PRINCIPLES
B. Experience in Controlled Setting with Skilled Experts
C. Knowledge of Airway Adjuncts and their Appropriate Use1397256787
VI. MEDICATIONS
A. GENERAL PRINCIPLES
B. NARCOTICS
C. BENZODIAZEPINES
D. OTHER COMMON NONBARBITURATE MEDICATIONS
VII. REVERSAL MEDICATIONS
A. NALOXONE (NARCAN)
B. FLUMAZENIL (ROMAZICON)
VIII. RECOVERY AND DISCHARGE
A. GENERAL PRINCIPLES
B. DISCHARGE GUIDELINES
9 - General Anesthesia
I. PREOPERATIVE ASSESSMENT AND PREPARATION
A. SURGICAL INTERVENTION OR PROCEDURE BEING PERFORMED
B. HISTORY AND CHART REVIEW
C. PHYSICAL EXAMINATION
D. LABORATORY DATA
E. RADIOLOGY, CARDIOLOGY, OTHER PREOPERATIVE TESTING
F. ASSESSMENT
G. ANESTHETIC PLAN
I. PREOPERATIVE PREPARATION
J. PREOPERATIVE MEDICATION GOALS
II. INTRAOPERATIVE MANAGEMENT
A. EQUIPMENT
B. TECHNIQUES OF ANESTHESIA
C. INTRAOPERATIVE COMPLICATIONS
III. PHARMACEUTICALS
A. IV ANESTHESIA
B. NEUROMUSCULAR BLOCKING DRUGS
C. REVERSAL OF NEUROMUSCULAR BLOCKADE
D. INHALATIONAL ANESTHESIA
E. LOCAL ANESTHETICS
IV. POSTOPERATIVE MANAGEMENT
A. PAIN MANAGEMENT
B. RESPIRATORY MONITORING
C. HEMODYNAMIC INSTABILITY
D. POSTOPERATIVE NAUSEA AND VOMITING
III - Surgical Critical Care
10 - Surgical Infection
I. BACKGROUND AND SCOPE OF PROBLEM
II. MOST COMMON INFECTIONS AFFECTING SURGICAL PATIENTS
A. CENTRAL LINE–ASSOCIATED BLOODSTREAM INFECTION
B. SURGICAL SITE INFECTIONS
C. CATHETER-ASSOCIATED URINARY TRACT INFECTIONS
D. CLOSTRIDIUM DIFFICILE INFECTION
E. VENTILATOR-ASSOCIATED PNEUMONIA
F. PURULENT SKIN AND SOFT TISSUE INFECTIONS
G. NECROTIZING SOFT TISSUE INFECTION
H. INTRAABDOMINAL INFECTIONS
III. SEPSIS
11 - Hemorrhage and Coagulation
I. GENERAL TOPICS
A. NORMAL BLOOD VOLUME AND COMPOSITION
B. CLASSES OF HEMORRHAGIC SHOCK (TABLE 11.1)
C. TYPING, SCREENING, AND CROSSMATCHING
D. GENERAL BLOOD PRODUCT ADMINISTRATION GUIDELINES
II. LABORATORY TESTS AND REFERENCE VALUES
A. COMPLETE BLOOD COUNT
B. PROTHROMBIN TIME
C. INTERNATIONAL NORMALIZED RATIO
D. ACTIVATED PARTIAL THROMBOPLASTIN TIME
E. ACTIVATED CLOTTING TIME
F. BLEEDING TIME
G. PLATELET FUNCTION TESTS
H. THROMBIN TIME
I. FIBRINOGEN
J. VISCOELASTIC TESTS
III. SPECIFIC BLOOD PRODUCTS
A. WHOLE BLOOD
B. PACKED RED BLOOD CELLS
C. FRESH FROZEN PLASMA
D. PLATELETS
E. CRYOPRECIPITATE
IV. MASSIVE TRANSFUSION AND DAMAGE CONTROL RESUSCITATION
A. DEFINITION OF MASSIVE TRANSFUSION VARIES, BUT MOST COMMONLY USED IS 10 OR MORE UNITS OF BLOOD PRODUCTS IN THE FIRST 24 HOURS
B. PREDICTORS OF NEED FOR MASSIVE TRANSFUSION
C. PRESENCE AND IMPLEMENTATION OF STANDARDIZED PROTOCOLS IMPROVE SURVIVAL IN PATIENTS REQUIRING MASSIVE TRANSFUSION
D. DAMAGE CONTROL RESUSCITATION IS A STRATEGY TO LIMIT ONGOING BLEEDING BY ADDRESSING HYPOTHERMIA, ACIDOSIS, AND COAGULOPATHY.
V. TRANSFUSION REACTIONS
A. IMMUNE MEDIATED
B. NONIMMUNOLOGIC REACTIONS
VI. SURGICAL COAGULOPATHY—GENERAL CONSIDERATIONS
A. COAGULATION CASCADE (FIG. 11.2)
B. MEDICAL HISTORY TO DETERMINE RISK FOR BLEEDING
VII. CONGENITAL BLEEDING DISORDERS
A. HEMOPHILIA A
B. HEMOPHILIA B (CHRISTMAS DISEASE)
C. VON WILLEBRAND DISEASE
VIII. ACQUIRED BLEEDING DISORDERS
A. VITAMIN K DEFICIENCY
B. HYPOTHERMIA
C. LIVER FAILURE
D. END-STAGE RENAL DISEASE
E. DISSEMINATED INTRAVASCULAR COAGULATION
F. ACQUIRED THROMBOCYTOPENIA
H. HYPERFIBRINOLYSIS
IX. MEDICATIONS
A. ANTIPLATELET AGENTS
B. HEPARINS
C. WARFARIN
D. DIRECT THROMBIN INHIBITORS
E. FACTOR XA INHIBITORS (FONDAPARINUX)
F. NEW ORAL ANTICOAGULANTS
G. ANTIFIBRINOLYTICS
12 - Shock
I. PATHOPHYSIOLOGY
II. HEMODYNAMIC CONSIDERATIONS
A. IMPORTANT RELATIONSHIPS
B. PRELOAD
C. AFTERLOAD
III. ORGAN RESPONSE TO SHOCK
A. NEUROENDOCRINE RESPONSE
B. MICROVASCULAR DYSFUNCTION
C. INFLAMMATORY RESPONSE
D. PULMONARY
E. RENAL
IV. MULTIORGAN DYSFUNCTION SYNDROME
A. DEFINITION
B. CAUSES
C. PREVENTIVE MEASURES
V. SHOCK STATES
A. HYPOVOLEMIC SHOCK
B. SEPTIC SHOCK
C. NEUROGENIC SHOCK
D. CARDIOGENIC SHOCK
E. HYPOADRENAL SHOCK/ADRENAL INSUFFICIENCY
VI. VASOACTIVE AGENTS
13 - Cardiopulmonary Monitoring
I. CARDIAC MONITORING
A. CARDIAC RHYTHMS
B. BLOOD PRESSURE MONITORING
C. HEMODYNAMIC MONITORING BASIC PRINCIPLES
D. SPECIFIC DEVICES FOR CARDIAC MONITORING
II. PULMONARY MONITORING
A. PULSE OXIMETRY
D. ARTERIAL OR VENOUS BLOOD GAS
III. IMPORTANT FORMULAS
A. CARDIAC OUTPUT
B. ARTERIAL CONTENT OF OXYGEN
C. OXYGEN DELIVERY
D. OXYGEN CONSUMPTION
14 - Mechanical Ventilation
I. DETERMINING NEED FOR MECHANICAL VENTILATION
A. AIRWAY INSTABILITY
B. RESPIRATORY FAILURE
C. GUIDELINES
II. VENTILATION VERSUS OXYGENATION
A. VENTILATION
B. OXYGENATION
III. NONINVASIVE POSITIVE PRESSURE VENTILATION
A. POSITIVE PRESSURE VENTILATION
B. INITIAL SETTINGS
C. ADVANTAGES
D. RESERVED
IV. CONVENTIONAL MECHANICAL VENTILATION
A. MODES OF VENTILATION
B. VENTILATOR STRATEGIES
C. LIBERATION FROM MECHANICAL VENTILATION
D. FAILURE TO LIBERATE FROM MECHANICAL VENTILATION
V. EFFECTS ON CARDIAC PERFORMANCE
A. ENDOTRACHEAL INTUBATION AND MECHANICAL VENTILATION PLACE IMPORTANT PHYSIOLOGIC DEMANDS ON PATIENTS
B. THE SHIFT FROM NEGATIVE PRESSURE TO POSITIVE PRESSURE VENTILATION CAN COMPROMISE PRELOAD BY
C. POSITIVE PRESSURE VENTILATION
D. THE EFFECTS OF POSITIVE PRESSURE VENTILATION ON CARDIAC PERFORMANCE
VI. NEED FOR TRACHEOSTOMY
VII. VENTILATOR CAUTIONS
A. DEFINITION OF ACUTE RESPIRATORY DISTRESS SYNDROME
B. ACUTE LUNG INJURY/ACUTE RESPIRATORY DISTRESS SYNDROME TREATED WITH PROTECTIVE LUNG STRATEGY
C. VENTILATOR-ASSOCIATED PNEUMONIA
VIII. PEARLS
A. STANDARD INITIAL VENTILATOR SETTINGS
IV - Trauma Surgery
15 - Primary and Secondary Survey
I. EPIDEMIOLOGY
A. MORTALITY
B. MECHANISMS OF INJURY
II. MANAGEMENT OF THE TRAUMA PATIENT
A. PRIMARY SURVEY
B. FURTHER EVALUATION AND TRANSFER
C. SECONDARY SURVEY
III. PEDIATRIC TRAUMA
A. MECHANISMS OF INJURY
B. PRIMARY SURVEY
IV. TRAUMA AND PREGNANCY
A. EPIDEMIOLOGY
B. ANATOMIC AND PHYSIOLOGIC CHANGES DURING PREGNANCY
C. MATERNAL EVALUATION
D. FETAL ASSESSMENT
V. PENETRATING NECK TRAUMA
A. ZONE I
B. ZONE II
C. ZONE III
D. NECK EXPLORATION
16 - Abdominal Trauma
I. PATHOPHYSIOLOGY
II. DIAGNOSIS
III. TREATMENT
V. SPECIAL CIRCUMSTANCES
17 - Thoracic Trauma
I. EPIDEMIOLOGY OF THORACIC TRAUMA
A. THORACIC TRAUMA
B. AFRICAN-AMERICAN MALES
C. MOTORCYCLE ACCIDENTS
II. PHYSICAL EXAMINATION OF THE CHEST
A. CHEST AUSCULTATION
B. POINT TENDERNESS
C. FLAIL CHEST
D. SUBCUTANEOUS EMPHYSEMA
E. DULLNESS VERSUS RESONANCE ON PERCUSSION
F. SEAT BELT SIGNS
III. ADJUNCTS TO THE PHYSICAL EXAMINATION
A. CHEST RADIOGRAPHS
IV. PATHOPHYSIOLOGY OF THORACIC TRAUMA
V. BLUNT CHEST TRAUMA
VI. PENETRATING CHEST TRAUMA
VII. RESUSCITATIVE THORACOTOMY
VIII. OTHER THORACIC PROCEDURES IN THE FACE OF TRAUMA
A. FOCUSED ASSESSMENT WITH SONOGRAPHY FOR TRAUMA EXAMINATION
B. PERICARDIOCENTESIS
C. SUBXIPHOID PERICARDIOTOMY
D. THORACOSCOPY
IX. POSTOPERATIVE CARE OF THE PATIENT WITH A CHEST INJURY
A. CHEST TUBE MANAGEMENT
X. COMPLICATIONS OF THORACIC TRAUMA
18 - Extremity Trauma
I. EVALUATION OF THE INJURED LIMB
A. GENERAL POINTS
B. EVALUATION OF FRACTURES AND DISLOCATIONS
II. OPEN FRACTURES
A. DEFINITION
B. COMPLICATIONS OF OPEN FRACTURES
C. GUSTILO-ANDERSON CLASSIFICATION SYSTEM (TABLE 18.1)
D. EMERGENCY DEPARTMENT MANAGEMENT OF OPEN FRACTURES
III. COMPARTMENT SYNDROME
A. DEFINITION
B. CAUSES OF COMPARTMENT SYNDROME
C. SIGNS AND SYMPTOMS
D. DIAGNOSIS OF COMPARTMENT SYNDROME
E. SURGICAL TREATMENT OF ACUTE COMPARTMENT SYNDROME
IV. PELVIC FRACTURES
A. EVALUATION OF PELVIC RING FRACTURES
V. VASCULAR INJURY IN EXTREMITY TRAUMA
A. HISTORY AND PHYSICAL
B. MANAGEMENT OF EXTREMITY TRAUMA
C. COMPLICATIONS OF VASCULAR INJURIES
VI. AMPUTATION IN TRAUMA
19 - Burn Care
I. CAUSATIVE FACTORS
A. SCALDS
B. FLAME
C. FLASH
D. CONTACT
II. INDICATIONS FOR HOSPITAL ADMISSION
A. OUTPATIENT SETTING
B. BURN UNIT SETTING
III. INITIAL MANAGEMENT
A. HISTORY
B. AIRWAY/BREATHING
C. BURN EVALUATION
D. FLUID RESUSCITATION
E. INITIAL PROCEDURES
F. INITIAL TESTS
G. MEDICATIONS
IV. PATHOPHYSIOLOGIC CHANGES ASSOCIATED WITH BURN INJURIES
A. EDEMA
B. HEMODYNAMICS
V. BURN WOUND CARE
A. GOALS OF BURN WOUND CARE
B. TOPICAL AGENTS
C. LOCAL CARE
D. EARLY EXCISION AND GRAFTING
E. GRAFTING
VI. SUPPORTIVE CARE
A. NUTRITION
B. PHYSICAL AND OCCUPATIONAL THERAPY
C. ANALGESIA
VII. MANAGEMENT OF INFECTION IN THE BURN PATIENT
A. THE MOST COMMON INFECTION IN BURN PATIENTS IS PNEUMONIA
B. PATHOGENESIS OF WOUND SEPSIS IN AN UNTREATED BURN WOUND
C. CLINICAL SIGNS
D. DIAGNOSIS OF INVASIVE BURN WOUND SEPSIS
E. BACTERIOLOGY OF NOSOCOMIAL BURN INFECTION
F. PREVENTION OF BURN INFECTION
G. TREATMENT OF BURN INFECTION
H. NONBACTERIAL INFECTION
VIII. ELECTRICAL INJURIES
A. TISSUE DESTRUCTION
B. TREATMENT
C. FLUID RESUSCITATION
D. EARLY DEBRIDEMENT
E. IMMEDIATE EXTREMITY FASCIOTOMY
IX. CHEMICAL INJURIES
A. MANAGEMENT
X. OUTPATIENT AND CLINIC TREATMENT
A. SELECTION
B. TREATMENT
C. FOLLOW-UP CARE
D. WOUNDS
XI. COMPLICATIONS OF BURN INJURIES
A. GASTROINTESTINAL
B. OCULAR
C. CUTANEOUS
D. MISCELLANEOUS
20 - Neurosurgical Emergencies
I. EVALUATION AND MANAGEMENT OF THE NEUROTRAUMA PATIENT
A. INITIAL ASSESSMENT
B. UNCONSCIOUS PATIENT
C. PHYSICAL EXAMINATION
D. RADIOLOGIC EVALUATION
II. CRANIAL TRAUMA
A. TRAUMATIC BRAIN INJURY
B. ELEVATED INTRACRANIAL PRESSURE
C. SPECIFIC TRAUMATIC CRANIAL INJURIES
D. PENETRATING TRAUMATIC BRAIN INJURY
E. TRAUMATIC BRAIN INJURY PROGNOSIS
III. SPINAL TRAUMA
A. GENERAL
B. ASSESSMENT
C. SPECIFIC SPINAL INJURIES
IV. PERIPHERAL NERVE TRAUMA
A. GENERAL
B. EVALUATION
C. TREATMENT
V. TRAUMATIC CEREBROVASCULAR INJURIES
B. BLUNT CEREBROVASCULAR INJURY
C. EVALUATION
D. TREATMENT
V - Gastrointestinal Surgery
21 - Acute Abdomen
I. PHYSIOLOGY OF ABDOMINAL PAIN
A. VISCERAL PAIN
B. SOMATIC PAIN
C. REFERRED PAIN
II. HISTORY
A. PAIN
B. VOMITING
C. BOWEL FUNCTION
D. MEDICAL HISTORY
E. MEDICATION
III. PHYSICAL EXAMINATION
A. GENERAL APPEARANCE
B. VITAL SIGNS
C. ABDOMINAL EXAMINATION
D. EXAMINATION OF PELVIC CAVITY
IV. LABORATORY EXAMINATION
A. WHITE BLOOD CELL COUNT
B. HEMATOCRIT
C. PLATELET COUNT
D. ELECTROLYTES
E. ARTERIAL BLOOD GAS
F. LIVER FUNCTION TESTS
G. AMYLASE LEVEL INCREASE
H. URINE STUDIES
I. TROPONINS
V. RADIOGRAPHIC EVALUATION
A. UPRIGHT CHEST RADIOGRAPH
B. ABDOMINAL RADIOGRAPH
C. ULTRASONOGRAPHY
D. COMPUTED TOMOGRAPHY SCAN
VI. INITIAL TREATMENT AND PREOPERATIVE PREPARATION
A. ASSESSMENT
B. DIET
C. INTRAVENOUS FLUIDS
D. HEMODYNAMIC MONITORING
E. NASOGASTRIC TUBE
F. FOLEY CATHETER
G. TREATMENT
22 - Abdominal Wall Hernias
I. HISTORICAL PERSPECTIVE
A. HENRY MARCY (1837–1924)
B. EDOARDO BASSINI (1844–1924)
C. SIR ASTLEY COOPER (1768–1841)
D. CHESTER MCVAY (1911–1987)
E. EDWARD EARLE SHOULDICE (1890–1965)
F. IRVING LICHTENSTEIN AND PARVIZ AMID
II. TERMINOLOGY
A. HERNIA
B. REDUCIBILITY
C. INCARCERATION
D. STRANGULATION
III. NATURAL HISTORY
A. INCIDENCE
IV. ANATOMIC CONSIDERATIONS
A. LAYERS OF THE ABDOMINAL WALL
B. INGUINAL CANAL
C. SPERMATIC CORD
D. PROCESSUS VAGINALIS
E. DEEP (INTERNAL) INGUINAL RING
F. SUPERFICIAL (EXTERNAL) INGUINAL RING
G. HESSELBACH TRIANGLE
H. INGUINAL (POUPART) LIGAMENT
I. ILIOPUBIC TRACT
J. LACUNAR (GIMBERNAT) LIGAMENT
K. PECTINEAL (COOPER) LIGAMENT
L. FEMORAL CANAL
M. INFERIOR LUMBAR (PETIT) TRIANGLE
N. SUPERIOR LUMBAR (GRYNFELTT) TRIANGLE
V. CLASSIFICATION OF HERNIAS
A. GROIN HERNIAS (FIG. 22.1)
B. VENTRAL HERNIAS
C. MISCELLANEOUS HERNIAS
VI. CAUSATIVE FACTORS
A. INDIRECT INGUINAL HERNIA
B. DIRECT INGUINAL HERNIA
C. FEMORAL HERNIA
D. CONTRIBUTING FACTORS
VII. DIAGNOSIS
A. HISTORY
B. EXAMINATION
C. SMALL BOWEL OBSTRUCTION
D. DIFFERENTIAL DIAGNOSIS OF GROIN MASS
E. REDUCTION OF INCARCERATED HERNIA
F. REDUCTION EN MASSE
VIII. PREOPERATIVE CONSIDERATIONS
A. PATIENT COMORBIDITIES AND RISK FACTORS
B. LAPAROSCOPIC VERSUS OPEN REPAIRS
IX. INGUINAL/FEMORAL HERNIA REPAIR
A. OPEN REPAIR
B. FEMORAL HERNIAS
C. LAPAROSCOPIC REPAIR
X. VENTRAL/UMBILICAL/INCISIONAL HERNIA REPAIR
A. OPEN REPAIR
B. LAPAROSCOPIC REPAIR
XI. POSTOPERATIVE COMPLICATIONS
A. RECURRENT HERNIA
B. INFECTION
C. BLEEDING
D. DYSEJACULATION
E. TESTICULAR ATROPHY
F. DIFFICULTY VOIDING
G. NEUROMA/NEURITIS
H. PAIN
I. URINARY RETENTION
23 - Gastrointestinal Bleeding
I. HISTORY
A. CHARACTERIZATION OF BLEEDING
B. CAUSATIVE FACTORS
C. ADDITIONAL MEDICAL HISTORY
II. PHYSICAL EXAMINATION
A. GENERAL APPEARANCE
B. VITAL SIGNS
C. SKIN
D. HEAD AND NECK
E. ABDOMEN
F. DIGITAL RECTAL EXAMINATION
III. INITIAL MANAGEMENT
A. ASSESS THE MAGNITUDE OF HEMORRHAGE
B. STABILIZE HEMODYNAMIC STATUS
C. MONITOR FOR CONTINUED BLOOD LOSS
IV. LABORATORY EVALUATION
A. TYPE AND CROSSMATCH
B. HEMOGLOBIN/HEMATOCRIT/RED BLOOD CELLS CHARACTERISTICS
C. PLATELET COUNT
D. PROTHROMBIN AND PARTIAL THROMBOPLASTIN TIMES
E. THROMBOELASTOGRAPHY
F. RENAL PROFILE
V. INVESTIGATIVE AND DIAGNOSTIC PROCEDURES
A. NASOGASTRIC TUBE
B. ENDOSCOPY
C. ANGIOGRAPHY
E. COMPUTED TOMOGRAPHY
VI. NONSURGICAL TREATMENT
A. ENDOSCOPIC
B. ELECTROCAUTERY
C. VASOPRESSIN INFUSION
D. EMBOLIZATION
VII. DISEASE-SPECIFIC THERAPY
A. ACUTE HEMORRHAGIC GASTRITIS
B. PEPTIC ULCER DISEASE
C. ESOPHAGOGASTRIC VARICES
D. MALLORY-WEISS TEAR
E. DIEULAFOY LESION (EXULCERATIO SIMPLEX)
F. NEOPLASM
G. DIVERTICULOSIS
H. ARTERIOVENOUS MALFORMATIONS
I. MECKEL DIVERTICULUM
J. BENIGN ANORECTAL DISEASE
K. AORTOENTERIC FISTULA
24 - Intestinal Obstruction
I. TERMINOLOGY
A. ILEUS
B. MECHANICAL OBSTRUCTION
C. SIMPLE OBSTRUCTION
D. CLOSED-LOOP OBSTRUCTION
E. STRANGULATION
II. CAUSATIVE FACTORS
A. SMALL BOWEL OBSTRUCTION
B. LARGE BOWEL OBSTRUCTION
D. ILEUS
III. PRESENTATION
A. HISTORY
B. PHYSICAL EXAMINATION
C. LABORATORY TESTS
IV. IMAGING
A. PLAIN FILMS
B. CONTRAST STUDIES
C. COMPUTED TOMOGRAPHY
V. MANAGEMENT
A. EXPECTANT/PREOPERATIVE MANAGEMENT (FIG. 24.2)
B. OPERATIVE MANAGEMENT
C. POSTOPERATIVE CARE
D. PARALYTIC ILEUS
VI. OUTCOMES
A. RECURRENCE
B. OPERATIVE MORTALITY
25 - Peptic Ulcer Disease
I. OCCURRENCE
II. PRESENTATION AND EVALUATION
A. SYMPTOMS
B. PHYSICAL EXAMINATION
C. LABORATORY STUDIES
D. DEFINITIVE DIAGNOSIS
E. MODIFIED JOHNSON CLASSIFICATION
III. PATHOGENESIS
IV. HELICOBACTER PYLORI
V. TREATMENT OF UNCOMPLICATED DISEASE
A. PREVENTION
B. EMPIRIC MEDICAL THERAPY
C. CONCERN FOR GASTRIC CANCER
D. SURGICAL THERAPY
VI. TREATMENT OF COMPLICATED DISEASE
A. CONCERN FOR GASTRIC CANCER
B. BLEEDING PEPTIC ULCER
C. PERFORATED PEPTIC ULCER
D. OBSTRUCTION
E. INTRACTABILITY—CURRENTLY RARE
VII. DETAILS OF SURGICAL OPTIONS
A. HIGHLY SELECTIVE VAGOTOMY (OR PROXIMAL GASTRIC OR PARIETAL CELL)
B. OMENTAL (GRAHAM) PATCH
C. VAGOTOMY AND DRAINAGE
D. VAGOTOMY AND ANTRECTOMY
E. DISTAL GASTRECTOMY
F. POSTOPERATIVE COMPLICATIONS
26 - Inflammatory Bowel Disease
I. INFLAMMATORY BOWEL DISEASE
A. ULCERATIVE COLITIS
B. CROHN DISEASE
C. INDETERMINATE COLITIS
D. ETIOLOGY
II. EXTRAINTESTINAL MANIFESTATIONS
A. CUTANEOUS
B. OCULAR
C. MUSCULOSKELETAL
D. HEPATOBILIARY
III. ULCERATIVE COLITIS
A. PATHOPHYSIOLOGY AND DISTRIBUTION
B. EPIDEMIOLOGY
C. CLINICAL MANIFESTATIONS
D. DIAGNOSIS
E. COMPLICATIONS
F. MEDICAL MANAGEMENT
G. SURGICAL MANAGEMENT
H. PROGNOSIS
IV. CROHN DISEASE
A. EPIDEMIOLOGY
B. PATHOPHYSIOLOGY AND DISTRIBUTION
C. CLINICAL MANIFESTATIONS
D. DIAGNOSIS
E. COMPLICATIONS
F. MEDICAL MANAGEMENT (SEE SECTION III.G)
G. SURGICAL MANAGEMENT
H. PROGNOSIS
V. INDETERMINATE COLITIS
A. TYPICALLY PRESENT WITH SYMPTOMS SIMILAR TO ULCERATIVE COLITIS
27 - Benign Esophageal Disease
I. ANATOMY
A. GENERAL DESCRIPTION
B. BLOOD SUPPLY AND NERVES
C. HISTOLOGY
II. PHYSIOLOGY
A. SWALLOWING MECHANISM
B. SPHINCTERS
III. MOTILITY DISORDERS
A. ACHALASIA
B. DIFFUSE ESOPHAGEAL SPASM
C. NUTCRACKER ESOPHAGUS
D. HYPERTENSIVE LES
E. SCLERODERMA
IV. DIVERTICULA
A. DEFINITION
B. PHARYNGOESOPHAGEAL (ZENKER DIVERTICULUM)
C. MIDESOPHAGEAL
D. EPIPHRENIC
V. GASTROESOPHAGEAL REFLUX
A. ANATOMY
B. PATHOPHYSIOLOGY
C. DIAGNOSIS
D. TREATMENT
E. HIATAL HERNIA
F. BARRETT ESOPHAGUS
VI. BENIGN TUMORS OF THE ESOPHAGUS
A. LEIOMYOMA
B. OTHER BENIGN LESIONS
VII. ESOPHAGEAL RUPTURE AND PERFORATION
A. CAUSATIVE FACTORS
B. CLINICAL PRESENTATION
C. DIAGNOSIS
D. TREATMENT
VIII. CAUSTIC INJURY
A. BACKGROUND
B. CLINICAL PRESENTATION
C. DIAGNOSIS
D. TREATMENT
28 - Benign Colorectal Disease
I. ANATOMY
A. RECTUM
B. ANAL CANAL
C. LEVATOR ANI MUSCLE
D. BLOOD SUPPLY AND LYMPHATIC DRAINAGE
II. HEMORRHOIDS
A. SIGNS AND SYMPTOMS
B. DIAGNOSIS
C. MEDICAL TREATMENT
D. OFFICE TREATMENT
E. SURGICAL HEMORRHOIDECTOMY
III. ANAL FISSURE
A. OVERVIEW
B. SIGNS AND SYMPTOMS
C. TREATMENT
IV. ANORECTAL ABSCESS
A. CLASSIFICATION (BASED ON LOCATION)
B. SIGNS AND SYMPTOMS
C. TREATMENT
V. FISTULA IN ANO
A. GENERAL
B. CLASSIFICATION
C. GOODSALL RULE
D. SIGNS AND SYMPTOMS
E. TREATMENT
VI. PILONIDAL DISEASE
A. GENERAL
B. TREATMENT
VII. ANAL AND PERIANAL INFECTIONS
A. CONDYLOMATA ACUMINATA
B. ANORECTAL HERPES
C. GONOCOCCAL PROCTITIS
VIII. PRURITUS ANI
A. ETIOLOGY
B. DIAGNOSIS
C. TREATMENT
IX. ANAL NEOPLASM
A. TUMORS OF THE ANAL CANAL
X. RECTAL PROLAPSE
A. CLASSIFICATION
B. CLINICAL FEATURES
C. EVALUATION
D. TREATMENT OPTIONS
XI. ANOSCOPY
A. GENERAL
B. TECHNIQUE
XII. RIGID SIGMOIDOSCOPY
A. GENERAL
B. TECHNIQUE
29 - Appendix
I. OVERVIEW
A. ANATOMY
B. FUNCTION
II. EPIDEMIOLOGY
A. GENERAL
B. MORBIDITY AND MORTALITY
III. PATHOPHYSIOLOGY
A. GENERAL
B. COMPLICATIONS
IV. PRESENTATION
A. HISTORY
B. PHYSICAL EXAMINATION
C. LABORATORY AND RADIOLOGIC FINDINGS
V. DIFFERENTIAL DIAGNOSIS
VI. COMPLICATIONS
A. PERFORATION
B. PERITONITIS
C. ABSCESS
VII. TREATMENT
A. GENERAL
B. TECHNIQUE
C. LAPAROSCOPY
D. FUTURE RESEARCH
VIII. SPECIAL CIRCUMSTANCES
A. OLDER ADULTS
B. INFANTS
C. PREGNANCY
IX. APPENDICEAL TUMORS
A. CARCINOID
B. ADENOCARCINOMA
C. PSEUDOMYXOMA
30 - Benign Pancreatic Disease
I. ANATOMY
A. EMBRYOLOGY
B. HISTOLOGY
C. GROSS ANATOMY
D. VASCULAR/LYMPHATIC ANATOMY
E. DUCT SYSTEM
II. ACUTE PANCREATITIS
A. BASICS
B. PATHOGENESIS
C. ETIOLOGY/RISK FACTORS
D. DIAGNOSIS
E. TREATMENT
F. PROGNOSIS
G. COMPLICATIONS
III. CHRONIC PANCREATITIS
A. BASICS
B. ETIOLOGY
C. DIAGNOSIS
D. TREATMENT
E. COMPLICATIONS
31 - Surgical Diseases of the Spleen
I. ANATOMY
A. AVERAGE ADULT SPLEEN
B. ENCAPSULATED
C. SPLENOMEGALY DEFINITION
D. BLOOD SUPPLY
E. STRUCTURAL SUPPORT
F. MICROANATOMY
G. ACCESSORY SPLEENS
II. FUNCTION
A. HEMATOLOGIC
B. IMMUNOLOGIC
III. GENERAL INDICATIONS FOR SPLENECTOMY
A. TRAUMA
B. RED BLOOD CELL DISORDERS
C. MYELOPROLIFERATIVE DISORDERS
D. WHITE BLOOD CELLS DISORDERS
E. PLATELET DISORDERS
F. OTHER SPLENIC DISORDERS
IV. SURGICAL TECHNIQUES
A. OPEN SPLENECTOMY
B. LAPAROSCOPIC SPLENECTOMY
C. HAND-ASSISTED TECHNIQUE
V. POSTSPLENECTOMY CONSIDERATIONS
A. OVERWHELMING POSTSPLENECTOMY INFECTION
B. POSTSPLENECTOMY HEMATOLOGIC CHANGES
C. HEMORRHAGE
D. INFECTION
E. PORTAL VEIN THROMBOSIS
F. PANCREATITIS, PSEUDOCYST, FISTULA
32 - Bariatric Surgery
I. EPIDEMIOLOGY OF MORBID OBESITY
A. DEFINITIONS
B. CAUSES OF OBESITY
C. EPIDEMIOLOGY
II. COMORBIDITY ASSOCIATED WITH MORBID OBESITY
A. NEOPLASIA
B. CARDIOVASCULAR DISEASE
C. PULMONARY DISEASE
D. ENDOCRINE DISEASE
E. GASTROINTESTINAL DISEASE
F. OTHER COMORBIDITIES ASSOCIATED WITH MORBID OBESITY
III. MEDICAL THERAPY FOR MORBID OBESITY
IV. TYPES OF PROCEDURES
A. MALABSORPTIVE OPERATIONS
B. RESTRICTIVE OPERATIONS
C. COMBINED OPERATIONS ARE RESTRICTIVE AND MALABSORPTIVE
V. PREOPERATIVE WORK-UP
A. PATIENT SELECTION CRITERIA
B. PREOPERATIVE ASSESSMENT—MULTIDISCIPLINARY APPROACH
C. CONTRAINDICATIONS
VI. SURGICAL PROCEDURES FOR THE BARIATRIC PATIENT
A. LAPAROSCOPIC SLEEVE GASTRECTOMY
B. LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS
C. LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING
D. JEJUNOILEAL BYPASS
E. VERTICAL BANDED GASTROPLASTY
F. BILIOPANCREATIC DIVERSION
VII. RESULTS OF BARIATRIC SURGERY
A. SURGICAL THERAPY
B. RISK REDUCTION
E. WEIGHT LOSS
VI - Surgical Oncology
33 - Tumor Biology, Syndromes, and Genetic Mutations
I. SELF-SUFFICIENCY IN GROWTH SIGNALS
A. GROWTH FACTORS
B. ALTERATION OF GROWTH SIGNALING PATHWAYS
C. SOS/RAS/RAF/MITOGEN-ACTIVATED PROTEIN KINASE PATHWAY
D. TUMOR GROWTH IS DEPENDENT ON MANY FACTORS
II. INSENSITIVITY TO GROWTH-INHIBITORY SIGNALS
A. RETINOBLASTOMA PROTEIN
III. EVASION OF PROGRAMMED CELL DEATH
A. P53 TUMOR-SUPPRESSOR PROTEIN
B. EXTRINSIC APOPTOSIS INDUCTION
IV. LIMITLESS REPLICATIVE POTENTIAL
V. SUSTAINED ANGIOGENESIS
VI. TISSUE INVASION AND METASTASIS
A. TETHERING MOLECULES ARE ALTERED
B. PROTEASES DEGRADE EXTRACELLULAR MATRICES
VII. GENETIC INSTABILITY
A. THE PREVIOUS SIX (I–VI) CHARACTERISTICS MUST BE OBTAINED THROUGH GENETIC ALTERATION
B. MALFUNCTION OF THE “CARETAKER” SYSTEM
VIII. FAMILIAL CANCER SYNDROMES
A. FAMILIAL ADENOMATOUS POLYPOSIS
B. HEREDITARY BREAST-OVARIAN CANCER SYNDROMES
D. LI-FRAUMENI SYNDROME
E. MULTIPLE ENDOCRINE NEOPLASIA
F. VON HIPPEL-LINDAU DISEASE
G. COWDEN SYNDROME
H. HEREDITARY DIFFUSE GASTRIC CANCER
I. PEUTZ-JEGHERS SYNDROME
IX. PHARMACOTHERAPY
A. TUMOR GROWTH AND KINETICS
B. DRUG MECHANISMS AND THERAPEUTICS
X. CHEMOTHERAPEUTIC AGENTS: MECHANISMS, USES, AND IMPORTANT TOXICITIES
A. ALKYLATING AGENTS
B. ANTIMETABOLITES
C. ANTITUMOR ANTIBIOTICS
D. MITOTIC INHIBITORS
E. HORMONAL AGENTS
F. IMMUNOTHERAPY
G. MISCELLANEOUS
RECOMMENDED READINGS
34 - Head and Neck Malignancy
I. EPIDEMIOLOGY
II. WORK-UP OF A NECK MASS
III. NECK DISSECTION
IV. TREATMENT OF CANCER BY SITE
A. CARCINOMA OF THE ORAL CAVITY AND LIP
B. OROPHARYNGEAL CARCINOMA
C. LARYNGEAL CANCER
D. HYPOPHARYNGEAL
E. NASOPHARYNGEAL CARCINOMA
F. SALIVARY GLAND TUMORS
V. NECK DISSECTION INDICATIONS FOR SALIVARY GLAND MALIGNANCY
A. RARER SITES OF CARCINOMA
35 - Esophageal Malignancy
I. ESOPHAGEAL ANATOMY
II. EPIDEMIOLOGY
III. HISTOLOGY AND RISK FACTORS
IV. DIAGNOSIS AND STAGING
V. TNM STAGING SYSTEM
VI. TREATMENT PLANNING
A. IMPLICATIONS FOR THERAPY
VII. ESOPHAGECTOMY
VIII. ESOPHAGECTOMY APPROACHES
IX. ENDOSCOPIC THERAPIES
X. CHEMOTHERAPY AND RADIOTHERAPY
XI. PALLIATIVE CARE
A. DYSPHAGIA AND OBSTRUCTION
B. ESOPHAGEAL-AIRWAY FISTULA
36 - Gastric Malignancy
I. ADENOCARCINOMA OF THE STOMACH
A. EPIDEMIOLOGY
B. RISK FACTORS
C. PATHOLOGIC CLASSIFICATIONS
D. CLINICAL MANIFESTATIONS
E. SCREENING
F. DIAGNOSIS/STAGING
I. SURGICAL TREATMENT
J. NEOADJUVANT/ADJUVANT THERAPY
K. PROGNOSIS (5-YEAR SURVIVAL)
II. GASTRIC LYMPHOMA
A. GENERAL CONSIDERATIONS
B. CLINICAL PRESENTATION
C. PATHOLOGY
D. DIAGNOSIS
E. TREATMENT
III. GASTROINTESTINAL STROMAL TUMORS
A. GENERAL CONSIDERATIONS
B. OTHER CHARACTERISTICS
C. DIAGNOSIS
D. PATHOLOGIC LESIONS
E. TREATMENT
37 - Small Bowel Malignancy
I. EPIDEMIOLOGY
A. INCIDENCE
B. TUMOR CHARACTERISTICS
C. GENETIC PREDISPOSITION AND PATHOGENESIS
II. DIAGNOSIS
III. STAGING
A. ADENOCARCINOMA
B. LYMPHOMA
C. SARCOMA AND CARCINOID TUMORS
IV. MANAGEMENT
A. SURGERY
B. CHEMOTHERAPY
38 - Malignant Colorectal and Perianal Disease
I. COLORECTAL CANCER: EPIDEMIOLOGY
A. EACH YEAR IN THE UNITED STATES, 135,000 CASES OF COLORECTAL CANCER WILL BE DIAGNOSED
B. ALMOST 50,000 PEOPLE DIE OF COLORECTAL CANCER ANNUALLY IN THE UNITED STATES.
II. RISK FACTORS
III. SIGNS AND SYMPTOMS
IV. SCREENING GUIDELINES FOR COLORECTAL CANCER
A. AVERAGE-RISK PATIENT, STARTING AT AGE 50–75 YEARS—ANY OF THE FOLLOWING SCREENING MODALITIES ARE ACCEPTED
C. FAMILIAL ADENOMATOUS POLYPOSIS
D. HEREDITARY NONPOLYPOSIS COLORECTAL CANCER
E. FAMILY HISTORY
V. POLYPS
VI. PATHOGENESIS
A. LOSS OF HETEROZYGOSITY PATHWAY—80% OF CASES
B. REPLICATION ERROR REPAIR PATHWAY—20% OF CASES
C. ADENOMATOUS POLYPOSIS SYNDROMES
D. NONADENOMATOUS POLYPOSIS SYNDROMES
E. NONPOLYPOSIS SYNDROMES
VII. PREOPERATIVE EVALUATION
A. COMPLETE HISTORY
B. COLONOSCOPY
C. RECTAL CANCER
D. CARCINOEMBRYONIC ANTIGEN
VIII. TREATMENT OF COLON CANCER
A. GENERAL PRINCIPLES
B. SURGICAL THERAPY FOR RESECTABLE MASSES
C. CHEMOTHERAPEUTIC REGIMENS
D. STAGE-SPECIFIC THERAPY
IX. RECTAL CANCER
A. STAGE-SPECIFIC THERAPY
B. OPERATIVE APPROACH
C. CHEMOTHERAPEUTIC REGIMENS
X. POSTOPERATIVE FOLLOW-UP
A. DIAGNOSIS AND TREATMENT
B. TREATMENT OF LOCAL RECURRENT DISEASE
XI. ANAL CANCER
XII. TUMORS OF THE ANAL CANAL
XIII. SIGNS AND SYMPTOMS
XIV. SCREENING
XV. ANATOMY AND CHARACTERIZATION
A. ANAL TUMORS ARE CLASSIFIED INTO TWO GROUPS
B. ANATOMY
XVI. TUMORS OF THE ANAL CANAL
A. ANAL INTRAEPITHELIAL NEOPLASIA
C. DIAGNOSIS
D. STAGING
E. TREATMENT
F. ADENOCARCINOMA OF THE ANAL CANAL
XVII. TUMORS OF THE ANAL MARGIN
A. SQUAMOUS CELL CARCINOMA
B. DIAGNOSIS AND STAGING
C. TREATMENT
XVIII. MALIGNANT MELANOMA OF THE ANAL MARGIN/CANAL
A. DIAGNOSIS AND STAGING
B. TREATMENT
39 - Malignant Pancreas Disease
I. PANCREATIC ADENOCARCINOMA
A. EPIDEMIOLOGY
B. CAUSATIVE FACTORS
C. PATHOLOGY
D. PRESENTATION
E. DIAGNOSTIC EVALUATION/STAGING
F. SURGICAL THERAPY/RESECTABILITY
G. NEOADJUVANT THERAPY
H. ADJUVANT THERAPY
I. SURVEILLANCE
J. SURVIVAL
II. PREMALIGNANT CYSTIC NEOPLASMS OF THE PANCREAS
A. MUCINOUS CYSTIC NEOPLASMS (MCNS)
B. INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS
40 - Diseases of the Breast
I. ANATOMY AND PHYSIOLOGY
A. ANATOMY BASICS
B. LYMPHATIC DRAINAGE
C. NERVES
D. BLOOD SUPPLY
E. PHYSIOLOGY
II. HISTORY
A. AGE
B. MASS
C. NIPPLE DISCHARGE (TABLE 40.1)
D. BREAST PAIN (MASTODYNIA)
E. GYNECOLOGIC HISTORY
F. MEDICAL HISTORY
G. SURGICAL HISTORY
H. FAMILY HISTORY
I. CONSTITUTIONAL SYMPTOMS
III. PHYSICAL EXAMINATION
A. INSPECTION
B. PALPATION
C. SCREENING
IV. RADIOGRAPHIC STUDIES
A. MAMMOGRAPHY
B. MAMMOGRAPHIC FINDINGS SUGGESTIVE OF MALIGNANCY
C. ULTRASONOGRAPHY
D. MAGNETIC RESONANCE IMAGING
E. DIGITAL BREAST TOMOSYNTHESIS
V. EVALUATION OF BREAST MASS
A. NIPPLE DISCHARGE
B. PALPABLE LESIONS
C. FINE-NEEDLE ASPIRATION BIOPSY
D. CORE NEEDLE BIOPSY (PERCUTANEOUS)
E. EXCISIONAL BIOPSY
VI. BENIGN BREAST DISEASE
A. GALACTORRHEA
B. FIBROCYSTIC CHANGES
C. FIBROADENOMA
D. PHYLLODES TUMOR AND CYSTOSARCOMA PHYLLODES
E. INTRADUCTAL PAPILLOMA
F. FAT NECROSIS
G. PLASMA CELL MASTITIS AND PERIDUCTAL MASTITIS
H. GALACTOCELE
I. MASTITIS AND BREAST ABSCESS
J. MONDOR DISEASE
K. GYNECOMASTIA
L. POLAND SYNDROME
VII. BREAST CANCER
A. EPIDEMIOLOGY
B. RISK FACTORS
C. CLINICAL PRESENTATION
D. TNM CLASSIFICATION
E. STAGING
F. PATHOLOGIC LESIONS
G. SURGICAL TREATMENT OPTIONS
H. SURGICAL TREATMENT BY STAGE
I. RADIOTHERAPY TO CHEST AND BREAST
J. CHEMOTHERAPY AND HORMONAL THERAPY
K. BREAST CANCER AND PREGNANCY
L. MALE BREAST CANCER
41 - Malignant Skin Lesions
I. BASAL CELL CARCINOMA
A. GENERAL
B. DIAGNOSIS
C. TREATMENT
II. SQUAMOUS CELL CARCINOMA
A. GENERAL
B. DIAGNOSIS
C. TREATMENT
III. MALIGNANT MELANOMA
A. GENERAL
B. CLINICAL PRESENTATION
C. TYPES OF MELANOMA
D. PROGNOSTIC FACTORS
E. STAGING
F. DIAGNOSIS
G. TREATMENT
IV. MERKEL CELL CARCINOMA
A. GENERAL
B. TREATMENT
VII - Hepatobiliary Surgery
42 - Benign Gallbladder and Biliary Tree
I. ANATOMY
A. GALLBLADDER
B. BILE DUCTS
C. ANOMALIES
II. CHOLELITHIASIS
A. INCIDENCE
B. CAUSATIVE FACTORS
C. TYPES OF GALLSTONES
D. TREATMENT OF ASYMPTOMATIC CHOLELITHIASIS
III. SYMPTOMATIC CHOLELITHIASIS
A. BILIARY COLIC
B. ACUTE CALCULOUS CHOLECYSTITIS
IV. CHOLEDOCHOLITHIASIS
A. CAUSATIVE FACTORS AND NATURAL HISTORY
B. TREATMENT
V. CHOLANGITIS
A. CAUSATIVE FACTORS AND PATHOPHYSIOLOGY
B. CLINICAL FEATURES AND DIAGNOSIS
C. TREATMENT
VI. ACALCULOUS CHOLECYSTITIS
A. EPIDEMIOLOGY AND PATHOGENESIS
B. NATURAL HISTORY
C. CLINICAL MANIFESTATION AND DIAGNOSIS
D. TREATMENT
VII. OTHER DISORDERS OF THE GALLBLADDER
A. GALLSTONE DISEASE IN PREGNANCY
B. BILIARY DYSKINESIA
C. BILIARY SLUDGE
D. MIRIZZI SYNDROME
E. GALLSTONE ILEUS
F. EMPHYSEMATOUS CHOLECYSTITIS
G. CALCIFIED “PORCELAIN” GALLBLADDER
VIII. MEDICAL TREATMENTS
A. ORAL DISSOLUTION THERAPY
B. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
IX. LAPAROSCOPIC CHOLECYSTECTOMY
A. SETUP
B. TECHNIQUE (FIGS. 42.1 AND 42.2)
C. POSTOPERATIVE CARE
D. COMPLICATIONS
43 - Malignant Gallbladder and Biliary Tree
I. GALLBLADDER CANCER
A. GENERAL CONSIDERATIONS
B. PRESENTATION
C. TREATMENT
II. BILE DUCT CANCER (CHOLANGIOCARCINOMA)
A. GENERAL CONSIDERATIONS
B. INTRAHEPATIC CHOLANGIOCARCINOMA
C. EXTRAHEPATIC CHOLANGIOCARCINOMA
44 - Benign Liver Disease, Cirrhosis, and Portal Hypertension
I. PATHOPHYSIOLOGY
II. MORPHOLOGY
III. ETIOLOGY
IV. DIAGNOSIS
V. CLASSIFICATION
VI. CONSEQUENCES OF CIRRHOSIS
VII. HEPATIC SYNDROMES
45 - Liver Tumors
VIII - Transplant Surgery
46 - Renal Transplantation
I. GENERAL CONSIDERATIONS
A. HISTORY AND EPIDEMIOLOGY
B. IMMUNOLOGY OF RENAL TRANSPLANTATION
C. IMMUNOSUPPRESSION
II. EVALUATION OF CANDIDATES FOR TRANSPLANTATION
A. INDICATIONS
C. RELATIVE CONTRAINDICATIONS
D. PATIENT EVALUATION
E. INDICATION FOR PRETRANSPLANT NATIVE NEPHRECTOMY
III. KIDNEY DONATION
A. LIVING DONOR KIDNEY TRANSPLANTATION
B. CLASSICALLY DEFINED DONOR CATEGORIES
IV. SPECIFIC OPERATIVE CONSIDERATIONS
A. LIVING DONOR NEPHRECTOMY
B. TRANSPLANT PROCEDURE
V. POSTOPERATIVE CONSIDERATIONS
A. POSTOPERATIVE CARE
B. ASSESSMENT OF GRAFT FUNCTION
C. COMPLICATIONS
VI. OUTCOMES
A. SURVIVAL BENEFIT OF RENAL TRANSPLANTATION
B. SURVIVAL
47 - Liver Transplantation
I. GENERAL CONSIDERATIONS
A. HISTORY
B. INDICATIONS AND LISTING PROCESS FOR TRANSPLANTATION
C. SPECIFIC INDICATIONS
D. CONTRAINDICATIONS
E. ORGAN SELECTION
II. SPECIFIC OPERATIVE CONSIDERATIONS
A. TRADITIONAL OPERATIVE TECHNIQUE
B. PIGGYBACK TECHNIQUE
C. LIVING DONOR HEPATECTOMY
III. POSTOPERATIVE CONSIDERATIONS
A. POSTOPERATIVE CARE
B. IMMUNOSUPPRESSION (PROTOCOLS VARY BY INSTITUTION)
C. ASSESSMENT OF GRAFT FUNCTION
D. COMPLICATIONS
48 - Pancreas Transplantation
I. GENERAL CONSIDERATIONS
A. HISTORY AND EPIDEMIOLOGY
B. INDICATIONS FOR PANCREAS TRANSPLANTATION
C. TYPES OF PANCREAS TRANSPLANTS
D. ORGAN SELECTION
II. SPECIFIC OPERATIVE CONSIDERATIONS
A. TRANSPLANT ANATOMY
B. MANAGEMENT OF EXOCRINE SECRETIONS
III. POSTOPERATIVE CONSIDERATIONS
A. POSTOPERATIVE CARE
B. COMPLICATIONS
C. OUTCOMES
IV. ISLET CELL TRANSPLANTATION
A. BACKGROUND
B. INDICATIONS
C. TECHNIQUE
D. OUTCOMES
V. PANCREAS VERSUS ISLET CELL TRANSPLANTATION
IX - Endocrine Surgery
49 - Thyroid
I. EMBRYOLOGY
A. THYROID DEVELOPMENT
B. DEVELOPMENTAL ANOMALIES
II. ANATOMY
A. OVERVIEW
B. ARTERIAL SUPPLY
C. VENOUS DRAINAGE
D. NERVES
E. LYMPHATICS
F. HISTOLOGY
III. PHYSIOLOGY
A. IODINE METABOLISM
B. THYROID HORMONE SYNTHESIS
C. THYROID HORMONE FUNCTION
D. THYROID HORMONE REGULATION
E. CALCITONIN
IV. WORK-UP OF THYROID DISEASE
A. CLINICAL PRESENTATION
B. LABORATORY DATA
C. IMAGING
D. BIOPSY
V. HYPERTHYROIDISM
A. DIFFUSE TOXIC GOITER—GRAVES DISEASE
B. TOXIC ADENOMA—PLUMMER DISEASE
C. TOXIC MULTINODULAR GOITER
D. THYROID STORM
VI. HYPOTHYROIDISM
A. CHRONIC LYMPHOCYTIC THYROIDITIS—HASHIMOTO THYROIDITIS
VII. THYROIDITIS AND NONTOXIC GOITERS
A. ACUTE SUPPURATIVE THYROIDITIS
B. SUBACUTE THYROIDITIS
C. RIEDELS THYROIDITIS (INVASIVE FIBROUS THYROIDITIS)
D. NONTOXIC GOITER
VIII. THYROID NODULES
A. CLINICAL PRESENTATION
B. CLINICAL EVALUATION
C. MANAGEMENT BASED ON FINE-NEEDLE ASPIRATION RESULTS
D. CYSTIC NODULES
E. INCIDENTALOMA
IX. THYROID NEOPLASMS
A. EPIDEMIOLOGY
B. PAPILLARY THYROID CARCINOMA
C. FOLLICULAR THYROID CARCINOMA
D. HÜRTHLE CELL CARCINOMA
E. MEDULLARY THYROID CANCER
F. ANAPLASTIC THYROID CANCER
G. THYROID LYMPHOMA
H. ADJUVANT THERAPY
50 - Parathyroid
I. PARATHYROID EMBRYOLOGY AND ANATOMY
A. EMBRYOLOGY
B. ANATOMY
C. PHYSIOLOGY
II. PRIMARY HYPERPARATHYROIDISM
A. GENERAL
B. CAUSATIVE FACTORS
C. PRESENTATION
D. DIAGNOSIS
E. MANAGEMENT
III. SECONDARY HYPERPARATHYROIDISM
A. CAUSATIVE FACTORS
B. SYMPTOMS
C. TREATMENT
IV. TERTIARY HYPERPARATHYROIDISM
A. CAUSATIVE FACTOR
B. SYMPTOMS
C. TREATMENT
V. PARATHYROID CARCINOMA
51 - Adrenal Gland
I. EMBRYOLOGY AND ANATOMY
A. GENERAL
B. ARTERIAL SUPPLY
C. VENOUS DRAINAGE
D. CORTEX
E. MEDULLA
II. ZONA GLOMERULOSA—MINERALOCORTICOIDS
A. PHYSIOLOGY
B. PRIMARY ALDOSTERONISM/CONN SYNDROME
III. ZONA FASICULATA—GLUCOCORTICOIDS
A. PHYSIOLOGY
B. CUSHING SYNDROME
IV. ZONA RETICULARIS—ANDROGENS
A. PHYSIOLOGY
B. ANDROGEN-BASED TUMORS
V. ADRENOCORTICAL CANCER
A. PHYSIOLOGY
B. PHEOCHROMOCYTOMA—CATECHOLAMINE-SECRETING TUMOR
VI. ADRENAL MEDULLA
A. PHYSIOLOGY
B. PHEOCHROMOCYTOMA—CATECHOLAMINE-SECRETING TUMOR
VII. INCIDENTALOMA
A. EPIDEMIOLOGY
B. CLINICAL EVALUATION
C. MANAGEMENT
VIII. ADRENAL INSUFFICIENCY
A. PATHOPHYSIOLOGY AND CLINICAL PRESENTATION
B. DIAGNOSIS
C. TREATMENT
IX. ADRENAL SURGERY
A. ADRENLAECTOMY
B. OPEN ADRENALECTOMY
C. LAPAROSCOPIC ADRENALECTOMY
52 - Neuroendocrine Tumors
I. NEUROENDOCRINE TUMORS
A. DEMOGRAPHICS
C. LOCATION
D. PRESENTATION
E. STAGING AND LOCALIZATION
F. MANAGEMENT
II. GASTRINOMA
A. DEMOGRAPHICS
B. LOCATION
C. PRESENTATION
D. DIAGNOSIS
E. MANAGEMENT
III. INSULINOMA
A. DEMOGRAPHICS
B. PRESENTATION
C. DIAGNOSIS
D. MANAGEMENT
IV. GLUCAGONOMA
A. DEMOGRAPHICS
B. PRESENTATION
C. DIAGNOSIS
D. MANAGEMENT
V. VASOACTIVE INTESTINAL POLYPEPTIDOMA, VIPOMA
A. DEMOGRAPHICS
B. PRESENTATION
C. DIAGNOSIS
D. MANAGEMENT
VI. SOMATOSTATINOMA
A. DEMOGRAPHICS
B. PRESENTATION
C. DIAGNOSIS
D. MANAGEMENT
VII. PANCREATIC POLYPEPTIDOMAS
A. DEMOGRAPHICS
B. PRESENTATION
C. DIAGNOSIS
D. MANAGEMENT
X - Vascular Surgery
53 - Thromboembolic Disease
I. INTRODUCTION
A. EPIDEMIOLOGY
B. CAUSATIVE FACTORS
D. CLINICAL PRESENTATION
E. DIFFERENTIAL DIAGNOSES
F. DIAGNOSIS
G. SEQUELAE
II. METHODS OF PROPHYLAXIS AND TREATMENT OF DEEP VENOUS THROMBOSES AND PULMONARY EMBOLI
A. DEEP VEIN THROMBOSIS PROPHYLAXIS
B. TREATMENT OF DEEP VEIN THROMBOSIS AND PULMONARY EMBOLI
C. PROPHYLACTIC INFERIOR VENA CAVA FILTER PLACEMENT
III. AN APPROACH TO PROPHYLAXIS
A. DETERMINE THE PATIENT’S RISK FACTORS
B. PROPHYLAXIS OF CHOICE
IV. APPROACH TO THE PATIENT WITH PULMONARY EMBOLUS
A. PHYSIOLOGY
D. SURGICAL TREATMENT OPTIONS
54 - Aneurysms
I. EPIDEMIOLOGY
A. GENERAL
B. CASE REPORT
C. RISK FACTORS
D. CAUSATIVE FACTORS
II. PATHOLOGY
A. LOCATION
B. CHARACTERISTICS
C. ASSOCIATED MANIFESTATIONS OF DIFFUSE ATHEROSCLEROSIS
III. NATURAL HISTORY
A. GENERAL CONSIDERATIONS
B. STATISTICS
IV. CLINICAL PRESENTATION
A. SYMPTOMS
B. PHYSICAL EXAMINATION
V. DIAGNOSTIC STUDIES
A. PLAIN FILMS
B. B-MODE ULTRASOUND
C. COMPUTED TOMOGRAPHY SCAN
D. MAGNETIC RESONANCE IMAGING
E. AORTOGRAPHY
VI. ELECTIVE MANAGEMENT OF ABDOMINAL AORTIC ANEURYSM
A. OPERATIVE INDICATIONS
B. PREOPERATIVE WORK-UP
C. PREOPERATIVE PREPARATION
VII. OPEN ABDOMINAL AORTIC ANEURYSM REPAIR
A. APPROACH
B. OPERATIVE STEPS
C. INTRAOPERATIVE PROBLEMS
D. PROSTHETIC GRAFT
E. POSTOPERATIVE COURSE
VIII. COMPLICATIONS
A. LOWER EXTREMITY ISCHEMIA
B. CARDIAC EVENTS
C. RENAL INSUFFICIENCY
D. STROKE
E. COLONIC ISCHEMIA
F. SPINAL CORD ISCHEMIA
G. SEXUAL DYSFUNCTION
H. LATE COMPLICATIONS
IX. ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR
A. INDICATIONS
B. PROCEDURE
C. LONG-TERM CARE
D. COMPLICATIONS
E. OUTCOMES
X. OPERATIVE MORTALITY
A. OPEN REPAIR
B. ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR
XI. RUPTURED ABDOMINAL AORTIC ANEURYSM
A. SYMPTOMS
B. PRINCIPLES OF MANAGEMENT
XII. ABDOMINAL AORTIC ANEURYSM SCREENING (TABLE 54.3)
A. ULTRASOUND
55 - Peripheral Vascular Disease
I. DEFINITIONS
II. PERIPHERAL ARTERIAL DISEASE
A. EPIDEMIOLOGY
B. RISK FACTORS
C. NATURAL HISTORY
D. PATHOPHYSIOLOGY
E. SYMPTOMS
F. PHYSICAL EXAMINATION FINDINGS
G. LAB WORK
H. DIAGNOSTIC STUDIES
III. MANAGEMENT OF ATHEROSCLEROTIC PERIPHERAL ARTERIAL DISEASE
A. MEDICAL MANAGEMENT
B. REVASCULARIZATION THERAPY
C. CRITICAL LIMB ISCHEMIA
D. ACUTE LIMB ISCHEMIA
IV. RENAL ARTERY DISEASE
A. EPIDEMIOLOGY
B. NATURAL HISTORY
C. CLINICAL CONSEQUENCE
D. PATHOPHYSIOLOGY
E. DIAGNOSIS
F. RENAL ARTERY ANEURYSMS
V. LOWER EXTREMITY ANEURYSM DISEASE
A. EPIDEMIOLOGY
B. NATURAL HISTORY
C. FEMORAL ARTERY ANEURYSMS
D. POPLITEAL ARTERY ANEURYSMS
E. FEMORAL ARTERY PSEUDOANEURYSM
F. MYCOTIC ANEURYSMS
VI. CHRONIC VENOUS INSUFFICIENCY
A. OVERVIEW
B. DIAGNOSIS
C. MANAGEMENT
56 - Carotid Disease
I. BACKGROUND: STROKE
II. DIAGNOSIS
A. HISTORY
B. PHYSICAL EXAMINATION
C. IMAGING
III. DIFFERENTIAL DIAGNOSIS OF STROKE/TRANSIENT ISCHEMIC ATTACKS
A. ATHEROSCLEROTIC DISEASE
B. FIBROMUSCULAR DYSPLASIA
C. COILS AND KINKS BECAUSE OF ANATOMIC VARIATION
D. CAROTID ANEURYSMS
E. CAROTID DISSECTION
F. RADIATION ARTERITIS
G. TAKAYASU ARTERITIS
H. GIANT CELL ARTERITIS
IV. MANAGEMENT
A. MEDICAL
B. SURGICAL—CAROTID ENDARTERECTOMY
C. ENDOVASCULAR—CAROTID ARTERY STENTING
V. POSTOPERATIVE COMPLICATIONS
A. CARDIOVASCULAR
B. NEUROLOGIC
VI. POSTOPERATIVE CARE
57 - Mesenteric Ischemia
I. ANATOMY AND PHYSIOLOGY
A. VASCULAR SUPPLY
B. COLLATERAL VESSELS
C. PHYSIOLOGY
II. EPIDEMIOLOGY
III. ACUTE MESENTERIC ISCHEMIA
A. RISK FACTORS
B. CLINICAL PRESENTATION
C. CAUSATIVE FACTORS
D. DIAGNOSIS
E. MANAGEMENT
IV. CHRONIC MESENTERIC ISCHEMIA
A. CAUSATIVE FACTORS
B. DIAGNOSIS
C. TREATMENT
D. PROGNOSIS
V. MESENTERIC VENOUS THROMBOSIS
A. CAUSATIVE FACTORS—VENOUS THROMBOSIS PREDOMINANTLY A RESULT OF STAGNATION OF BLOOD FLOW, HYPERCOAGULABILITY, AND VASCULAR INJU...
B. CLINICAL PRESENTATION
C. DIAGNOSIS
D. TREATMENT
E. PROGNOSIS
VI. MEDIAN ARCUATE LIGAMENT SYNDROME (CELIAC ARTERY COMPRESSION SYNDROME)
A. CAUSATIVE FACTORS
B. PRESENTATION
C. DIAGNOSIS
D. TREATMENT
58 - Dialysis Access
I. INTRODUCTION
II. GENERAL OVERVIEW OF DIALYSIS ACCESS TYPES
A. SHORT-TERM/EMERGENT ACCESS
B. LONG-TERM ACCESS
III. DIALYSIS CATHETERS
A. NONTUNNELED (NONCUFFED CATHETERS)
B. TUNNELED CATHETERS (CUFFED)
IV. ARTERIOVENOUS FISTULAS AND GRAFTS
A. ARTERIOVENOUS FISTULA
B. ARTERIOVENOUS GRAFT
V. ARTERIOVENOUS FISTULA MATURATION
VI. COMPLICATIONS OF ARTERIOVENOUS FISTULAS AND GRAFTS
VII. PERITONEAL DIALYSIS
59 - The Diabetic Patient
I. DEFINITIONS
A. DIABETES
B. METABOLIC SYNDROME
II. MEDICAL THERAPIES
A. ORAL ANTIHYPERGLYCEMICS
B. INSULIN
D. ADJUSTING MEDICATIONS FOR SURGERY
E. HYPOGLYCEMIA (BLOOD GLUCOSE LEVEL LESS THAN 70 MG/DL)
F. DIABETIC KETOACIDOSIS
G. NONKETOTIC HYPEROSMOLAR HYPERGLYCEMIA
III. GLYCEMIC CONTROL IN THE CRITICALLY ILL PATIENT
A. HYPERGLYCEMIC RESPONSE TO SURGERY AND ANESTHESIA
B. IATROGENIC HYPERGLYCEMIA
C. GLYCEMIC CONTROL
D. SPECIAL POPULATIONS
IV. COMPLICATIONS OF DIABETES
A. TISSUE HYPOXIA CAUSED BY MICROVASCULAR DISEASE
V. DIABETIC FOOT ULCERS
XI - Cardiothoracic Surgery
60 - Benign Tumors of the Lung
I. OVERVIEW
II. HISTORY
III. PHYSICAL EXAMINATION
IV. INITIAL EVALUATION
V. IMAGING
VI. BIOPSY OPTIONS
VII. EPITHELIAL TUMORS
A. POLYPS
B. PAPILLOMA
C. MUCOUS GLAND ADENOMA
VIII. MESENCHYMAL TUMORS
A. VESSEL ORIGIN
IX. MISCELLANEOUS TUMORS
A. FIBROMA
B. HAMARTOMA
C. TERATOMA
X. OTHER TUMORS
A. LIPOMA
B. CHONDROMA
XI. INFLAMMATORY PSEUDOTUMORS
A. PLASMA CELL GRANULOMA
B. PULMONARY HYALINIZING GRANULOMA
XII. OTHER BENIGN TUMORS
A. MUCINOUS CYSTADENOMA
B. NODULAR AMYLOID
61 - Malignant Tumors of the Lung
I. EPIDEMIOLOGY
A. GENERAL
B. MORTALITY
II. ETIOLOGY
A. CIGARETTE SMOKING
B. EXPOSURE
III. SCREENING
A. GENERAL
B. SCREENING MODALITIES
IV. SOLITARY PULMONARY NODULE
A. GENERAL
B. DIFFERENTIAL DIAGNOSIS
C. RADIOGRAPHIC CHARACTERISTICS OF BENIGN NODULE
D. MANAGEMENT OF SOLITARY PULMONARY NODULE
V. CLINICAL FEATURES
A. RESPIRATORY
B. ASSOCIATED SYNDROMES
C. EVIDENCE OF METASTATIC OR LOCALLY ADVANCED DISEASE
D. METHOD OF SPREAD
VI. PATHOLOGY
A. HISTOLOGIC CLASSIFICATION
B. LOCATION OF PRIMARY TUMORS
VII. ADENOCARCINOMA—40%
A. GENERAL
B. PATHOLOGIC FEATURES
VIII. SQUAMOUS CELL CARCINOMA—20%
A. GENERAL
B. PATHOLOGIC FEATURES
IX. LARGE CELL CARCINOMA—10%
A. GENERAL
B. PATHOLOGIC FEATURES
X. NEUROENDOCRINE CARCINOMA—20%–25%
A. GENERAL
XI. OTHER—5%–10%
A. GENERAL
XII. DIAGNOSIS
A. CHEST RADIOGRAPH
B. CHEST COMPUTED TOMOGRAPHY SCAN
C. POSITRON EMISSION TOMOGRAPHY SCAN
D. CLINICAL STAGING
E. TISSUE BIOPSY
F. CLASSIFICATION AND STAGING
XIII. TREATMENT
XIV. THE FUTURE
62 - Thymus and Mediastinal Tumors
I. ANATOMY AND EMBRYOLOGY
II. ASSESSMENT OF MEDIASTINAL MASSES
III. ANTERIOR MEDIASTINAL MASSES
A. THYMOMAS
B. THYMIC CARCINOMA
C. GERM CELL TUMORS
D. LYMPHOMAS
IV. VISCERAL MEDIASTINAL COMPARTMENT MASSES
A. BRONCHOGENIC CYSTS
B. ENTERIC (DUPLICATION) CYSTS
C. NEUROENTERIC CYSTS
D. PERICARDIAL CYSTS
V. POSTERIOR MEDIASTINAL MASSES
A. NERVE SHEATH TUMORS
63 - Cardiac Surgery
I. PREOPERATIVE EVALUATION
A. HISTORY
B. PHYSICAL EXAMINATION—COMPLETE AND SYSTEMS BASED
C. PREOPERATIVE TESTING
D. PREOPERATIVE ORDERS
II. OPERATIVE PROCEDURES
A. CORONARY ARTERY BYPASS GRAFTING
B. VALVE REPLACEMENT OR REPAIR
C. INFECTIVE ENDOCARDITIS
D. AORTIC DISSECTION
E. TRAUMATIC AORTIC DISRUPTION
F. AORTIC ANEURYSMS
G. CONGENITAL HEART SURGERY
III. POSTOPERATIVE CARE
A. HEMODYNAMICS
B. ARRHYTHMIAS
C. ANTIARRHYTHMICS
D. ANTICOAGULATION
E. HARDWARE
IV. POSTOPERATIVE COMPLICATIONS
A. ARRHYTHMIAS
B. BLEEDING
C. CARDIAC TAMPONADE
D. RENAL FAILURE
E. RESPIRATORY FAILURE
F. LOW CARDIAC OUTPUT SYNDROME
G. CARDIAC TAMPONADE
V. PHARMACOLOGY
A. INOTROPES
B. VASOPRESSORS
C. VASODILATORS
D. POSTOPERATIVE FEVER
E. CENTRAL NERVOUS SYSTEM COMPLICATIONS
64 - Cardiac Transplantation
I. HISTORY
II. INDICATIONS
III. CONTRAINDICATIONS
A. ABSOLUTE CONTRAINDICATIONS
B. RELATIVE CONTRAINDICATIONS
IV. PREOPERATIVE EVALUATION
V. LISTING CRITERIA
VI. LISTING STATUS ACCORDING TO WHOM IT MAY CONCERN: ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK POLICIES
VII. MEDICAL AND MECHANICAL BRIDGES TO TRANSPLANT
VIII. DONOR SELECTION, EVALUATION, AND MANAGEMENT
A. DONOR SELECTION
B. DONOR EVALUATION
IX. DONOR HEART PROCUREMENT
X. OPERATIVE TECHNIQUE FOR CARDIAC TRANSPLANTATION
XI. POSTOPERATIVE MANAGEMENT
XII. IMMUNOSUPPRESSION AND LONG-TERM MANAGEMENT
XIII. PREVENTION OF OPPORTUNISTIC INFECTION
XIV. SURVIVAL
XII - Surgical Subspecialties
65 - General Pediatric Surgery
I. FLUIDS AND NUTRITION
A. MAINTENANCE FLUIDS
B. RESUSCITATION FLUIDS
C. FLUID BALANCE
D. ACID-BASE ANOMALIES
E. TOTAL PARENTERAL NUTRITION
II. LESIONS OF THE HEAD AND NECK
A. THRYOGLOSSAL DUCT CYST
B. BRANCHIAL CLEFT ANOMALIES
III. THORACIC DISORDERS
A. PULMONARY SEQUESTRATION
B. CONGENITAL CYSTIC ADENOMATOID MALFORMATION
C. CONGENITAL DIAPHRAGMATIC HERNIA
IV. ESOPHAGEAL ANOMALIES
A. TRACHEOESOPHAGEAL FISTULA
B. ISOLATED ESOPHAGEAL ATRESIA—TYPE A (6%)
C. SURVIVAL
V. GASTROINTESTINAL TRACT
A. HYPERTROPHIC PYLORIC STENOSIS
B. INTESTINAL OBSTRUCTION IN THE NEONATE
D. NECROTIZING ENTEROCOLITIS
E. MECKEL DIVERTICULUM
F. APPENDICITIS
G. GASTROESOPHAGEAL REFLUX
VI. ABDOMINAL WALL DEFECTS
A. OMPHALOCELE
B. GASTROSCHISIS
C. UMBILICAL HERNIA
D. INGUINAL HERNIA
E. SHORT BOWEL SYNDROME
VII. ANORECTAL MALFORMATIONS
VIII. NEOPLASMS
A. NEUROBLASTOMA
B. WILMS TUMOR
66 - Neurosurgery
I. CRANIAL URGENCIES AND EMERGENCIES
A. SPONTANEOUS SUBARACHNOID HEMORRHAGE
C. MALIGNANT STROKE (FIG. 66.3)
D. HYDROCEPHALUS
II. SPINAL URGENCIES AND EMERGENCIES
A. DEGENERATIVE SPINAL DISEASE
III. CNS TUMORS
A. BRAIN TUMORS (FIG. 66.5)
B. SPINAL TUMORS (FIG. 66.7)
IV. CNS INFECTIOUS URGENCIES AND EMERGENCIES (FIG. 66.8)
A. EPIDURAL ABSCESS
B. SUBDURAL EMPYEMA
C. PARENCHYMAL ABSCESS
V. OTHER NEUROSURGICAL URGENCIES/EMERGENCIES
A. SEIZURES AND STATUS EPILEPTICUS
B. BACLOFEN TOXICITY AND WITHDRAWAL
VI. HERNIATION SYNDROMES AND BRAIN DEATH
A. HERNIATION SYNDROMES CAN RESULT FROM A VARIETY OF BOTH TRAUMATIC AND NONTRAUMATIC CRANIAL PATHOLOGIES; THERE ARE FOUR COMMON ...
B. BRAIN DEATH
67 - Orthopedic Surgery
I. ASSESSMENT OF THE ORTHOPEDIC PATIENT
A. BASIC ADVANCED TRAUMA LIFE SUPPORT PRINCIPLES
II. ORTHOPEDIC EMERGENCIES
A. HEMODYNAMICALLY UNSTABLE PELVIC FRACTURES
B. OPEN FRACTURES
C. COMPARTMENT SYNDROME
D. VASCULAR INJURY ASSOCIATED WITH EXTREMITY TRAUMA
E. TRAUMATIC ARTHROTOMIES
F. GUNSHOT WOUNDS
G. BITE INJURIES
68 - Plastic Surgery: Breast Reconstruction
I. INTRODUCTION
II. RELEVANT ANATOMY FOR RECONSTRUCTION
A. VASCULAR SUPPLY (FIG. 68.1)
B. INNERVATION
III. PREOPERATIVE EVALUATION
A. GOALS OF RECONSTRUCTION
B. TIMING
C. CURRENT TECHNIQUES
D. TECHNIQUE SELECTION CRITERIA
IV. TECHNIQUES
A. PROSTHETIC RECONSTRUCTION USING IMPLANTS AND EXPANDERS
B. AUTOLOGOUS TISSUE TRANSFER
C. NIPPLE AREOLAR COMPLEX RECONSTRUCTION (FIG. 68.4)
V. ONCOPLASTIC SURGERY
A. DEFINITION
B. CONSIDERATIONS
C. TECHNIQUES
VI. POSTRECONSTRUCTION FOLLOW-UP
XIII - Future of Surgery
69 - Robotics and Newer Surgical Technologies
I. SINGLE-INCISION LAPAROSCOPIC SURGERY
II. ROBOTIC SURGERY
III. NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY
IV. ENDOLUMINAL AND ENDOVASCULAR SURGERY
XIV - Procedures
70 - Procedures
I. INDICATIONS FOR AN ARTIFICIAL AIRWAY
A. ABSOLUTE
B. RELATIVE
II. NONSURGICAL TECHNIQUES
A. INITIAL/TEMPORIZING MANEUVERS
B. OROTRACHEAL INTUBATION
C. NASOTRACHEAL INTUBATION
D. COMPLICATIONS
III. SURGICAL AIRWAY OPTIONS AND METHODS
A. CRICOTHYROIDOTOMY
B. TRACHEOSTOMY
C. PERCUTANEOUS TRACHEOSTOMY
D. COMPLICATIONS
IV. ALTERNATE AIRWAY METHODS
A. COMBITUBE
B. FIBEROPTIC BRONCHOSCOPY
C. LARYNGEAL MASK AIRWAY
V. ARTERIAL CATHETERIZATION
A. INDICATIONS
B. TECHNIQUES
C. COMPLICATIONS
VI. BLADDER CATHETERIZATION
A. INDICATIONS FOR INDWELLING URETHRAL CATHETER
B. COMPLICATIONS OF INDWELLING URINARY CATHETER
C. CONTRAINDICATIONS OF BLADDER CATHETERIZATION
D. TECHNIQUES
E. ALTERNATIVES
VII. CENTRAL VENOUS LINES
A. INDICATIONS
C. TECHNIQUES
D. COMPLICATIONS
VIII. ENTERAL ACCESS
A. NASOGASTRIC TUBES
B. OROGASTRIC TUBES
C. FEEDING TUBES
X. PULMONARY ARTERY (SWAN-GANZ) CATHETERIZATION
A. INDICATIONS
B. DESIGN
C. MEASUREMENT
D. PITFALLS
XI. ABSCESS DRAINAGE
A. TECHNIQUE
XII. THORACENTESIS
A. INDICATIONS
B. TECHNIQUE
C. POSITIONING
D. PROCEDURE
E. INTERPRETATION OF RESULTS (TABLE 70.3)
F. COMPLICATIONS
XV - Rapid References
71 - Rapid References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
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