Additional Information
Book Details
Abstract
Core Topics in General & Emergency Surgery meets the needs of surgeons in higher training and practising consultants for a contemporary and evidence-based account of this sub-specialty that is relevant to their general surgical practice. It is a practical reference source incorporating the most current information on recent developments, management issues and operative procedures. The text is thoroughly referenced and supported by evidence-based recommendations wherever possible, distinguishing between strong evidence to support a conclusion, and evidence suggesting that a recommendation can be reached on the balance of probabilities.
This is a title in the Companion to Specialist Surgical Practice series whose eight volumes are an established and highly regarded source of information for the specialist general surgeon.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within each major surgical sub-specialty.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
- An expanded authorship team across the series includes additional European and World experts with an increased emphasis on global practice.
- The contents of the series have been extensively revised in line with recently published evidence.
- The volume contains a new chapter on the complications of bariatric surgery.
- This updated text will appeal to all General Surgeons who wish to keep up to date in both elective and emergency conditions, while providing the relevant information for the Specialist Surgeon who is still required to look after undifferentiated emergencies and carry out routine elective general surgical procedures.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Core Topics in General and Emergency Surgery: A Companion to Specialist Surgical Practice | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Contributors | vii | ||
| Series Editors' preface | ix | ||
| Editor's preface | xi | ||
| Acknowledgements | xi | ||
| Evidence-based practice in surgery | xiii | ||
| Chapter 1: Evidence-based practice in surgery | 1 | ||
| Introduction | 1 | ||
| The need for evidence-based medicine | 2 | ||
| The process of evidence-based medicine | 3 | ||
| Sources of evidence | 3 | ||
| Journals | 4 | ||
| Evidence-based Medicine | 4 | ||
| Evidence-based Nursing | 4 | ||
| Evidence-based Mental Health | 4 | ||
| Internet resources | 4 | ||
| NHS Evidence | 4 | ||
| BMJ Evidence Centre | 4 | ||
| Academic units | 4 | ||
| Cochrane Collaboration | 4 | ||
| Centre for Evidence-based Medicine | 5 | ||
| Review Body for Interventional Procedures (ReBIP) | 5 | ||
| NHS agencies | 5 | ||
| Centre for Reviews and Dissemination (CRD) | 5 | ||
| NIHR Health Technology Assessment Programme | 5 | ||
| Critical appraisal | 5 | ||
| Randomised controlled trials | 5 | ||
| Systematic literature reviews | 8 | ||
| 1. Develop a protocol for a clearly defined question | 8 | ||
| 2. Literature search | 8 | ||
| 3. Evaluating the studies | 9 | ||
| 4. Synthesis of the results | 9 | ||
| 5. Discussion | 9 | ||
| Meta-analysis | 9 | ||
| Heterogeneity | 9 | ||
| Clinical guidelines | 11 | ||
| The National Institute for Clinical Excellence (NICE) | 12 | ||
| Scottish Intercollegiate Guidelines Network (SIGN) | 12 | ||
| Effective Practice and Organisation of Care (EPOC) | 12 | ||
| Integrated care pathways (ICPs) | 13 | ||
| Grading the evidence | 13 | ||
| Determining strength of evidence | 14 | ||
| Type and quality of study | 14 | ||
| Robustness of findings | 15 | ||
| Applicability | 15 | ||
| Grading system for evidence | 15 | ||
| Grading of recommendations | 16 | ||
| Implementation of evidence-based medicine | 16 | ||
| Audit | 18 | ||
| References | 19 | ||
| Appendix | 20 | ||
| Possible sources of further information, useful Internet sites and contact addresses | 20 | ||
| Organisations specialising in evidence-based practice, systematic reviews, etc | 21 | ||
| Sources of reviews and abstracts relating to evidence-based practice | 21 | ||
| Journals available on the internet | 22 | ||
| Databases, bibliographies and catalogues | 22 | ||
| Sources of guidelines and integrated care pathways | 22 | ||
| Useful texts | 22 | ||
| Chapter 2: Outcomes and health economic issues in surgery | 23 | ||
| Introduction | 23 | ||
| Outcome measures | 23 | ||
| Mortality | 24 | ||
| Condition-specific outcome measures | 25 | ||
| Patient-reported outcome measures (PROMs) | 26 | ||
| The measurement of pain | 26 | ||
| Health-related quality of life | 27 | ||
| EQ-5D | 27 | ||
| SF-36 | 27 | ||
| SF-6D | 27 | ||
| Nottingham Health Profile | 28 | ||
| Quality-adjusted life-years | 28 | ||
| Utilities | 28 | ||
| Rating scale or visual analogue scales | 29 | ||
| Standard gamble | 29 | ||
| Time trade-off | 29 | ||
| Obtaining utilities from health-related quality of life | 29 | ||
| Costs, charges and resource use | 30 | ||
| Counting costs in base year | 31 | ||
| Discounting | 31 | ||
| Marginal costing | 32 | ||
| Summary of cost analysis | 32 | ||
| Economic evaluation | 32 | ||
| Cost-minimisation analysis | 33 | ||
| Cost-effectiveness analysis | 33 | ||
| Cost–utility analysis | 34 | ||
| Incremental cost-effectiveness ratios | 34 | ||
| Cost-effectiveness league tables | 34 | ||
| Willingness-to-pay thresholds | 35 | ||
| Cost–benefit analysis | 35 | ||
| Choosing an evaluation method | 35 | ||
| Sensitivity analysis | 36 | ||
| Simple sensitivity analysis | 36 | ||
| Threshold analysis | 36 | ||
| Analysis of extremes | 36 | ||
| Probabilistic sensitivity analysis | 36 | ||
| Value of information analysis | 37 | ||
| Ethical issues | 37 | ||
| Recent advances | 37 | ||
| Summary | 37 | ||
| References | 38 | ||
| Chapter 3: Day case surgery | 41 | ||
| Introduction | 41 | ||
| The development of day surgery | 42 | ||
| How does it work for the patient? | 43 | ||
| Facilities for day surgery | 43 | ||
| The day surgery cycle | 44 | ||
| Patient selection | 44 | ||
| Social factors | 44 | ||
| Age | 44 | ||
| Body mass index | 45 | ||
| Smoking | 45 | ||
| Medical factors | 45 | ||
| Diabetes mellitus | 46 | ||
| Cardiac disease | 46 | ||
| Asthma | 46 | ||
| Preoperative assessment | 46 | ||
| Investigations | 47 | ||
| Day of surgery admission | 47 | ||
| Patient discharge | 47 | ||
| How do we do it? | 48 | ||
| Anaesthesia | 48 | ||
| Premedication | 48 | ||
| Sedation | 48 | ||
| Local and regional anaesthesia | 49 | ||
| General anaesthesia | 49 | ||
| Surgery | 50 | ||
| Surgical practice: controversies | 50 | ||
| Laparoscopic cholecystectomy | 50 | ||
| Prostatectomy | 51 | ||
| Head and neck | 51 | ||
| Bariatric and other surgery | 51 | ||
| Recovery | 51 | ||
| Postoperative instructions and discharge | 51 | ||
| Postoperative complications | 52 | ||
| Paediatric day surgery | 52 | ||
| What will happen next? | 53 | ||
| References | 54 | ||
| Chapter 4: Abdominal hernias | 57 | ||
| Introduction | 57 | ||
| Aetiology | 57 | ||
| Mesh | 58 | ||
| Epigastric hernia | 60 | ||
| Aetiology | 60 | ||
| Clinical presentation | 60 | ||
| Management | 60 | ||
| Operative details | 60 | ||
| Complications | 61 | ||
| Umbilical and para-umbilical hernias | 61 | ||
| Congenital umbilical hernias | 61 | ||
| Chapter 5: Organisation of emergency general surgical services and the early assessment and investigation of the acute abdomen | 81 | ||
| Introduction | 81 | ||
| Organisation of emergency general surgical services | 82 | ||
| Separation of elective and emergency surgery | 82 | ||
| Subspecialisation in emergency general surgery | 83 | ||
| Early assessment of the acute abdomen | 83 | ||
| Conditions associated with abdominal pain | 84 | ||
| History and examination (including computer-aided diagnosis) | 85 | ||
| Initial blood investigations and early decision-making | 86 | ||
| Radiological investigations | 87 | ||
| Plain radiology | 87 | ||
| Contrast radiology | 87 | ||
| Perforated peptic ulcer | 87 | ||
| Small-bowel obstruction | 88 | ||
| Large-bowel obstruction | 90 | ||
| Acute diverticulitis | 91 | ||
| Ultrasonography (US) | 91 | ||
| Computed tomography (CT) | 92 | ||
| Magnetic resonance imaging (MRI) | 94 | ||
| Laparoscopy | 94 | ||
| References | 95 | ||
| Chapter 6: Perforations of the upper gastrointestinal tract | 100 | ||
| Introduction | 100 | ||
| Peptic ulcer perforation | 100 | ||
| Prognosis | 100 | ||
| Treatment | 101 | ||
| Role of Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs) | 102 | ||
| The role of cyclo-oxygenase-2 (COX-2)-specific inhibitors | 103 | ||
| Laparoscopic versus open repair | 104 | ||
| Giant duodenal ulcer perforation | 104 | ||
| Perforated gastric ulcers | 105 | ||
| Oesophageal perforation | 105 | ||
| Classification | 105 | ||
| Diagnosis | 105 | ||
| Non-operative management | 107 | ||
| Endoscopic stenting | 108 | ||
| Surgical intervention | 108 | ||
| Oesophageal exclusion and diversion | 109 | ||
| Primary repair | 109 | ||
| Immediate resection | 109 | ||
| Corrosive perforation | 110 | ||
| Perforation after endotherapy for mucosal/submucosal tumours | 110 | ||
| Duodenal and jejunal perforations during endoscopic retrograde cholangiopancreatography (ERCP) | 110 | ||
| References | 112 | ||
| Chapter 7: Acute non-variceal upper gastrointestinal bleeding | 117 | ||
| Introduction | 117 | ||
| Aetiology | 117 | ||
| Initial assessment and triage | 118 | ||
| Scoring systems | 118 | ||
| Initial management | 119 | ||
| Massive haemorrhage | 119 | ||
| Use of blood and blood products | 119 | ||
| Early pharmacological treatment | 120 | ||
| Endoscopy | 120 | ||
| Endoscopic technique | 120 | ||
| Management of bleeding due to causes other than peptic ulceration | 121 | ||
| Gastritis/duodenitis | 121 | ||
| Mallory–Weiss syndrome | 121 | ||
| Oesophagitis | 121 | ||
| Neoplastic disease | 121 | ||
| Dieulafoy's lesion | 121 | ||
| Endoscopic management of bleeding peptic ulcers | 122 | ||
| Endoscopic stigmata of bleeding | 122 | ||
| Endoscopic treatment | 122 | ||
| Injection | 123 | ||
| Thermal methods | 123 | ||
| Mechanical methods | 124 | ||
| Hemospray ® | 124 | ||
| Single versus combined methods | 124 | ||
| Limit of endoscopic therapy | 124 | ||
| Second-look endoscopy | 124 | ||
| Pharmacological management of bleeding peptic ulcers | 125 | ||
| Acid suppression | 125 | ||
| Surgical management of bleeding peptic ulcers | 125 | ||
| Choice of surgical procedure for bleeding peptic ulcers | 125 | ||
| Management of recurrent bleeding | 126 | ||
| The role of selective mesenteric embolisation | 127 | ||
| Helicobacter pylori eradication | 128 | ||
| Use of NSAIDs | 128 | ||
| Summary | 128 | ||
| References | 129 | ||
| Chapter 8: Pancreaticobiliary emergencies | 132 | ||
| Introduction | 132 | ||
| Biliary colic and acute cholecystitis | 132 | ||
| Pathogenesis | 132 | ||
| Clinical presentation | 132 | ||
| Initial radiological imaging | 133 | ||
| Management of patients with acute gallbladder disease and suspected bile duct stones | 134 | ||
| Treatment | 135 | ||
| Biliary colic | 135 | ||
| Acute cholecystitis | 136 | ||
| Antibiotic cover for urgent cholecystectomy | 138 | ||
| Non-surgical options for decompressing the gallbladder in acute cholecystitis | 138 | ||
| Management of acute gallstone disease in pregnancy | 139 | ||
| Gallbladder torsion | 139 | ||
| Acute acalculous cholecystitis | 139 | ||
| Acute cholangitis | 140 | ||
| Pathogenesis | 140 | ||
| Presentation | 140 | ||
| Investigation | 141 | ||
| Management | 141 | ||
| Acute pancreatitis | 142 | ||
| Aetiology | 142 | ||
| Pathogenesis | 142 | ||
| Clinical presentation | 143 | ||
| Diagnosis (see also Chapter 5) | 143 | ||
| Establishment of aetiology | 144 | ||
| Management | 145 | ||
| General guidelines | 145 | ||
| Initial resuscitation | 145 | ||
| Severity stratification | 145 | ||
| Imaging in acute pancreatitis | 145 | ||
| Specific therapies for acute pancreatitis | 145 | ||
| Early ERCP | 146 | ||
| Antibiotic therapy | 146 | ||
| Early enteral nutrition | 148 | ||
| Other potential treatment strategies | 150 | ||
| Probiotic therapy | 150 | ||
| Anticytokine therapy | 150 | ||
| Prognosis | 150 | ||
| Treatment of gallstones in acute gallstone pancreatitis | 150 | ||
| Managing the acute sequelae of acute pancreatitis | 151 | ||
| Infected necrosis | 151 | ||
| Haemorrhage | 151 | ||
| Iatrogenic pancreaticobiliary emergencies | 151 | ||
| ERCP-related complications | 151 | ||
| Post-pancreatectomy haemorrhage | 152 | ||
| References | 153 | ||
| Chapter 9: Acute conditions of the small bowel and appendix | 158 | ||
| Introduction | 158 | ||
| Small-bowel obstruction | 158 | ||
| Mechanism | 158 | ||
| Presentation | 159 | ||
| Initial management | 159 | ||
| Investigation | 160 | ||
| Non-operative management | 160 | ||
| Surgical management | 161 | ||
| Operative principles | 161 | ||
| Special conditions | 162 | ||
| Radiation enteritis | 162 | ||
| Malignant obstruction | 162 | ||
| Abdominal wall hernia | 163 | ||
| Enterolith obstruction | 163 | ||
| Intussusception | 164 | ||
| Connective tissue disorders | 164 | ||
| Intestinal obstruction in the early postoperative period | 164 | ||
| Laparoscopy | 164 | ||
| Peritonitis | 164 | ||
| Crohn's disease | 165 | ||
| Presentation | 165 | ||
| Investigation | 165 | ||
| Surgery for acute Crohn's disease presenting de novo | 165 | ||
| Mesenteric ischaemia | 165 | ||
| Meckel's diverticulum | 166 | ||
| Haemorrhage | 167 | ||
| Acute appendicitis | 167 | ||
| Pathology | 168 | ||
| Clinical features | 168 | ||
| Investigations | 169 | ||
| Differential diagnosis | 169 | ||
| Management | 170 | ||
| Surgical treatment | 170 | ||
| Conventional appendicectomy | 170 | ||
| Laparoscopic appendicectomy | 170 | ||
| Technique | 171 | ||
| The normal appendix at open surgery | 171 | ||
| The normal appendix at laparoscopy | 171 | ||
| Non-surgical treatment | 172 | ||
| Treatment of atypical presentation of acute appendicitis | 172 | ||
| Appendix mass | 172 | ||
| Appendix abscess | 173 | ||
| Chronic appendicitis | 173 | ||
| Appendicitis in pregnancy | 174 | ||
| Postoperative complications and outcome | 174 | ||
| Hospital stay | 174 | ||
| Wound infection | 175 | ||
| Other septic complications | 175 | ||
| Prognosis | 175 | ||
| References | 176 | ||
| Chapter 10: Colonic emergencies | 179 | ||
| Introduction | 179 | ||
| Preparation for operation | 179 | ||
| Disease process | 179 | ||
| Colonic ischaemia | 179 | ||
| Aetiological factors and pathophysiology | 180 | ||
| Diagnosis | 180 | ||
| Treatment | 181 | ||
| Colonic obstruction | 181 | ||
| Colonic volvulus | 181 | ||
| Sigmoid volvulus | 182 | ||
| Ileosigmoid knotting | 183 | ||
| Transverse colon volvulus | 184 | ||
| Caecal volvulus | 184 | ||
| Acute colonic pseudo-obstruction | 185 | ||
| Aetiology | 185 | ||
| Presentation | 185 | ||
| Investigation (see also Chapter 5) | 186 | ||
| Management | 186 | ||
| Malignant large-bowel obstruction | 187 | ||
| Presentation | 187 | ||
| Investigation | 188 | ||
| Management | 188 | ||
| Inflammation and infection | 191 | ||
| Acute colonic diverticulitis | 191 | ||
| Presentation | 191 | ||
| Investigation | 191 | ||
| Management | 192 | ||
| Operative management | 192 | ||
| Neutropenic enterocolitis | 193 | ||
| Toxic colitis | 193 | ||
| Perforation | 194 | ||
| Stercoral perforation | 194 | ||
| Anastomotic dehiscence | 195 | ||
| Causes | 195 | ||
| Presentation | 195 | ||
| Investigations | 196 | ||
| Management | 196 | ||
| Bowel damage at colonoscopy | 197 | ||
| Colonic bleeding | 197 | ||
| Diagnosis and non-surgical management | 198 | ||
| Radionuclide imaging | 198 | ||
| Colonoscopy | 198 | ||
| Angiography | 198 | ||
| CT angiography | 199 | ||
| Surgical management | 199 | ||
| References | 201 | ||
| Chapter 11: Anorectal emergencies | 204 | ||
| Introduction | 204 | ||
| Anorectal anatomy | 204 | ||
| Perianal abscess | 204 | ||
| Clinical features | 205 | ||
| Radiological imaging | 205 | ||
| Treatment | 206 | ||
| Technical tips | 206 | ||
| Fistula-in-ano | 207 | ||
| Management of secondary perianal sepsis | 208 | ||
| Malignant disease | 208 | ||
| Inflammatory bowel disease | 208 | ||
| Necrotising infection | 208 | ||
| Anorectal sepsis in children | 208 | ||
| Pilonidal abscess | 209 | ||
| Acute anal fissure | 209 | ||
| Haemorrhoids | 210 | ||
| Thrombosed haemorrhoids | 210 | ||
| Anorectal haemorrhage | 211 | ||
| Anorectal trauma | 211 | ||
| Foreign bodies | 211 | ||
| References | 212 | ||
| Chapter 12: Paediatric surgical emergencies | 215 | ||
| Introduction | 215 | ||
| Neonatal period | 215 | ||
| Prenatal diagnosis | 215 | ||
| Intestinal obstruction | 215 | ||
| Assessment | 215 | ||
| Specific forms of intestinal obstruction | 218 | ||
| Oesophageal atresia | 218 | ||
| Meconium ileus | 218 | ||
| Intestinal atresia/stenosis | 219 | ||
| Hirschsprung's disease | 219 | ||
| Anorectal malformations | 219 | ||
| Malrotation | 220 | ||
| Inflammatory conditions | 221 | ||
| Assessment | 221 | ||
| Specific forms of abdominal inflammation | 221 | ||
| Meconium peritonitis | 221 | ||
| Necrotising enterocolitis | 221 | ||
| Isolated ileal perforation | 222 | ||
| Other neonatal conditions | 223 | ||
| Incarcerated inguinal hernia | 223 | ||
| Abdominal wall defects | 223 | ||
| Infancy | 224 | ||
| Hypertrophic pyloric stenosis | 224 | ||
| Intussusception | 224 | ||
| Children | 225 | ||
| Appendicitis | 225 | ||
| Fluid resuscitation of the child with a surgical emergency | 226 | ||
| Paediatric trauma | 226 | ||
| References | 227 | ||
| Chapter 13: Abdominal trauma | 229 | ||
| Introduction | 229 | ||
| Risk factors | 229 | ||
| Transport | 229 | ||
| Regional trauma systems | 230 | ||
| Assessment in the emergency department | 230 | ||
| Diagnostic modalities in blunt abdominal trauma | 231 | ||
| Routine screening radiographs | 231 | ||
| Special diagnostic studies | 231 | ||
| Computed tomography (CT) | 231 | ||
| Diagnostic ultrasound | 232 | ||
| Diagnostic peritoneal lavage (DPL) | 232 | ||
| Diagnostic laparoscopy | 232 | ||
| Laparotomy | 232 | ||
| Mandatory laparotomy | 232 | ||
| Selective laparotomy (i.e. selective conservatism) in penetrating injury | 233 | ||
| Operative management of abdominal trauma | 233 | ||
| Laparotomy for trauma | 233 | ||
| The unstable patient with intra-abdominal bleeding | 234 | ||
| The unstable patient with intra-abdominal and pelvic haemorrhage | 234 | ||
| The stable patient with combined head, chest and abdominal injuries | 234 | ||
| The patient with abdominal injuries and limb fractures | 234 | ||
| Trauma laparotomy: a systematic approach | 234 | ||
| Preparation | 235 | ||
| Incision | 235 | ||
| Bleeding control | 235 | ||
| Contamination control | 235 | ||
| Physiological control | 235 | ||
| Full inspection for injury | 235 | ||
| Damage control laparotomy | 235 | ||
| Patient selection for damage control | 236 | ||
| Stage 1: Damage control procedure | 236 | ||
| Arrest bleeding and the resulting (causative) coagulopathy | 236 | ||
| Limit contamination and the associated sequelae | 236 | ||
| Temporary abdominal closure | 237 | ||
| Stage 2: Transfer to the intensive care unit for ongoing resuscitation | 237 | ||
| Stage 3: Resuscitation in the intensive care unit | 237 | ||
| Stage 4: Return to the operating theatre for definitive surgery | 237 | ||
| Stage 5: Definitive surgery and abdominal wall reconstruction if required | 237 | ||
| Abdominal compartment syndrome | 237 | ||
| Definition | 238 | ||
| Pathophysiology | 238 | ||
| Effect of raised IAP on organ function | 238 | ||
| Renal function | 238 | ||
| Cardiac function | 239 | ||
| Respiratory function | 239 | ||
| Visceral perfusion | 239 | ||
| Intracranial contents | 239 | ||
| Measurement of IAP | 239 | ||
| Pitfalls of IAP pressure measurement | 239 | ||
| Abdominal perfusion pressure | 240 | ||
| Management of raised IAP | 240 | ||
| General support | 240 | ||
| Reversible factors | 240 | ||
| Surgery for raised IAP | 240 | ||
| Summary | 240 | ||
| Organ injury scaling systems | 240 | ||
| Surgical decision-making in abdominal trauma | 243 | ||
| Antibiotic prophylaxis in abdominal trauma 58, 59 | 243 | ||
| Management of abdominal injury | 243 | ||
| Hepatic injury | 243 | ||
| Pancreatic trauma | 245 | ||
| Aorta and inferior vena cava | 246 | ||
| Colonic injuries | 246 | ||
| Complex pelvic fracture | 247 | ||
| Technique of extraperitoneal packing | 247 | ||
| Non-operative approach to abdominal solid-organ injuries | 248 | ||
| Liver | 248 | ||
| Spleen | 249 | ||
| Penetrating injury | 249 | ||
| Interventional radiology | 249 | ||
| Angio-embolisation in liver injuries | 249 | ||
| Angio-embolisation in blunt splenic injuries | 250 | ||
| Angio-embolisation in severe pelvic fractures | 250 | ||
| References | 251 | ||
| Recommended reading | 254 | ||
| Websites | 254 | ||
| Appendix: Scaling system for organ-specific injuries | 254 | ||
| Scaling system for organ-specific injuries | 254 | ||
| Chapter 14: Venous thromboembolism: prevention, diagnosis and treatment | 268 | ||
| Introduction | 268 | ||
| Epidemiology of VTE | 268 | ||
| Pathophysiology of venous thromboembolism | 269 | ||
| Thrombus formation | 269 | ||
| Virchow's triad | 269 | ||
| Stasis | 269 | ||
| Venous injury | 269 | ||
| Hypercoagulability | 270 | ||
| Risk factors for VTE | 270 | ||
| Inherited thrombophilias | 270 | ||
| Factor V Leiden and the prothrombin gene mutation | 270 | ||
| Hyperhomocysteinaemia | 270 | ||
| Other thrombophilias | 270 | ||
| Acquired thrombophilias | 270 | ||
| Antiphospholipid syndrome (APLS) | 270 | ||
| Heparin-induced thrombocytopenia (HIT) | 271 | ||
| Other risk factors for VTE | 271 | ||
| Age | 271 | ||
| Obesity | 271 | ||
| Family history of VTE | 271 | ||
| Medical illness and malignancy | 271 | ||
| Hormone replacement therapy (HRT) and combined oral contraceptive pill (cOCP) | 271 | ||
| Pregnancy and puerperium | 272 | ||
| Travel | 272 | ||
| Superficial thrombophlebitis | 272 | ||
| Surgery | 272 | ||
| Prevention of venous thromboembolic disease | 272 | ||
| Guidelines | 272 | ||
| Thromoboprophylaxis | 273 | ||
| Methods of thromboprophylaxis | 273 | ||
| Mobilisation and leg exercises | 273 | ||
| Mechanical thromboprophylaxis | 273 | ||
| Pharmacological methods | 273 | ||
| Vitamin K antagonists | 273 | ||
| Aspirin and antiplatelet agents | 273 | ||
| Heparins | 274 | ||
| Fondaparinux | 274 | ||
| New oral anticoagulants | 274 | ||
| Duration of thromboprophylaxis | 274 | ||
| Diagnosis of venous thromboembolic disease | 274 | ||
| Diagnosis of DVT | 275 | ||
| Clinical features of DVT | 275 | ||
| Diagnostic algorithms for DVT | 275 | ||
| D-dimer | 275 | ||
| Imaging techniques for DVT | 276 | ||
| Venous ultrasound | 276 | ||
| Impedance plethysmography (IP) | 276 | ||
| Venography | 276 | ||
| Computed tomography (CT) | 276 | ||
| Magnetic resonance imaging (MRI) and angiography (MRA) | 276 | ||
| Summary of diagnostic methods in DVT | 276 | ||
| Diagnosis of pulmonary embolism | 276 | ||
| Clinical presentation and pretest probability | 276 | ||
| Investigation for PE | 277 | ||
| Chest X-ray (CXR) | 277 | ||
| Computed tomography pulmonary angiogram (CTPA) | 277 | ||
| Ventilation/perfusion (V/Q) scanning | 277 | ||
| Echocardiography | 277 | ||
| MRI | 277 | ||
| Investigation in pregnancy | 277 | ||
| Summary of diagnostic methods for PE | 278 | ||
| Management of venous thromboembolic disease | 278 | ||
| Aims of treatment | 278 | ||
| High-risk PE | 278 | ||
| Anticoagulation | 278 | ||
| UFH | 278 | ||
| LMWH | 279 | ||
| Fondaparinux | 279 | ||
| Vitamin K antagonists | 279 | ||
| Rivaroxaban | 280 | ||
| Thrombolysis | 280 | ||
| Inferior vena caval (IVC) filters | 280 | ||
| Duration of anticoagulation | 280 | ||
| References | 281 | ||
| Chapter 15: Patient assessment and surgical risk | 286 | ||
| Introduction | 286 | ||
| Why assess surgical risk? | 286 | ||
| How can we assess surgical risk? | 286 | ||
| Estimation of surgical risk | 287 | ||
| Clinical assessment | 287 | ||
| Risk prediction models and scoring systems | 287 | ||
| POSSUM | 288 | ||
| CR-POSSUM (colorectal) | 288 | ||
| O-POSSUM (oesophagogastric) | 289 | ||
| V-POSSUM (vascular) | 289 | ||
| ASA | 290 | ||
| Surgical mortality probability model | 291 | ||
| Revised Cardiac Risk Index | 291 | ||
| Other risk prediction models | 291 | ||
| Functional assessment | 291 | ||
| Cardiopulmonary exercise testing (CPEX) | 293 | ||
| Other objective measures of exercise capacity | 293 | ||
| Biomarkers to assess risk | 294 | ||
| Communicating risk | 294 | ||
| References | 296 | ||
| Chapter 16: Perioperative and intensive care management of the surgical patient | 298 | ||
| Introduction | 298 | ||
| How big is the problem? | 298 | ||
| Why do patients die after surgery? | 299 | ||
| What is a high-risk surgical patient? | 299 | ||
| Variables associated with postoperative complications and death | 300 | ||
| The role of the splanchnic circulation | 300 | ||
| Strategies to improve outcomes | 300 | ||
| Oxygen delivery | 300 | ||
| Measurement and monitoring of cardiac output | 301 | ||
| Protocol-driven therapy to augment oxygen delivery | 301 | ||
| Fluid resuscitation | 301 | ||
| Timing of protocol-driven therapy | 302 | ||
| Conclusions | 303 | ||
| References | 304 | ||
| Chapter 17: Surgical nutrition | 307 | ||
| Introduction | 307 | ||
| Metabolic response to feeding, trauma and sepsis | 307 | ||
| Trauma | 308 | ||
| Protein metabolism | 308 | ||
| Carbohydrate metabolism | 309 | ||
| Fat metabolism | 310 | ||
| Mineral and micronutrient metabolism | 310 | ||
| Sepsis | 310 | ||
| Nutritional requirements | 310 | ||
| Proteins and amino acids | 310 | ||
| Energy requirements | 311 | ||
| Minerals and micronutrients | 311 | ||
| Identification of patients who are malnourished | 312 | ||
| Anthropometric measures | 312 | ||
| Height and weight | 312 | ||
| Body composition | 312 | ||
| Subcutaneous fat thickness | 312 | ||
| Bioelectrical impedance | 312 | ||
| Biochemical measures | 312 | ||
| Serum proteins | 312 | ||
| Nitrogen balance | 313 | ||
| Tests of function | 313 | ||
| Immune competence | 313 | ||
| Muscle function | 313 | ||
| Skeletal muscle | 313 | ||
| Respiratory muscle | 313 | ||
| Nutrition risk index | 313 | ||
| How should nutritional status be assessed in clinical practice? | 313 | ||
| The Malnutrition Universal Screening Tool (MUST) | 313 | ||
| Significance of the resultant score and clinical management | 314 | ||
| Subjective global assessment | 314 | ||
| Assessment of protein and energy balance | 314 | ||
| Assessment of body composition | 314 | ||
| Assessment of physiological function | 314 | ||
| Re-feeding syndrome | 314 | ||
| Nutritional support in surgical practice | 315 | ||
| Route of nutritional support | 315 | ||
| Enteral nutritional support | 315 | ||
| The importance of enteral nutrition | 315 | ||
| Routes of access for enteral nutritional support | 315 | ||
| Nasoenteric tubes | 315 | ||
| Gastrostomy tubes | 315 | ||
| Jejunostomy tubes | 316 | ||
| Nutrient solutions available for enteral nutrition | 316 | ||
| Polymeric diets | 316 | ||
| Elemental diets | 316 | ||
| Special formulations | 316 | ||
| Modular diets | 316 | ||
| Enteral nutrition delivery and complications | 316 | ||
| Parenteral nutritional support | 317 | ||
| Parenteral routes of access | 317 | ||
| Central venous access | 317 | ||
| Technical aspects of feeding lines | 317 | ||
| Catheter care | 318 | ||
| Peripheral venous access | 318 | ||
| Nutrients used in parenteral feeding solutions | 318 | ||
| Nitrogen sources | 318 | ||
| Energy sources | 318 | ||
| Other nutrients | 319 | ||
| Delivery and administration of PN | 319 | ||
| Complications of parenteral nutritional support | 319 | ||
| Monitoring patients receiving nutritional support | 320 | ||
| Nutritional support teams | 320 | ||
| Nutritional support in defined clinical situations | 320 | ||
| Nutritional support in the perioperative period | 320 | ||
| Parenteral nutrition | 320 | ||
| Enteral nutrition | 321 | ||
| Nutritional support in patients with acute pancreatitis (see also Chapter 8) | 321 | ||
| Nutritional supplementation in inflammatory bowel disease | 321 | ||
| Nutritional support in enterocutaneous fistulas | 322 | ||
| Nutritional support in patients with burns | 322 | ||
| Nutritional supplementation with key nutrients: application to clinical practice | 322 | ||
| Combinations of these nutrients and their place in practice | 323 | ||
| References | 325 | ||
| Chapter 18: Abdominal sepsis and abdominal compartment syndrome | 328 | ||
| Introduction | 328 | ||
| Pathophysiology of sepsis | 328 | ||
| The slippery slope of sepsis | 329 | ||
| Treatment strategies in sepsis | 330 | ||
| The Surviving Sepsis Campaign | 330 | ||
| Systematic assessment | 330 | ||
| Antimicrobial therapy in abdominal sepsis | 332 | ||
| Imaging in abdominal sepsis | 332 | ||
| Early source control in abdominal sepsis | 333 | ||
| Aims of treatment in abdominal sepsis | 333 | ||
| Abdominal sepsis on the ICU | 334 | ||
| Assessment on the ICU | 335 | ||
| Re-operating in abdominal sepsis | 335 | ||
| Damage control laparotomy | 336 | ||
| Second-look or planned re-laparotomy | 337 | ||
| Leaving the abdomen open (laparostomy) | 337 | ||
| Abdominal compartment syndrome | 338 | ||
| Intestinal fistulas | 339 | ||
| Chronic abdominal sepsis | 341 | ||
| References | 341 | ||
| Chapter 19: Complications of bariatric surgery presenting to the general surgeon | 344 | ||
| Introduction | 344 | ||
| Causes of obesity | 344 | ||
| Mechanisms of weight loss surgery | 345 | ||
| Bariatric operations | 345 | ||
| Gastric band | 346 | ||
| Roux-en-Y gastric bypass | 346 | ||
| Mini-gastric bypass | 346 | ||
| Sleeve gastrectomy | 346 | ||
| Duodenal switch | 347 | ||
| Intragastric balloon | 347 | ||
| Older, more obsolete operations | 347 | ||
| Jejuno-ileal bypass (JIB) | 347 | ||
| Vertical banded gastroplasty (VBG) | 348 | ||
| Newer procedures | 349 | ||
| Ileal transposition | 349 | ||
| Endoscopic duodenojejunal sleeve | 349 | ||
| Gastric plication | 349 | ||
| Implantable neuroregulators (gastric ‘pacemakers’) | 349 | ||
| Complications of bariatric surgery | 350 | ||
| General complications | 350 | ||
| Specific complications | 350 | ||
| Clinical presentation | 350 | ||
| Gastric band patients | 350 | ||
| Vomiting and/or dysphagia | 350 | ||
| Band too tight | 350 | ||
| Acute band ‘slippage’ | 351 | ||
| Band erosion | 352 | ||
| Abdominal pain | 352 | ||
| Chest pain | 353 | ||
| Mega-oesophagus | 353 | ||
| Port problems | 353 | ||
| Migration | 353 | ||
| Leakage | 353 | ||
| Infection | 353 | ||
| Skin erosion | 353 | ||
| Sleeve gastrectomy patients | 353 | ||
| Staple-line leak or bleed | 353 | ||
| Splenic infarction | 353 | ||
| Omental necrosis | 353 | ||
| Sleeve stenosis | 354 | ||
| Gastric bypass/BPD/duodenal switch patients | 354 | ||
| Staple-line leak | 354 | ||
| Staple-line bleed | 354 | ||
| Small-bowel enterotomy | 354 | ||
| Early small-bowel obstruction | 354 | ||
| Late small-bowel obstruction | 354 | ||
| Gastro-gastric fistula | 355 | ||
| Dumping syndrome | 355 | ||
| Mini-gastric bypass patients | 355 | ||
| Gastric balloon patients | 355 | ||
| Duodenojejunal barrier patients | 356 | ||
| Migration | 356 | ||
| Duodenal bleeding | 356 | ||
| Bowel obstruction | 356 | ||
| Gastric plication patients | 356 | ||
| Patients with older, now obsolete operations | 356 | ||
| Other postoperative problems | 356 | ||
| Gallstones | 356 | ||
| Nutritional deficiencies | 356 | ||
| Failure to lose weight | 357 | ||
| References | 357 | ||
| Index | 359 |