BOOK
Essential Surgery E-Book
Simon J.F. Harper | Kourosh Saeb-Parsy | Clive R. G. Quick | Philip J. Deakin
(2013)
Additional Information
Book Details
Abstract
Essential Surgery is a comprehensive and highly illustrated textbook suitable for both clinical medical students as well junior surgical trainees, preparing for postgraduate qualifications in surgery such as the MRCS. Covering general surgery, trauma, orthopaedics, vascular surgery, paediatric surgery, cardiothoracic surgery and urology, it incorporates appropriate levels of basic science throughout. The book is ideal for modern clinical courses as well as being a practical manual for readers at more advanced levels. Its main aim is to stimulate the reader to a greater enjoyment and understanding of the practice of surgery.
- Essential Surgery incorporates a problem-solving approach wherever possible, emphasising how diagnoses are made and why particular treatments are used.
- The pathophysiological basis of surgical diseases is discussed in relation to their management, acting as a bridge between basic medical sciences and clinical problems.
- The uniformity of the writing style and the clarity of elucidation will encourage continued reading, while the emphasis on the principles of surgery will enable a real understanding of the subject matter.
- The book’s extensive use of original illustrations, boxes and tables emphasises important concepts and will aid revision.
- The principles of operative surgery and perioperative care are explained together with outlines of common operations, enabling students and trainee surgeons to properly understand procedures and to participate intelligently in the operating department.
- A major revision of the text has taken full account of the progressive evolution of surgery and includes new concepts that have advanced medical understanding.
- New topics have been added to ensure the book’s contents match the curriculum of the UK Intercollegiate MRCS examination, including patient safety, surgical ethics, communication, consent, clinical audit and principles of research.
- The broad experience of surgical teaching and training of two new authors has brought a fresh perspective on the book’s contents and its presentation.
- New consensus guidelines for managing common disorders have been incorporated where appropriate.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Half_title_page | i | ||
| Publisher’s note about the authors | ii | ||
| Essential Surgery | iii | ||
| Copyright Page | iv | ||
| Foreword | v | ||
| Preface | vi | ||
| Changes for this edition | vi | ||
| Operative surgery | vii | ||
| Acknowledgements | viii | ||
| Table Of Contents | x | ||
| 1 Principles of Surgical Care | 1 | ||
| 1 Mechanisms of surgical disease and surgery in practice | 3 | ||
| A short history of surgery | 3 | ||
| Approaches to surgical problems | 4 | ||
| What do surgeons do? | 4 | ||
| What sort of patients come to surgeons? | 4 | ||
| The diagnostic process | 4 | ||
| Formulating a diagnosis | 4 | ||
| Principal mechanisms of surgical disease | 4 | ||
| Congenital conditions | 5 | ||
| Acquired conditions | 5 | ||
| Trauma | 5 | ||
| Inflammation | 5 | ||
| Infection | 5 | ||
| Neoplasia | 6 | ||
| Vascular disorders | 6 | ||
| Degenerative disorders | 6 | ||
| Metabolic disorders | 6 | ||
| Endocrine disorders and hormonal therapy | 6 | ||
| Other abnormalities of tissue growth | 6 | ||
| Iatrogenic disorders | 6 | ||
| Drugs, toxins and diet | 7 | ||
| Psychogenic disorders | 7 | ||
| Disorders of function | 7 | ||
| Medical ethics and confidentiality | 7 | ||
| Confidentiality | 8 | ||
| Do not resuscitate (DNR) orders | 8 | ||
| Guidelines for when a DNR may be issued: | 8 | ||
| Communication | 8 | ||
| With patients | 8 | ||
| Palliative care | 8 | ||
| Breaking bad news | 9 | ||
| Communicating with colleagues | 9 | ||
| Communication via the clinical record | 9 | ||
| Evidence-based medicine and guidelines | 10 | ||
| History | 10 | ||
| Cherry-picking the evidence versus systematic review | 10 | ||
| Longitudinal or cohort studies | 10 | ||
| Ranking the quality of evidence (Box 1.5) | 10 | ||
| Other classifications of quality of evidence | 11 | ||
| Quality and limitations of clinical trials | 11 | ||
| Resources | 11 | ||
| Guidelines | 11 | ||
| Keeping up to date: continuing medical education | 11 | ||
| Consent to treatment | 12 | ||
| When is consent necessary? | 12 | ||
| The unconscious patient | 12 | ||
| Practical aspects of consent for treatment | 12 | ||
| Obtaining consent (Box 1.6) | 12 | ||
| Consent in children | 13 | ||
| Jehovah’s Witnesses | 13 | ||
| Clinical governance and clinical audit | 13 | ||
| Management attitude to quality of care | 13 | ||
| Education and training of clinical staff | 13 | ||
| Clinical audit | 13 | ||
| Clinical effectiveness | 13 | ||
| Research and development | 13 | ||
| Clinical performance | 13 | ||
| Risk management | 13 | ||
| Information management | 14 | ||
| Surgical (clinical) audit | 14 | ||
| Medical research versus medical audit | 14 | ||
| Carrying out an audit (Box 1.7) | 14 | ||
| Peer group review of medical audit data | 15 | ||
| Examples of how clinical audit can improve the quality of care: | 15 | ||
| Confidential enquiry into perioperative deaths (CEPOD) | 15 | ||
| Educational lessons from CEPOD | 15 | ||
| Research in surgery | 15 | ||
| How are potentially improved methods evaluated? | 15 | ||
| Design of research and experiments | 16 | ||
| Clinical trials | 16 | ||
| Drug trials | 16 | ||
| Trial design and conduct | 16 | ||
| Patient safety | 16 | ||
| Dealing with an adverse event | 16 | ||
| Introduction | 16 | ||
| General hazards | 17 | ||
| Theatre safety | 17 | ||
| Surgical mishaps | 17 | ||
| Injuries and hazards of moving and positioning patients | 18 | ||
| Peripheral nerve injuries | 18 | ||
| Eye injuries | 18 | ||
| Direct pressure effects | 18 | ||
| Burns | 18 | ||
| Hypothermia | 18 | ||
| Infection risks | 18 | ||
| Hazards during immediate postoperative recovery | 18 | ||
| Radiation hazards | 18 | ||
| Disease processes | 19 | ||
| 2 Managing physiological change in the surgical patient | 19 | ||
| Systemic responses | 19 | ||
| Factors responsible for systemic responses (Box 2.1) | 19 | ||
| Management of the deteriorating patient | 19 | ||
| Stressors in the surgical patient | 19 | ||
| Direct and indirect tissue trauma | 19 | ||
| Fall in intravascular volume | 19 | ||
| Reduced cardiac output and peripheral perfusion | 20 | ||
| Systemic inflammatory responses and sepsis (see Ch. 3) | 20 | ||
| Pain | 20 | ||
| Stress | 20 | ||
| Excess heat loss | 20 | ||
| Blood coagulation changes | 20 | ||
| Starvation and stress-induced catabolism | 20 | ||
| Metabolic responses to pathophysiological stress | 20 | ||
| Effects on carbohydrate metabolism | 21 | ||
| Effects on body proteins and nitrogen metabolism | 21 | ||
| Effects on lipid stores and metabolism | 21 | ||
| Fluid, electrolyte and acid–base management | 21 | ||
| Introduction | 21 | ||
| Normal fluid and electrolyte homeostasis | 21 | ||
| Maintenance of water and sodium | 22 | ||
| Maintenance of potassium | 23 | ||
| Limits of compensatory mechanisms | 23 | ||
| Physiological changes in response to surgery and trauma | 23 | ||
| Effects of a fall in renal perfusion | 23 | ||
| Other factors in water conservation | 23 | ||
| Postoperative situation | 23 | ||
| Abdominal compartment syndrome | 24 | ||
| Problems of fluid and electrolyte depletion | 24 | ||
| Loss of whole blood or plasma | 24 | ||
| Gastrointestinal fluid loss | 24 | ||
| Intra-abdominal accumulation of inflammatory fluid | 25 | ||
| Systemic sepsis (SIRS and multiple organ dysfunction syndrome) | 25 | ||
| Abnormal insensible fluid loss | 25 | ||
| Preventing acute renal failure | 25 | ||
| Common fluid and electrolyte problems | 25 | ||
| Intermediate elective operations and uncomplicated emergency operations | 25 | ||
| Introduction to management | 25 | ||
| Major operations | 26 | ||
| Enhanced recovery programmes | 26 | ||
| Abnormalities of individual electrolytes | 26 | ||
| Abnormalities of plasma sodium concentration | 26 | ||
| Hyponatraemia | 26 | ||
| Hypernatraemia | 27 | ||
| Abnormalities of plasma potassium concentration | 27 | ||
| Hypokalaemia | 27 | ||
| Hyperkalaemia | 28 | ||
| Acid–base disturbances (see Fig. 2.4 and Table 2.4) | 28 | ||
| Metabolic acidosis | 28 | ||
| Respiratory acidosis | 28 | ||
| Metabolic alkalosis | 29 | ||
| Respiratory alkalosis | 29 | ||
| Nutritional management in the surgical patient | 29 | ||
| Essential principles | 29 | ||
| Recognising the patient at risk | 30 | ||
| Effects of starvation | 30 | ||
| Simple starvation | 30 | ||
| Trauma, surgery or sepsis | 31 | ||
| Supplementary nutrition | 31 | ||
| Methods of giving supplementary nutrition | 31 | ||
| Sip feeds | 31 | ||
| Tube feeds | 32 | ||
| Total parenteral nutrition (TPN) | 32 | ||
| Indications for TPN | 32 | ||
| Methods of giving TPN | 32 | ||
| Refeeding syndrome | 32 | ||
| 3 Immunity, inflammation and infection | 34 | ||
| Immune responses | 34 | ||
| Introduction | 34 | ||
| Innate immunity | 34 | ||
| Adaptive immunity | 34 | ||
| Inflammation | 35 | ||
| Acute inflammation | 35 | ||
| Introduction | 35 | ||
| Resolution | 35 | ||
| Abscess formation (Fig. 3.3) | 35 | ||
| The chronic state | 36 | ||
| Antibiotics and abscesses | 36 | ||
| Organisation and repair | 36 | ||
| Wound healing | 36 | ||
| Healing by primary intention | 36 | ||
| Healing by secondary intention | 36 | ||
| Factors impairing wound healing | 37 | ||
| Chronic inflammation | 37 | ||
| Chronic abscesses | 39 | ||
| Chronic ulcers | 39 | ||
| Specific granulomatous infections and inflammations | 39 | ||
| Infection | 41 | ||
| General principles | 41 | ||
| Methods of control of nosocomial infection | 41 | ||
| Environment | 41 | ||
| Staff | 41 | ||
| Patients | 41 | ||
| Procedures | 41 | ||
| Universal blood and body fluid precautions | 41 | ||
| Hepatitis B vaccination | 42 | ||
| Needle-stick and other penetrating injuries | 42 | ||
| Viral infection following sharps injury | 42 | ||
| Use of microbiological tests in managing surgical infections | 42 | ||
| Principles of treatment of surgical infection | 43 | ||
| Removal of infected foci | 43 | ||
| Antibiotic therapy (see Table 3.1) | 43 | ||
| Empirical antibiotic therapy | 43 | ||
| Specific antibiotic therapy | 43 | ||
| Nutritional support | 43 | ||
| Bacteria of particular surgical importance | 44 | ||
| Staphylococci | 44 | ||
| Pathophysiology | 44 | ||
| Antibiotic sensitivities | 44 | ||
| MRSA | 45 | ||
| Streptococci | 45 | ||
| 2 Perioperative Care | 93 | ||
| 7 Preoperative assessment | 95 | ||
| Introduction | 95 | ||
| Principles of preoperative assessment | 95 | ||
| Essentials of preoperative assessment | 95 | ||
| Explanations to the patient and informed consent | 95 | ||
| Planning the recovery period | 97 | ||
| Marking the operation site | 97 | ||
| Immediate preoperative starvation and fluid restriction | 97 | ||
| Liaison with anaesthetist | 97 | ||
| Operating theatre arrangements | 97 | ||
| Planning the order of an operating list | 97 | ||
| Preparation for major operation | 98 | ||
| History | 98 | ||
| Presenting complaint | 98 | ||
| Results of outpatient investigations | 98 | ||
| Systems enquiry | 98 | ||
| Past medical history | 98 | ||
| Family history | 100 | ||
| Social history | 100 | ||
| Drug history | 100 | ||
| Examination | 100 | ||
| Summary | 100 | ||
| 8 Medical problems | 101 | ||
| Introduction | 101 | ||
| Cardiac and cerebrovascular disease | 101 | ||
| 1. ischaemic heart disease | 101 | ||
| Clinical problems | 101 | ||
| a. Stable angina and myocardial infarction more than three months previously | 101 | ||
| b. Acute coronary syndrome (ACS) | 102 | ||
| 2. chronic heart failure (CHF) | 102 | ||
| Clinical problems | 102 | ||
| a. CHF before operation | 102 | ||
| b. Decompensated heart failure developing during or after operation | 102 | ||
| Preoperative assessment of cardiac failure | 102 | ||
| 3. cardiac arrhythmias | 103 | ||
| Clinical problems | 103 | ||
| a. Atrial fibrillation (Fig. 8.2) | 103 | ||
| b. Bradycardia | 104 | ||
| c. Other arrhythmias | 104 | ||
| 4. hypertension | 104 | ||
| Clinical problems | 104 | ||
| a. Mild-to-moderate essential hypertension | 104 | ||
| b. Treated hypertension | 104 | ||
| c. Severe or poorly controlled hypertension | 104 | ||
| Preoperative assessment of hypertensive patients | 105 | ||
| 5. cerebrovascular disease | 105 | ||
| 6. valvular heart disease | 105 | ||
| Aortic stenosis | 105 | ||
| Infective endocarditis and indications for antibiotic prophylaxis | 106 | ||
| Respiratory diseases | 106 | ||
| Clinical problems | 106 | ||
| a. Chronic obstructive pulmonary disease (COPD) | 106 | ||
| b. Cigarette smoking | 107 | ||
| c. Current respiratory infections | 107 | ||
| d. Asthma | 107 | ||
| e. Previous pulmonary embolism or deep venous thrombosis | 107 | ||
| Preoperative investigation of respiratory disease | 107 | ||
| Perioperative management of respiratory disease and high-risk patients | 107 | ||
| Gastrointestinal disorders | 108 | ||
| Malnutrition | 108 | ||
| Nutritional assessment | 108 | ||
| Indications for nutritional support | 108 | ||
| Dental problems | 108 | ||
| Peptic ulcer disease | 108 | ||
| Gastro-oesophageal reflux disease (GORD) | 108 | ||
| Inflammatory bowel disease | 108 | ||
| Hepatic disorders | 108 | ||
| Clinical problems | 108 | ||
| a. History of jaundice | 108 | ||
| b. Presence of obstructive jaundice | 109 | ||
| c. The patient with known hepatitis | 109 | ||
| d. The patient with known cirrhosis | 109 | ||
| Preoperative assessment and management | 109 | ||
| Renal disorders | 110 | ||
| Clinical problems | 110 | ||
| a. Mild/moderate chronic renal failure (CKD stage 1–3, eGFR > 30 ml/min) | 110 | ||
| b. Severe chronic renal failure (CKD stage 4–5, eGFR < 30 ml/min) | 110 | ||
| Preoperative assessment | 110 | ||
| Diabetes mellitus | 110 | ||
| Clinical problems | 111 | ||
| a. Insulin-dependent diabetes | 111 | ||
| b. Diabetics controlled on oral hypoglycaemic drugs | 111 | ||
| c. Diabetics controlled by diet alone | 111 | ||
| d. Poorly controlled diabetes on emergency admission | 112 | ||
| Thyroid disease | 112 | ||
| Thyrotoxicosis (Fig. 8.6)Case History Fig. 8.6 Thyrotoxic eye signs This woman of 36 presented with a typical history of primary thyrotoxicosis (Graves’ disease), with weight loss, irritability and menstrual irregularity. In addition her eyesight had become blurred. She had florid exophthalmos with protruding eyeballs (proptosis) and lid lag. She was barely able to close her eyelids and would soon be at risk of corneal drying | 112 | ||
| Hypothyroidism | 112 | ||
| Disorders of adrenal function | 113 | ||
| Adrenal insufficiency | 113 | ||
| Perioperative ‘steroid cover’ | 113 | ||
| Cushing’s syndrome | 113 | ||
| Musculoskeletal and neurological disorders | 113 | ||
| Rheumatoid arthritis | 113 | ||
| Preoperative assessment of a patient with rheumatoid arthritis | 113 | ||
| Haematological disorders | 113 | ||
| Anaemias | 113 | ||
| Haemoglobinopathies | 114 | ||
| Polycythaemia | 114 | ||
| Leukaemia, leucopenia and thrombocytopenia | 115 | ||
| Bleeding disorders | 115 | ||
| Clinical problems of bleeding disorders | 115 | ||
| a. Inherited clotting disorders | 115 | ||
| b. Anticoagulant therapy | 115 | ||
| c. Liver disease | 115 | ||
| d. Aspirin and clopidogrel therapy | 115 | ||
| e. Malabsorption of fat-soluble vitamins | 115 | ||
| Psychiatric disorders | 115 | ||
| Mental illness and learning disability | 115 | ||
| Alcoholism and drug addiction | 115 | ||
| Problems of drug withdrawal | 115 | ||
| Dementia | 116 | ||
| Obesity | 117 | ||
| Chronic drug therapy | 117 | ||
| 9 Blood transfusion | 118 | ||
| Principles of blood transfusion | 118 | ||
| Laboratory aspects of blood transfusion | 118 | ||
| Blood grouping and compatibility testing | 118 | ||
| Storage and useful life of blood | 118 | ||
| Blood transfusion in clinical practice | 118 | ||
| Blood transfusion and elective surgery | 118 | ||
| Volume and rate of transfusion | 119 | ||
| Volume and rate in haemorrhage | 119 | ||
| Volume and rate in anaemia | 120 | ||
| Reducing the need for bank blood transfusion | 120 | ||
| Non-transfusion methods | 120 | ||
| Preoperative | 120 | ||
| Intraoperative | 120 | ||
| Autologous transfusion | 120 | ||
| Preoperative autologous donation (PAD) | 120 | ||
| Acute normovolaemic haemodilution (ANH) | 120 | ||
| Intraoperative cell salvage (IOCS) | 120 | ||
| Postoperative cell salvage (POCS) | 120 | ||
| Hazards and complications of blood transfusion | 120 | ||
| Febrile non-haemolytic transfusion reactions (FNHTR) | 120 | ||
| Haemolytic reactions | 121 | ||
| Allergic reactions | 121 | ||
| Infection | 121 | ||
| Infections transmitted by donor blood or blood product transfusion | 121 | ||
| Hepatitis viruses | 121 | ||
| Human immunodeficiency virus (HIV) | 121 | ||
| Cytomegalovirus | 122 | ||
| Protozoal infection—malaria | 122 | ||
| Variant Creutzfeldt–Jakob disease (vCJD) | 122 | ||
| Contamination of blood or giving sets with microorganisms | 122 | ||
| Immunosuppressive effects of blood transfusion | 122 | ||
| Fluid overload | 122 | ||
| Transfusion-related acute lung injury (TRALI) | 122 | ||
| Delayed transfusion reactions | 122 | ||
| Post-transfusion purpura (PTP) | 122 | ||
| Transfusion-associated graft versus host disease (Ta-GvHD) | 122 | ||
| 10 Principles and techniques of operative surgery including neurosurgery and orthopaedics | 123 | ||
| 3 Principles of Accident Surgery | 197 | ||
| 15 Major trauma | 199 | ||
| 4 Symptoms, Diagnosis and Management | 245 | ||
| Abdomen, general principles | 247 | ||
| 18 Non-acute abdominal pain and other abdominal symptoms and signs | 247 | ||
| Introduction | 247 | ||
| Pain | 247 | ||
| Character, timing and site of the pain | 247 | ||
| The site of origin, distribution and radiation of the pain | 247 | ||
| Diseases causing non-acute abdominal pain—typical patterns | 247 | ||
| Non-acute abdominal pain in children | 248 | ||
| Approach to investigation of non-acute abdominal pain | 249 | ||
| Dysphagia and odynophagia | 249 | ||
| Clinical presentation | 249 | ||
| Approach to investigation of dysphagia | 249 | ||
| Weight loss, anorexia and associated symptoms | 250 | ||
| Approach to investigation of weight loss, anorexia and associated symptoms | 252 | ||
| Anal and perianal symptoms | 252 | ||
| Anal bleeding | 252 | ||
| Anal pain and discomfort | 252 | ||
| Perianal itching and irritation | 252 | ||
| ‘Something coming down’ | 253 | ||
| Perianal discharge | 253 | ||
| Approach to investigation of anal and perianal symptoms | 253 | ||
| Change in bowel habit, rectal bleeding and related symptoms | 253 | ||
| Frequency of defaecation and stool consistency | 253 | ||
| Constipation | 255 | ||
| Diarrhoea | 255 | ||
| Erratic bowel habit | 255 | ||
| Changes in the nature of the stool | 255 | ||
| Presence of frank blood, altered blood or mucus in the stool | 255 | ||
| Frank rectal bleeding | 255 | ||
| Occult faecal blood loss | 256 | ||
| Rectal passage of mucus or pus | 256 | ||
| Tenesmus | 256 | ||
| Approach to investigation of change in bowel habit | 256 | ||
| Iron deficiency anaemia | 256 | ||
| Approach to investigation of anaemia | 256 | ||
| Obstructive jaundice | 257 | ||
| The normal enterohepatic circulation (Fig. 18.8) | 257 | ||
| Pathophysiology of obstructive jaundice | 257 | ||
| History and examination of patients with obstructive jaundice | 258 | ||
| History-taking | 258 | ||
| Examination | 258 | ||
| Approach to investigation of jaundice | 259 | ||
| Urine tests | 259 | ||
| Blood tests | 259 | ||
| Imaging | 259 | ||
| Hepatobiliary ultrasonography | 259 | ||
| CT scanning | 259 | ||
| Endoscopic and magnetic resonance cholangio-pancreatography | 259 | ||
| Laparoscopy and liver biopsy | 259 | ||
| Principles of management of obstructive jaundice | 261 | ||
| Potentially curable obstructions | 261 | ||
| Obstruction due to incurable tumour | 262 | ||
| Terminal disease | 262 | ||
| Special risks of surgery in the jaundiced patient | 262 | ||
| Abdominal mass or distension | 262 | ||
| Clinical assessment of an abdominal mass | 263 | ||
| History | 263 | ||
| General examination | 264 | ||
| Examination of an abdominal mass | 264 | ||
| Examination of masses in specific regions of the abdomen (see Fig. 18.1) | 264 | ||
| Mass in the right hypochondrium (right upper quadrant or RUQ) | 264 | ||
| Epigastric mass | 264 | ||
| Mass in the left hypochondrium (left upper quadrant or LUQ) | 264 | ||
| Mass in the loin or flank | 264 | ||
| Mass in the left iliac fossa | 264 | ||
| Suprapubic mass | 264 | ||
| Mass in the right iliac fossa | 265 | ||
| Central abdominal mass | 265 | ||
| Rectal mass and findings on pelvic examination | 265 | ||
| Interpretation of a finding of ascites | 265 | ||
| Malignant ascites | 265 | ||
| Lymphatic obstruction | 265 | ||
| Tuberculosis | 265 | ||
| Non-surgical causes | 265 | ||
| Diffuse abdominal distension | 265 | ||
| Approach to investigation of an abdominal mass or distension | 266 | ||
| Laboratory tests | 266 | ||
| Radiology | 266 | ||
| Endoscopy | 266 | ||
| Other methods of tissue diagnosis | 266 | ||
| Examination under anaesthesia, laparoscopy and exploratory laparotomy | 266 | ||
| 19 The acute abdomen and acute gastrointestinal haemorrhage | 267 | ||
| Introduction | 267 | ||
| Basic principles of managing the acute abdomen | 267 | ||
| Disorders and diseases causing the acute abdomen | 267 | ||
| Intestinal obstruction | 267 | ||
| Pathophysiology of intestinal obstruction | 267 | ||
| Symptoms of intestinal obstruction | 267 | ||
| Vomiting | 267 | ||
| Pain | 269 | ||
| Constipation | 269 | ||
| Effects of the competence of the ileocaecal valve | 269 | ||
| Incomplete obstruction | 269 | ||
| Physical signs of intestinal obstruction | 269 | ||
| General examination | 269 | ||
| Groin examination | 269 | ||
| Abdominal examination | 269 | ||
| Radiological investigation of suspected bowel obstruction | 270 | ||
| The adynamic bowel | 270 | ||
| Pseudo-obstruction of the colon | 270 | ||
| Principles of management of intestinal obstruction | 271 | ||
| Bowel strangulation | 271 | ||
| Pathophysiology of bowel strangulation | 271 | ||
| Symptoms and signs of bowel strangulation | 272 | ||
| Principles of management of suspected bowel strangulation | 272 | ||
| Peritonitis | 272 | ||
| Pathophysiology and clinical features of peritonitis | 272 | ||
| Intra-abdominal haemorrhage | 273 | ||
| Principles of management of peritonitis | 273 | ||
| Intra-abdominal abscess | 273 | ||
| Pathophysiology and clinical features of intra-abdominal abscess | 273 | ||
| Principles of management of an intra-abdominal abscess | 274 | ||
| Perforation of an abdominal viscus | 274 | ||
| Pathophysiology and clinical features of perforation | 274 | ||
| Principles of management of perforation | 275 | ||
| Acute bowel ischaemia | 275 | ||
| Pathophysiology and clinical features of intestinal ischaemia | 275 | ||
| Principles of management of intestinal ischaemia | 276 | ||
| Major gastrointestinal haemorrhage | 276 | ||
| Pathophysiology and clinical features | 276 | ||
| Management of upper gastrointestinal haemorrhage | 276 | ||
| Initial management and resuscitation | 276 | ||
| Clinical history, examination and investigation | 276 | ||
| Stratification of risk | 278 | ||
| Endoscopic management of acute upper gastrointestinal haemorrhage | 278 | ||
| Surgical management | 279 | ||
| More distal gastrointestinal haemorrhage | 280 | ||
| Upper gastrointestinal and hepatobiliary | 281 | ||
| 20 Gallstone diseases and related disorders | 281 | ||
| Introduction | 281 | ||
| Structure and function of the biliary system | 281 | ||
| Pathophysiology of the biliary system | 282 | ||
| Gallstone composition | 282 | ||
| The role of inflammation and infection | 282 | ||
| The role of chronic obstruction | 283 | ||
| Other pathological mechanisms | 283 | ||
| Epidemiology of gallstones | 283 | ||
| Investigation of gall bladder pathology | 284 | ||
| Blood tests for haematological and liver abnormalities | 284 | ||
| Imaging in investigating gall bladder pathology | 284 | ||
| Investigating the biliary duct system | 284 | ||
| The non-jaundiced patient | 284 | ||
| The jaundiced patient | 285 | ||
| Clinical presentations of gallstone disease | 286 | ||
| Chronic symptoms suggestive of gall bladder disease | 286 | ||
| Biliary colic | 286 | ||
| Clinical features | 286 | ||
| Management | 286 | ||
| Acute cholecystitis | 286 | ||
| Pathophysiology and clinical features | 286 | ||
| Management | 288 | ||
| Acute cholecystectomy | 288 | ||
| Empyema of the gall bladder | 288 | ||
| Cholecysto-duodenal fistula and gallstone ileus | 288 | ||
| Carcinoma of the gall bladder | 288 | ||
| Bile duct stones | 288 | ||
| Pathophysiology | 288 | ||
| Clinical presentations of stones in the biliary tract | 289 | ||
| Obstructive jaundice | 289 | ||
| Asymptomatic duct stones | 289 | ||
| Acute pancreatitis | 289 | ||
| Ascending cholangitis | 289 | ||
| Management of gallstone disease | 289 | ||
| Non-surgical treatment of gallstones | 289 | ||
| Surgical management of gallstones | 290 | ||
| Indications for surgery and preparation of the patient | 290 | ||
| Cholecystectomy—open versus laparoscopic surgery | 290 | ||
| Laparoscopic management of gall bladder disease | 290 | ||
| Operative technique | 290 | ||
| Results of laparoscopic cholecystectomy | 290 | ||
| Operations on the common bile duct | 291 | ||
| Exploration of the common bile duct | 291 | ||
| Endoscopic management of bile duct stones | 292 | ||
| Complications of biliary surgery | 292 | ||
| The retained stone | 292 | ||
| Biliary peritonitis | 292 | ||
| Bile duct damage | 293 | ||
| Haemorrhage | 293 | ||
| Hazards of pre-existing jaundice | 293 | ||
| Ascending cholangitis and other infections | 293 | ||
| 21 Peptic ulceration and related disorders | 294 | ||
| Introduction | 294 | ||
| Pathophysiology and epidemiology of peptic disorders | 294 | ||
| Pathophysiology of peptic ulceration | 294 | ||
| Outcomes of breaches of the mucosal barrier | 294 | ||
| Epidemiology and aetiology of peptic ulcer disease | 295 | ||
| The size of the problem | 295 | ||
| Sites of peptic ulceration (see Fig. 21.2) | 296 | ||
| Stomach and duodenum | 296 | ||
| Oesophagus | 296 | ||
| Aetiological factors in peptic disease | 296 | ||
| H. pylori infection | 296 | ||
| Acid–pepsin production | 297 | ||
| Mucosal resistance | 297 | ||
| Other mucosal irritants | 297 | ||
| Investigation and clinical features of peptic disorders | 297 | ||
| Investigation of suspected peptic ulcer disease | 297 | ||
| Endoscopy | 297 | ||
| Contrast radiology | 298 | ||
| Presenting features of peptic ulcer disease | 298 | ||
| Non-acute presentations of peptic ulcer disease | 298 | ||
| Peptic disorders of the oesophagus | 298 | ||
| Peptic disorders of the stomach | 298 | ||
| Gastritis | 298 | ||
| Stress ulcers | 298 | ||
| Chronic gastric ulceration | 299 | ||
| Peptic disorders of the duodenum | 300 | ||
| Duodenitis | 300 | ||
| Chronic duodenal ulceration | 301 | ||
| Management of chronic peptic ulcer disease | 301 | ||
| Control of predisposing or aggravating causes | 301 | ||
| Elimination of proven H. pylori infection | 302 | ||
| Diminishing of irritant effects of acid–pepsin | 302 | ||
| Administration of mucosal protective agents | 302 | ||
| Reduction of acid secretion | 303 | ||
| H2-receptor blockade and proton pump antagonists | 303 | ||
| Vagotomy | 303 | ||
| Surgical removal of intractable ulcers and gastrin-secreting tissue | 303 | ||
| Complications and side-effects of partial gastrectomy | 304 | ||
| Correction of secondary anatomical problems | 304 | ||
| Emergency presentations of peptic ulcer disease | 304 | ||
| Haemorrhage from a peptic ulcer | 305 | ||
| Perforation of a peptic ulcer | 305 | ||
| Clinical presentation of perforated peptic ulcer | 305 | ||
| Diagnosis of perforated peptic ulcer | 305 | ||
| Surgical management of peptic perforation | 305 | ||
| Conservative management of perforated duodenal ulcer | 306 | ||
| Pyloric stenosisCase History Fig. 21.10 Gastric outlet obstruction Barium meal examination in a woman of 78 who presented with a 2-week history of vomiting. She was grossly dehydrated with a hypochloraemic alkalosis. She was resuscitated and a nasogastric tube passed. This film shows huge gastric dilatation and no flow of barium beyond the pylorus. She also has incidental gallstones (GS). The obstruction proved to be due to chronic duodenal ulceration, but a diagnosis of carcinoma of the gastric antrum must be considered in such a patient | 306 | ||
| Clinical features of pyloric stenosis | 306 | ||
| Biochemical abnormalities in pyloric stenosis | 306 | ||
| Management of pyloric stenosis | 306 | ||
| 22 Disorders of the oesophagus | 307 | ||
| Introduction | 307 | ||
| Carcinoma of the oesophagus | 307 | ||
| Pathology and clinical features | 307 | ||
| Epidemiology and aetiology | 307 | ||
| Investigation of suspected oesophageal carcinoma | 307 | ||
| Staging the cancer | 308 | ||
| Management of carcinoma of the oesophagus | 308 | ||
| Surgery | 309 | ||
| Inoperable lesions | 310 | ||
| Hiatus hernia and reflux oesophagitis | 310 | ||
| Pathophysiology | 310 | ||
| Clinical features of reflux oesophagitis | 311 | ||
| Management of hiatus hernia and reflux oesophagitis | 312 | ||
| Reducing reflux | 312 | ||
| Prokinetic agents | 312 | ||
| Reducing acid–pepsin production | 312 | ||
| Management of strictures | 312 | ||
| Surgery for hiatus hernia and reflux oesophagitis | 312 | ||
| Achalasia | 313 | ||
| Pathophysiology and clinical presentation | 313 | ||
| Investigation of suspected achalasia | 313 | ||
| Management of achalasia | 313 | ||
| Pharyngeal pouch | 314 | ||
| Oesophageal web | 314 | ||
| Gastro-oesophageal varices | 314 | ||
| Pathophysiology | 314 | ||
| Elective management | 315 | ||
| Management of bleeding gastro-oesophageal varices | 315 | ||
| Diagnosis and resuscitation | 315 | ||
| Treatment | 315 | ||
| 23 Tumours of the stomach and small intestine | 317 | ||
| Introduction | 317 | ||
| Carcinoma of stomach | 317 | ||
| Pathology of gastric carcinoma | 317 | ||
| Epidemiology of gastric carcinoma | 317 | ||
| Aetiology of gastric carcinoma and premalignant conditions | 318 | ||
| Atrophic gastritis | 318 | ||
| Helicobacter pylori infection | 318 | ||
| Dietary factors | 318 | ||
| Clinical features of gastric carcinoma | 318 | ||
| Spread of gastric cancer | 318 | ||
| Direct spread and metastasis | 319 | ||
| Investigation of suspected gastric carcinoma | 319 | ||
| Initial diagnosis | 319 | ||
| Staging | 319 | ||
| Management of gastric carcinoma | 320 | ||
| Radical surgery | 320 | ||
| Chemotherapy and radiotherapy | 320 | ||
| Palliative procedures | 320 | ||
| Gastric polyps | 320 | ||
| Gastrointestinal stromal tumours (GIST) | 320 | ||
| Small bowel gastrointestinal stromal tumours | 322 | ||
| Gastric and small bowel lymphomas | 322 | ||
| Pathology and clinical features of lymphomas | 322 | ||
| Management of lymphomas | 322 | ||
| Carcinoid tumours | 323 | ||
| Pathology of carcinoid tumours | 323 | ||
| Clinical presentation of carcinoid tumours | 323 | ||
| Management of carcinoid tumours | 323 | ||
| Other tumours of the small intestine | 323 | ||
| 24 Tumours of the pancreas and hepatobiliary system; the spleen | 324 | ||
| Introduction | 324 | ||
| Carcinoma of the pancreas | 324 | ||
| Pathology | 324 | ||
| Clinical features of ductal pancreatic carcinoma | 324 | ||
| Pain and other abdominal symptoms and signs | 324 | ||
| Obstructive jaundice | 324 | ||
| Approach to investigation of suspected pancreatic carcinoma (Box 24.2) | 325 | ||
| CT and ultrasound imaging | 325 | ||
| Endoscopic ultrasound (EUS) and needle aspiration cytology | 326 | ||
| Magnetic resonance cholangio-pancreatography (MRCP) | 326 | ||
| Endoscopic retrograde cholangio-pancreatography (ERCP) and therapeutic intervention | 326 | ||
| Lesions in the body and tail of the pancreas | 326 | ||
| Cystic neoplasms of the pancreas | 326 | ||
| Management of pancreatic carcinoma | 327 | ||
| Surgical resection and adjuvant therapy | 327 | ||
| Palliation of pancreatic cancer | 327 | ||
| Endocrine tumours of the pancreas | 327 | ||
| Insulinomas (Fig. 24.4) | 327 | ||
| Glucagonomas | 327 | ||
| Gastrinomas | 327 | ||
| Multiple endocrine neoplasia syndromes (MEN) | 327 | ||
| Biliary and periampullary tumours | 327 | ||
| Management of extrahepatic cholangiocarcinoma and periampullary carcinoma | 329 | ||
| Carcinoma of the gall bladder | 329 | ||
| Primary sclerosing cholangitis | 329 | ||
| Liver tumours and abscesses | 329 | ||
| Liver abscesses | 330 | ||
| Hepatocellular carcinoma | 330 | ||
| Clinical features and management of hepatocellular carcinoma | 331 | ||
| Secondary liver tumours | 331 | ||
| The spleen | 331 | ||
| Elective splenectomy | 332 | ||
| 25 Pancreatitis | 333 | ||
| Introduction | 333 | ||
| Acute Pancreatitis | 333 | ||
| Aetiology and epidemiology of acute pancreatitis | 333 | ||
| Pathophysiology of acute pancreatitis | 333 | ||
| Clinical features of acute pancreatitis (see Box 25.3) | 335 | ||
| Investigation of suspected pancreatitis | 335 | ||
| Plasma amylase | 335 | ||
| Imaging | 336 | ||
| Endoscopy | 336 | ||
| Clinical classification | 336 | ||
| Mild acute pancreatitis | 336 | ||
| Severe acute pancreatitis | 337 | ||
| Management of acute pancreatitis | 337 | ||
| Mild attacks | 337 | ||
| Severe attacks | 337 | ||
| Endoscopy and surgery in severe acute pancreatitis | 338 | ||
| Complications of acute pancreatitis | 338 | ||
| Mortality | 338 | ||
| Pancreatic necrosis and infection | 338 | ||
| Fluid collections around the pancreas | 338 | ||
| Pancreatic pseudocyst | 338 | ||
| Pancreatic abscess | 339 | ||
| Complications of severe acute pancreatitis | 339 | ||
| Late complications of acute pancreatitis | 339 | ||
| Recurrent and Chronic Pancreatitis | 339 | ||
| Recurrent acute pancreatitis | 339 | ||
| Chronic pancreatitis | 339 | ||
| Coloproctology | 341 | ||
| 26 Appendicitis | 341 | ||
| Introduction | 341 | ||
| Anatomy of the appendix | 341 | ||
| Pathophysiology of appendicitis | 341 | ||
| Clinical features of appendicitis | 342 | ||
| Classic appendicitis | 342 | ||
| Other presentations of acute appendicitis | 342 | ||
| Making the diagnosis of appendicitis | 343 | ||
| Special points in the history and examination | 343 | ||
| Differential diagnosis | 344 | ||
| The equivocal diagnosis | 344 | ||
| Problems in the diagnosis of appendicitis | 345 | ||
| The very young | 345 | ||
| The elderly | 345 | ||
| Pregnancy | 345 | ||
| The ‘grumbling’ appendix | 346 | ||
| Appendicectomy | 346 | ||
| Antibiotic prophylaxis | 346 | ||
| Technique of appendicectomy | 346 | ||
| Open appendicectomy | 347 | ||
| Laparoscopic appendicectomy | 347 | ||
| The ‘lily-white’ appendix | 347 | ||
| The appendix mass | 349 | ||
| 27 Colorectal polyps and carcinoma | 350 | ||
| Introduction | 350 | ||
| Colorectal Polyps | 350 | ||
| Adenomatous polyps and adenomas | 350 | ||
| Classification of colonic adenomas | 351 | ||
| Distribution of colorectal adenomas | 351 | ||
| Symptoms and signs of colorectal polyps | 351 | ||
| Diagnosis and management of colorectal polyps | 351 | ||
| Adenocarcinoma of Colon and Rectum | 353 | ||
| Epidemiology of colorectal carcinoma | 353 | ||
| Inherited conditions causing bowel cancer | 353 | ||
| Polyposis syndromes | 353 | ||
| Hereditary non-polyposis colorectal cancer (HNPCC) | 353 | ||
| Pathophysiology of colorectal carcinoma | 353 | ||
| Presentation of large bowel carcinoma | 356 | ||
| Blood loss and anaemia | 356 | ||
| Change of bowel habit and large bowel obstruction | 356 | ||
| Rectal bleeding | 356 | ||
| Tenesmus | 356 | ||
| Perforation | 356 | ||
| Clinical signs in suspected colorectal carcinoma | 356 | ||
| Investigation of suspected colorectal carcinoma | 356 | ||
| Blood tests | 356 | ||
| Imaging for staging | 356 | ||
| Management of colorectal carcinoma | 357 | ||
| Staging of colorectal carcinoma | 358 | ||
| Operations for colorectal cancer | 358 | ||
| The role of adjuvant radiotherapy and chemotherapy | 359 | ||
| Management of advanced disease and recurrence | 360 | ||
| Complications of large bowel surgery | 360 | ||
| Stomas | 361 | ||
| Indications and general principles | 361 | ||
| Permanent stomas | 361 | ||
| Temporary stomas | 361 | ||
| Emergency procedures | 361 | ||
| Defunctioning stomas | 361 | ||
| Bowel rest | 361 | ||
| Types of stoma | 361 | ||
| Loop stoma | 361 | ||
| Split or ‘spectacle’ stoma | 361 | ||
| End stoma | 362 | ||
| Hartmann’s procedure: end colostomy and rectal stump | 363 | ||
| Irrigation technique for managing a colostomy | 363 | ||
| Complications of colostomy and ileostomy | 363 | ||
| 28 Chronic inflammatory disorders of the bowel | 364 | ||
| Introduction | 364 | ||
| Epidemiology and aetiology of inflammatory bowel disease | 364 | ||
| Ulcerative Colitis | 365 | ||
| Pathophysiology of ulcerative colitis | 366 | ||
| Clinical features of ulcerative colitis | 366 | ||
| Clinical examination and investigation of suspected ulcerative colitis | 367 | ||
| Proctitis | 367 | ||
| Contrast radiology | 367 | ||
| Endoscopy | 367 | ||
| Fulminant ulcerative colitis | 367 | ||
| Management of ulcerative colitis | 368 | ||
| Aminosalicylate preparations | 368 | ||
| Corticosteroids | 369 | ||
| Other supportive measures | 369 | ||
| Surgery for ulcerative colitis | 369 | ||
| Crohn’s Disease | 369 | ||
| Pathophysiology and clinical consequences of crohn’s disease | 370 | ||
| Effects of mucosal inflammation | 370 | ||
| Effects of transmural inflammation | 370 | ||
| Perianal inflammation | 371 | ||
| Systemic features | 371 | ||
| Symptoms and signs in crohn’s disease | 371 | ||
| Approach to investigation of suspected crohn’s disease | 371 | ||
| Management of Crohn’s disease | 372 | ||
| Anti-inflammatory agents | 372 | ||
| Immunomodulators | 373 | ||
| Other supportive treatments | 373 | ||
| The role of surgery in Crohn’s disease | 373 | ||
| Other Chronic Inflammations of the Colon | 374 | ||
| Amoebic colitis | 374 | ||
| Clinical features of amoebic colitis | 374 | ||
| Diagnosis of amoebiasis | 374 | ||
| Treatment of amoebiasis | 374 | ||
| Microscopic colitis | 374 | ||
| 29 Disorders of large bowel motility, structure and perfusion | 375 | ||
| Introduction | 375 | ||
| Modern diet and disease | 375 | ||
| Epidemiological observations | 375 | ||
| Mechanisms of disease caused by modern diet | 375 | ||
| Dietary fibre content | 376 | ||
| Irritable bowel syndrome | 376 | ||
| Clinical features of irritable bowel syndrome | 376 | ||
| Pathophysiology and aetiology of irritable bowel syndrome | 377 | ||
| Management of irritable bowel syndrome | 377 | ||
| Constipation | 377 | ||
| Clinical features of constipation | 377 | ||
| Pathophysiology of chronic constipation | 378 | ||
| Management of constipation | 378 | ||
| Sigmoid volvulus (Fig. 29.1) | 378 | ||
| Pathophysiology of sigmoid volvulus | 378 | ||
| Clinical features of sigmoid volvulus | 378 | ||
| Management of sigmoid volvulus | 378 | ||
| Diverticular disease | 379 | ||
| Pathophysiology of diverticular disease | 379 | ||
| Complications of diverticular disease | 380 | ||
| Clinical presentations of diverticular disease and their management | 380 | ||
| Chronic grumbling diverticular pain (see Fig. 29.3b) | 380 | ||
| Acute diverticulitis (i.e. spreading pericolic inflammation, see Fig. 29.3c) | 380 | ||
| Hinchey classification of abscesses and perforation | 380 | ||
| Pericolic abscess (see Fig. 29.3d) | 380 | ||
| Diverticular perforation (Fig. 29.3e) | 381 | ||
| Fistula formation into other abdominal or pelvic structures (Fig. 29.3g) | 382 | ||
| Intestinal obstruction (Fig. 29.3h) | 382 | ||
| Acute rectal haemorrhage (Fig. 29.3f) | 383 | ||
| Colonic angiodysplasias | 383 | ||
| Ischaemic colitis | 383 | ||
| 30 Anal and perianal disorders | 385 | ||
| Introduction | 385 | ||
| Anatomy of the anal canal | 385 | ||
| Haemorrhoids | 385 | ||
| Pathogenesis of haemorrhoids | 387 | ||
| Classification of haemorrhoids | 387 | ||
| Symptoms and signs of haemorrhoids | 388 | ||
| Acute presentations of haemorrhoids | 388 | ||
| Conservative management and prevention of haemorrhoids | 388 | ||
| Surgical treatments for haemorrhoids | 388 | ||
| Injection of sclerosants or banding | 388 | ||
| Haemorrhoidectomy | 389 | ||
| Haemorrhoidal artery ligation operation (HALO) | 389 | ||
| Thrombosed external haemorrhoids | 389 | ||
| Anal fissure | 389 | ||
| Management of anal fissure | 389 | ||
| Anorectal abscesses | 390 | ||
| Pathophysiology and clinical features | 390 | ||
| Treatment of anorectal abscesses | 391 | ||
| Anal fistula | 392 | ||
| Pilonidal sinus and abscess | 393 | ||
| Pilonidal abscess | 393 | ||
| Treatment of pilonidal sinus | 393 | ||
| Rectal prolapse | 394 | ||
| Management of rectal prolapse | 394 | ||
| Faecal incontinence (Table 30.1) | 394 | ||
| Anorectal incontinence | 395 | ||
| Anal warts (condylomata accuminata) | 395 | ||
| Squamous cell carcinoma of the anus | 395 | ||
| Epidemiology | 395 | ||
| Clinical features | 395 | ||
| Other rare anal neoplasms | 396 | ||
| Proctalgia fugax | 396 | ||
| Pruritus ani | 396 | ||
| Thoracic surgery excluding cardiac | 397 | ||
| 31 Thoracic surgery | 397 | ||
| Introduction | 397 | ||
| Investigative techniques | 397 | ||
| Imaging | 397 | ||
| Lung function tests | 397 | ||
| Bronchoscopy | 397 | ||
| Pleural aspiration and percutaneous biopsy | 398 | ||
| Video-mediastinoscopy | 398 | ||
| Thoracoscopy | 398 | ||
| Anterior mediastinotomy | 398 | ||
| Thoracotomy | 398 | ||
| Therapeutic procedures | 399 | ||
| Tracheostomy | 399 | ||
| Principles of tracheostomy | 399 | ||
| Complications of tracheostomy | 399 | ||
| Thoracotomy | 400 | ||
| Posterolateral thoracotomy | 400 | ||
| Lateral thoracotomy | 400 | ||
| Anterior thoracotomy | 400 | ||
| Median sternotomy | 400 | ||
| Specific thoracic disorders | 400 | ||
| Problems affecting the pleural space | 400 | ||
| Introduction | 400 | ||
| Pneumothorax | 400 | ||
| Treatment of pneumothorax | 401 | ||
| Aspiration | 401 | ||
| Intercostal tube drainage | 401 | ||
| Treatment of persistent or recurrent pneumothorax | 401 | ||
| Excess pleural fluid | 401 | ||
| Malignant effusions | 402 | ||
| Empyema | 402 | ||
| Haemothorax | 403 | ||
| Lung abscess | 403 | ||
| Cancer of the lung | 404 | ||
| Staging of lung cancer and its implications | 405 | ||
| Palliative treatment | 405 | ||
| Surgical treatment of lung cancer | 405 | ||
| Non-malignant indications for lung resection | 406 | ||
| Malignant mesothelioma | 406 | ||
| Presentation of malignant mesothelioma | 406 | ||
| Investigation | 406 | ||
| Treatment | 406 | ||
| Benign asbestos diseases of the chest | 406 | ||
| Disorders of the mediastinum | 406 | ||
| Anterior mediastinum | 406 | ||
| Retrosternal thyroid | 406 | ||
| Thymus | 407 | ||
| Parathyroid | 407 | ||
| Lymph node enlargement | 407 | ||
| Germ cell tumours | 407 | ||
| Middle mediastinum | 407 | ||
| Posterior mediastinum | 407 | ||
| Groin and male genitalia | 408 | ||
| 32 Hernias and other groin problems | 408 | ||
| Introduction | 408 | ||
| Lumps in the groin | 408 | ||
| Clinical examination | 408 | ||
| Position for examination | 408 | ||
| Consistency and reducibility | 408 | ||
| Relationship to the inguinal ligament | 409 | ||
| Direct and indirect inguinal hernias (Fig. 32.3) | 410 | ||
| Inguinal and femoral hernias | 410 | ||
| Inguinal hernia | 410 | ||
| Anatomical considerations | 411 | ||
| Mechanisms of inguinal hernia formation | 412 | ||
| Spigelian hernia | 412 | ||
| Natural history of inguinal hernia | 412 | ||
| Hernial strangulation | 412 | ||
| Management of inguinal hernias | 413 | ||
| Inguinal herniorrhaphy and herniotomy | 414 | ||
| Complications of hernia repair | 414 | ||
| Recurrence | 414 | ||
| Laparoscopic inguinal hernia repair (described in Ch. 10) | 414 | ||
| Postoperative care and return to normal activities | 414 | ||
| Trusses | 414 | ||
| Femoral hernia | 414 | ||
| Clinical features of femoral hernia | 414 | ||
| Strangulated femoral hernia | 416 | ||
| Management of femoral hernia | 416 | ||
| Enlarged inguinal lymph nodes | 417 | ||
| Clinical features of enlarged inguinal lymph nodes | 417 | ||
| Saphena varix | 417 | ||
| Femoral artery aneurysm | 417 | ||
| Chronic groin pain | 418 | ||
| Ventral hernias | 418 | ||
| Epigastric hernias (see Fig. 32.16) | 418 | ||
| Umbilical and paraumbilical hernias | 419 | ||
| 33 Disorders of the male genitalia | 420 | ||
| Disorders of the scrotal contents | 420 | ||
| Introduction | 420 | ||
| Clinical examination of scrotal lumps and swellings | 420 | ||
| The origin of a scrotal lump | 420 | ||
| Testicular and epididymal lumps | 420 | ||
| Scrotal pain | 420 | ||
| Acute pain (Box 33.1) | 420 | ||
| Chronic pain | 421 | ||
| Inflammation of the epididymis and testis | 422 | ||
| Epididymitis | 422 | ||
| Tuberculous epididymitis | 422 | ||
| Orchitis | 422 | ||
| Hydrocoele | 423 | ||
| Primary hydrocoele | 423 | ||
| Management | 423 | ||
| Hydrocoele of the cord | 423 | ||
| Fournier’s scrotal gangrene | 423 | ||
| Epididymal cyst and spermatocoele | 423 | ||
| Varicocoele | 423 | ||
| Testicular tumours | 424 | ||
| Pathology of testicular tumours | 425 | ||
| Seminomas | 425 | ||
| Teratomas | 425 | ||
| Clinical features of testicular tumours | 426 | ||
| Investigation and treatment of testicular tumours | 426 | ||
| Tumour markers | 427 | ||
| Surgical exploration | 427 | ||
| Management of seminoma | 427 | ||
| Management of teratomas and other non-seminomatous germ cell tumours | 427 | ||
| Long-term surveillance | 427 | ||
| Fertility | 427 | ||
| Absent scrotal testis (cryptorchidism) | 427 | ||
| Management of maldescent of the testis | 428 | ||
| Torsion of the testis or epididymal appendage | 428 | ||
| Testicular torsion (Figs. 33.8 and 33.9) | 428 | ||
| Torsion of the epididymal appendage (hydatid of morgagni) | 428 | ||
| Management of suspected testicular torsion | 428 | ||
| Trauma to the testis | 429 | ||
| Male sterilisation | 429 | ||
| Disorders of the penis | 429 | ||
| Foreskin problems in adults | 429 | ||
| Phimosis | 429 | ||
| Balano-posthitis (balanitis) | 430 | ||
| Paraphimosis | 430 | ||
| Circumcision | 430 | ||
| Peyronie’s disease | 431 | ||
| Carcinoma of the penis | 431 | ||
| Priapism | 432 | ||
| Urology | 433 | ||
| 34 Symptoms, signs and investigation of urinary tract disorders | 433 | ||
| Introduction | 433 | ||
| Symptoms of urinary tract disease | 433 | ||
| Symptoms caused by intrinsic disease of the urinary tract | 433 | ||
| Urinary symptoms caused by non-urinary disease | 434 | ||
| The common symptoms of urinary tract disease | 434 | ||
| Abdominal pain | 435 | ||
| Pain arising from the kidneys and upper tract | 435 | ||
| Pain arising from the bladder and lower tract | 435 | ||
| Pain simulating urinary tract disease | 435 | ||
| Haematuria | 435 | ||
| Causes of haematuria (see Fig. 34.2 for renal causes) | 435 | ||
| Diagnostic features of haematuria | 436 | ||
| Dysuria | 436 | ||
| Disorders of micturition | 436 | ||
| Lower Urinary Tract Symptoms (LUTS) | 436 | ||
| Retention of urine | 436 | ||
| Acute retention | 437 | ||
| Chronic retention | 437 | ||
| Urinary incontinence | 437 | ||
| Loss of cortical control | 438 | ||
| Disorders of sacral reflex control of detrusor and sphincter function | 438 | ||
| Structural abnormalities of the bladder or sphincter | 438 | ||
| Pneumaturia | 438 | ||
| Haemospermia | 439 | ||
| Approach to the diagnosis of urinary symptoms | 439 | ||
| Special points in the history | 439 | ||
| Physical examination | 439 | ||
| General examination | 439 | ||
| Abdominal examination | 439 | ||
| Rectal examination | 439 | ||
| Investigation of suspected urinary tract disease | 440 | ||
| Are any blood tests likely to be helpful in diagnosis? | 440 | ||
| What urine tests are indicated? | 440 | ||
| Where is the lesion? | 441 | ||
| Suspected upper tract lesions | 442 | ||
| Ultrasound | 442 | ||
| CT scanning | 442 | ||
| Intravenous urography | 443 | ||
| Special contrast investigations | 443 | ||
| Radionuclide scanning | 443 | ||
| Suspected lower tract lesions | 443 | ||
| Radiography and ultrasound | 443 | ||
| Cystourethroscopy | 443 | ||
| Other investigations | 444 | ||
| 35 Disorders of the prostate | 445 | ||
| Introduction | 445 | ||
| Anatomy | 445 | ||
| Benign prostatic hyperplasia | 445 | ||
| Pathophysiology of benign prostatic hyperplasia | 445 | ||
| Clinical features of benign prostatic hyperplasia | 446 | ||
| Complications of bladder outlet obstruction | 446 | ||
| Management of benign prostatic hyperplasia | 447 | ||
| Diagnosis | 447 | ||
| Relief of chronic retention and obstructive effects on the kidney | 448 | ||
| Cystoscopy | 448 | ||
| Drug treatments | 448 | ||
| Transurethral resection of prostate (TURP) and other transurethral treatments | 448 | ||
| Retropubic prostatectomy | 449 | ||
| Complications of TURP and open prostatectomy | 449 | ||
| Long-term catheterisation or stenting | 449 | ||
| Acute urinary retention and its management | 449 | ||
| Diagnosis of acute retention | 449 | ||
| Catheterisation | 449 | ||
| Evaluating the underlying cause and any precipitating factors | 449 | ||
| ‘Trial without catheter’ | 449 | ||
| Indwelling catheters and their management | 452 | ||
| Catheters in paraplegic patients | 452 | ||
| Carcinoma of the prostate | 452 | ||
| Pathophysiology of prostatic carcinoma | 452 | ||
| Symptoms and signs of prostatic cancer | 453 | ||
| Approach to investigation of suspected prostatic carcinoma (Figs 35.6 and 35.7) | 454 | ||
| Management of prostatic carcinoma | 455 | ||
| Early-stage disease (stages T1 or T2; N0, M0) | 455 | ||
| Locally advanced disease (stages T3 or T4, N0, M0) | 455 | ||
| Metastatic disease (stage N+ and/or M+) | 455 | ||
| Hormonal therapy | 455 | ||
| Prostatitis | 456 | ||
| Acute prostatitis | 456 | ||
| Chronic prostatitis | 456 | ||
| 36 Tumours of the kidney and urinary tract | 457 | ||
| Introduction | 457 | ||
| Renal cell carcinoma | 457 | ||
| Pathology of renal cell carcinoma | 457 | ||
| Staging of renal cell carcinoma | 457 | ||
| Clinical features of renal cell carcinoma | 457 | ||
| Approach to investigation of suspected renal cell carcinoma | 457 | ||
| Management of renal cell carcinoma | 459 | ||
| Urothelial carcinoma (transitional cell carcinoma) | 459 | ||
| Epidemiology and aetiology of urothelial carcinoma | 459 | ||
| Pathology of urothelial carcinoma | 460 | ||
| Clinical features of urothelial carcinoma | 460 | ||
| Investigation of suspected urothelial carcinoma | 460 | ||
| Staging of urothelial tumours of the bladder | 461 | ||
| Management of urothelial carcinoma | 461 | ||
| Bladder tumours | 461 | ||
| Urothelial tumours of the upper tract | 462 | ||
| Unusual urinary tract tumours | 462 | ||
| Follow-up and control of recurrent disease | 463 | ||
| 37 Stone disease of the urinary tract | 464 | ||
| Introduction | 464 | ||
| Pathophysiology of stone disease | 464 | ||
| Chemical composition | 464 | ||
| Mechanisms of stone formation | 464 | ||
| Calcium-containing stones | 464 | ||
| Stones caused by excessive urinary excretion of a stone constituent | 464 | ||
| Other predisposing factors | 464 | ||
| Clinical features of stone disease | 464 | ||
| Obstruction of urinary flow | 465 | ||
| Pelvicalyceal obstruction | 465 | ||
| Passage of stones into the ureter | 466 | ||
| Predisposition to infection | 466 | ||
| Local irritation and tissue damage | 467 | ||
| Investigation and management of suspected urinary tract stones | 467 | ||
| Approach to investigation | 467 | ||
| Methods of investigation | 467 | ||
| Indications for stone removal (Box 37.3) | 468 | ||
| Methods of stone removal | 468 | ||
| Cystoscopic techniques | 468 | ||
| Open surgical methods | 468 | ||
| Percutaneous techniques of stone removal | 468 | ||
| Non-invasive stone removal technique (Fig. 37.6c) | 470 | ||
| Management of acute ureteric colic | 470 | ||
| Investigation of ureteric colic | 470 | ||
| Long-term management of urological stone disease | 470 | ||
| Management of metabolic abnormalities | 470 | ||
| Long-term follow-up of patients with urinary tract stones | 471 | ||
| 38 Urinary tract infections | 472 | ||
| Introduction | 472 | ||
| Bacterial infections of the lower urinary tract | 472 | ||
| Pathophysiology of lower urinary tract infections | 472 | ||
| Clinical features of lower urinary tract infections | 472 | ||
| Bacteriological diagnosis of lower urinary tract infections | 472 | ||
| Management of bladder infections | 473 | ||
| Recurrent bladder infections | 473 | ||
| The elderly, debilitated and infirm | 473 | ||
| Young and middle-aged women | 473 | ||
| Patients with urinary tract abnormalities predisposing to infection | 473 | ||
| Upper urinary tract infections | 473 | ||
| Pathophysiology of upper urinary tract infections | 473 | ||
| Clinical features of upper urinary tract infections | 474 | ||
| Management of upper urinary tract infections | 474 | ||
| Complications of acute pyelonephritis (see Figs 38.1 and 38.2)Case History Fig. 38.2 Perinephric abscess This woman of 55 presented with a 3-week history of left loin pain and 48 hours of rigors. The photograph shows a large abscess surrounding the left kidney, ‘pointing’ in the posterior loin. A plain abdominal film showed a staghorn calculus in the kidney and isotope studies showed no function in that kidney. The abscess was drained percutaneously and she was treated with antibiotics. The kidney was later removed | 474 | ||
| Pyonephrosis | 474 | ||
| Perinephric abscess | 474 | ||
| Urinary tract infection in the catheterised patient | 474 | ||
| Genitourinary tuberculosis | 474 | ||
| Pathophysiology of genitourinary tuberculosis | 474 | ||
| Clinical features and investigation of genitourinary tuberculosis | 475 | ||
| Management of genitourinary tuberculosis | 475 | ||
| Schistosomiasis | 475 | ||
| Clinical presentations of schistosomiasis | 475 | ||
| Management of schistosomiasis | 476 | ||
| Urethral infections and strictures | 476 | ||
| Urethral infections | 476 | ||
| Urethral stricture | 476 | ||
| 39 Congenital disorders and diseases secondarily involving the urinary tract | 478 | ||
| Congenital urinary tract disorders | 478 | ||
| Introduction | 478 | ||
| Polycystic kidneys | 478 | ||
| Medullary sponge kidney | 478 | ||
| Duplex systems | 478 | ||
| Renal cysts | 479 | ||
| Horseshoe kidney | 479 | ||
| Renal ectopia and other renal abnormalities | 480 | ||
| Urachal abnormalities (see Fig. 39.6) | 482 | ||
| Diseases secondarily involving the urinary tract | 482 | ||
| Introduction | 482 | ||
| Tumours and inflammatory causes | 482 | ||
| Retroperitoneal fibrosis (RPF) | 482 | ||
| Cardiovascular disorders | 484 | ||
| 40 Pathophysiology, clinical features and diagnosis of vascular disease affecting the limbs | 484 | ||
| Introduction | 484 | ||
| Vascular insufficiency of the limb (Table 40.1) | 484 | ||
| Symptoms and signs in the limb | 484 | ||
| Pain | 484 | ||
| Intermittent claudication | 485 | ||
| Chronic ischaemic rest pain | 486 | ||
| Acute critical ischaemia | 487 | ||
| Deep venous thrombosis (acute venous insufficiency) | 489 | ||
| Skin changes | 490 | ||
| Changes in skin colour and temperature (see Table 40.7) | 490 | ||
| The acutely cold white foot | 490 | ||
| Colour change in venous thrombosis | 490 | ||
| The chronically cold foot | 490 | ||
| Blue toes | 490 | ||
| Black toes | 491 | ||
| Redness | 491 | ||
| The warm foot | 491 | ||
| Abnormal pigmentation | 492 | ||
| Lower limb ulceration (Box 40.1) | 492 | ||
| History of the ulcer | 492 | ||
| Site of the ulcer | 493 | ||
| Characteristics of the ulcer | 494 | ||
| Nature of the surrounding tissues | 494 | ||
| Regional features | 495 | ||
| Limb swelling | 495 | ||
| 41 Managing lower limb arterial insufficiency, the diabetic foot and major amputations | 496 | ||
| Introduction | 496 | ||
| Chronic lower limb ischaemia | 496 | ||
| Intermittent claudication | 496 | ||
| Symptoms | 496 | ||
| Physical signs of intermittent claudication | 496 | ||
| Natural history of intermittent claudication | 496 | ||
| The fate of the leg | 496 | ||
| The fate of the patient | 497 | ||
| Severe ischaemia | 497 | ||
| Critical ischaemia | 497 | ||
| Managing lower limb ischaemia | 497 | ||
| Investigation of chronic lower limb arterial insufficiency | 497 | ||
| The ankle brachial pressure index (ABPI) | 497 | ||
| Duplex ultrasonography | 497 | ||
| Arteriography (see Ch. 5) | 497 | ||
| Approach to management of chronic lower limb arterial insufficiency | 497 | ||
| Conservative management | 498 | ||
| Mild to moderate claudication | 498 | ||
| Disabling claudication | 498 | ||
| Techniques of revascularisation for chronic arterial insufficiency | 499 | ||
| Percutaneous transluminal angioplasty (PTA) | 499 | ||
| Arterial reconstructive surgery | 499 | ||
| Aorto-iliac disease | 501 | ||
| Femoro-popliteal disease | 501 | ||
| Complications of arterial surgery | 501 | ||
| Other therapies for arterial insufficiency | 501 | ||
| Intravenous and intra-arterial drug therapies | 501 | ||
| Sympathectomy | 501 | ||
| Acute lower limb ischaemia | 502 | ||
| Pathophysiology | 502 | ||
| Embolism | 502 | ||
| Thrombosis | 503 | ||
| Clinical features of acute lower limb ischaemia (Box 41.3) | 503 | ||
| Principles of managing the acutely ischaemic limb | 505 | ||
| Thrombosis or embolism? | 505 | ||
| Embolectomy | 505 | ||
| The diabetic foot | 505 | ||
| Pathophysiology of the diabetic foot | 505 | ||
| Identifying the causes of diabetic foot problems | 506 | ||
| Clinical presentations of diabetic foot complications | 506 | ||
| Management of neuropathic foot complications | 506 | ||
| Control of infection | 506 | ||
| Removal of necrotic tissue | 507 | ||
| Prevention of the diabetic foot | 507 | ||
| Lower limb amputation | 508 | ||
| Level of amputation | 508 | ||
| 42 Aneurysms and other peripheral arterial disorders | 510 | ||
| Aneurysms (see Table 42.1) | 510 | ||
| Pathology of aneurysms | 510 | ||
| Clinical presentation of aneurysms (see Table 42.1) | 510 | ||
| Principles of management of aneurysms | 512 | ||
| Indications for operation (see Box 42.1) | 512 | ||
| Investigation of aneurysms (see Fig. 42.2) | 512 | ||
| Non-ruptured AAA | 512 | ||
| Leaking or ruptured AAA | 513 | ||
| Principles of aneurysm surgery | 513 | ||
| Open abdominal aortic aneurysm surgery (Fig. 42.3) | 513 | ||
| Endovascular aneurysm repair (see Fig. 42.5) | 513 | ||
| Other applications of EVAR | 515 | ||
| Upper limb problems (see Table 40.5, p. 488) | 515 | ||
| Upper limb ischaemia | 515 | ||
| Thoracic outlet compression | 516 | ||
| Subclavian steal syndrome | 516 | ||
| Extracranial cerebral arterial insufficiency | 517 | ||
| Carotid artery insufficiency | 517 | ||
| Pathophysiology of carotid artery disease | 517 | ||
| Investigation of suspected carotid artery disease | 517 | ||
| Treatment of carotid artery disease | 518 | ||
| Medical versus surgical or radiological intervention | 518 | ||
| Acute symptoms | 518 | ||
| Asymptomatic carotid stenosis | 518 | ||
| Technique of endarterectomy | 518 | ||
| Carotid angioplasty and stenting | 518 | ||
| Arterial insufficiency in other organs | 518 | ||
| Mesenteric ischaemia | 518 | ||
| Chronic mesenteric ischaemia | 519 | ||
| Renal ischaemia | 519 | ||
| Renal artery stenosis | 519 | ||
| Pathophysiology of renal artery stenosis | 519 | ||
| Treatment | 519 | ||
| Complications of arterial surgery | 519 | ||
| Systemic complications of arterial surgery | 519 | ||
| Local complications of arterial surgery (Fig. 42.9) | 520 | ||
| Haemorrhage | 520 | ||
| Embolism | 520 | ||
| Thrombosis | 521 | ||
| Graft infection | 521 | ||
| False aneurysm formation | 521 | ||
| Long-term follow-up after arterial surgery | 521 | ||
| 43 Venous disorders of the lower limb | 523 | ||
| Venous thrombosis and the post-thrombotic limb | 523 | ||
| Anatomy of the lower limb venous system | 523 | ||
| Presentation and consequences of venous thrombosis (Table 43.1) | 523 | ||
| Pathophysiology of post-thrombotic problems | 523 | ||
| Investigation of venous insufficiency | 524 | ||
| Management of post-thrombotic problems | 525 | ||
| Venous ulcers | 525 | ||
| Long-term care and prevention | 526 | ||
| Axillary vein thrombosis | 526 | ||
| Varicose veins | 527 | ||
| Pathophysiology of varicose veins | 527 | ||
| Symptoms and signs of varicose veins | 528 | ||
| Investigation of varicose veins | 528 | ||
| Management of varicose veins | 531 | ||
| Indications for surgical treatment of varicose veins | 531 | ||
| Endovenous treatment of varicose veins | 531 | ||
| Perioperative management of the patient having varicose vein surgery | 531 | ||
| 44 Cardiac surgery | 532 | ||
| Introduction and cardiopulmonary bypass | 532 | ||
| Assessing risk in cardiac surgery | 532 | ||
| Congenital cardiac disease | 532 | ||
| Types of congenital heart disease | 532 | ||
| Cyanotic heart disease | 532 | ||
| Acyanotic heart disease | 534 | ||
| Management of congenital heart disease | 534 | ||
| Palliating congenital cardiac disorders | 534 | ||
| Correcting congenital cardiac disorders | 534 | ||
| Acquired heart disease | 534 | ||
| Coronary heart disease (see Table 44.3 for clinical presentations) | 534 | ||
| Pathophysiology | 534 | ||
| Control of predisposing factors | 534 | ||
| Management of coronary artery disease | 535 | ||
| Percutaneous angioplasty techniques | 535 | ||
| Coronary artery bypass grafting (CABG) | 535 | ||
| Surgical technique (Fig. 44.4) | 536 | ||
| Other types of surgery for ischaemic heart disease | 537 | ||
| Valvular heart disease | 538 | ||
| Aortic valve disease | 538 | ||
| Mitral valve disease | 538 | ||
| Valve prostheses (Fig. 44.5) | 538 | ||
| Indications for valve surgery | 538 | ||
| Pericardial disease | 538 | ||
| Disease of the thoracic aorta | 539 | ||
| Aortic dissection | 539 | ||
| Thoracic aneurysms | 539 | ||
| Trauma to the thoracic aorta | 540 | ||
| Pulmonary embolism | 540 | ||
| Disorders of the breast and skin | 541 | ||
| 45 Disorders of the breast | 541 | ||
| Introduction to breast disease | 541 | ||
| Anatomy of the female breast | 541 | ||
| Symptoms and signs of breast disease | 541 | ||
| Special points in history taking | 541 | ||
| Examination of the breasts | 543 | ||
| Lumps | 543 | ||
| Paget’s disease of the nipple | 546 | ||
| Investigation of breast disorders | 546 | ||
| Imaging | 546 | ||
| Biopsy | 546 | ||
| Breast cancer | 549 | ||
| Introduction | 549 | ||
| Risk factors | 549 | ||
| Age | 549 | ||
| Genetic factors | 549 | ||
| Hormonal factors | 549 | ||
| Social and geographic factors | 549 | ||
| Epidemiology | 549 | ||
| Environmental factors | 549 | ||
| Pathology | 549 | ||
| Tumour types | 549 | ||
| In situ carcinoma | 549 | ||
| Paget’s disease of the nipple | 550 | ||
| Inflammatory carcinoma | 550 | ||
| Tumour grade | 550 | ||
| Natural history of breast cancer | 550 | ||
| Principles of management of breast cancer (Boxes 45.5 and 45.6) | 551 | ||
| Staging | 551 | ||
| PROGNOSTIC STATUS | 552 | ||
| Loco-regional treatment | 552 | ||
| Breast conservation surgery | 553 | ||
| Mastectomy | 553 | ||
| Reconstructive surgery | 553 | ||
| Axillary surgery | 553 | ||
| Sentinel node biopsy | 553 | ||
| Axillary clearance | 554 | ||
| Radiotherapy | 554 | ||
| Adjuvant systemic treatment | 555 | ||
| Chemotherapy | 555 | ||
| Hormonal therapy | 555 | ||
| Biological therapies | 556 | ||
| Control of advanced and disseminated disease (Figs 45.15–45.18) | 556 | ||
| Long-term follow-up | 558 | ||
| Life expectancy and prognosis | 558 | ||
| Benign breast disorders | 559 | ||
| Abnormalities of normal development and involution (ANDI) | 559 | ||
| Pathology | 559 | ||
| Clinical presentation and management | 559 | ||
| Managing fibrocystic change | 559 | ||
| Fibroadenoma | 560 | ||
| Pathology | 560 | ||
| Clinical presentation and management | 560 | ||
| Duct papilloma | 560 | ||
| Traumatic fat necrosis | 560 | ||
| Infections of the breast | 560 | ||
| Duct ectasia | 561 | ||
| Male breast disorders | 561 | ||
| Gynaecomastia (Fig. 45.26) | 561 | ||
| Male breast cancer | 562 | ||
| 46 Disorders of the skin | 563 | ||
| Introduction | 563 | ||
| Structure of normal skin (Fig. 46.1) | 563 | ||
| Symptoms and signs of skin disorders | 563 | ||
| History and examination | 564 | ||
| Principles of managing skin lesions | 566 | ||
| Lesions originating in the epidermis | 566 | ||
| Benign epidermal lesions | 566 | ||
| Skin tags (squamous cell papillomas) | 566 | ||
| Warts | 567 | ||
| Seborrhoeic keratosis | 567 | ||
| Keratoacanthoma | 567 | ||
| Melanotic lesions | 567 | ||
| Benign naevi | 567 | ||
| Lentigo | 567 | ||
| Management of pigmented lesions | 568 | ||
| Premalignant and malignant epidermal conditions | 568 | ||
| Solar (senile) keratosis and intra-epidermal carcinoma | 568 | ||
| Pathology and clinical features | 568 | ||
| Management | 569 | ||
| Squamous cell carcinoma | 569 | ||
| Pathology | 569 | ||
| Clinical presentation | 569 | ||
| Management of squamous cell carcinoma | 570 | ||
| Basal cell carcinoma (BCC) | 570 | ||
| Pathology and clinical features | 570 | ||
| Management of basal cell carcinomas | 571 | ||
| Malignant melanoma | 571 | ||
| Introduction and pathology | 571 | ||
| Risk factors | 571 | ||
| Melanoma subtypes | 571 | ||
| Clinical features of malignant melanoma | 572 | ||
| Prognostic factors | 572 | ||
| Management of malignant melanoma | 573 | ||
| Lesions originating in the dermis | 573 | ||
| Cysts | 573 | ||
| Epidermal cysts | 573 | ||
| Surgical removal (see Ch. 10) | 573 | ||
| Inflamed epidermal cysts | 573 | ||
| Pilar cysts | 573 | ||
| Infective lesions | 574 | ||
| Pyogenic granuloma | 574 | ||
| Furuncle (boil) and carbuncle | 574 | ||
| Necrotising fasciitis | 574 | ||
| Miscellaneous lesions | 575 | ||
| Sebaceous hyperplasia | 575 | ||
| Keloid scars | 575 | ||
| Histiocytoma | 575 | ||
| Dermoid cysts | 575 | ||
| Implantation (epi)dermoids | 575 | ||
| Malignant lesions | 575 | ||
| Secondary (metastatic) carcinoma | 575 | ||
| Kaposi’s sarcoma | 575 | ||
| Lesions of the hypodermis and deeper tissues | 576 | ||
| Cellulitis | 576 | ||
| Cellulitis of the lower limb | 576 | ||
| Lipoma and liposarcoma | 576 | ||
| Neurofibroma, neurofibromatosis and schwannoma | 576 | ||
| Ganglion | 577 | ||
| Lesions of vascular origin | 577 | ||
| Campbell de morgan spots | 577 | ||
| Spider naevi | 577 | ||
| Angiomas | 578 | ||
| ‘Port-wine stains’ | 578 | ||
| Strawberry naevi | 578 | ||
| Cystic hygroma | 578 | ||
| Congenital syndromes | 578 | ||
| Glomus tumour | 578 | ||
| Lesions derived from skin appendages | 578 | ||
| Benign appendage tumours | 578 | ||
| Disorders of the nails | 578 | ||
| Ingrowing toenail | 578 | ||
| Pathophysiology | 578 | ||
| Management | 580 | ||
| Conservative treatment | 580 | ||
| Surgical treatment | 580 | ||
| Onychogryphosis | 580 | ||
| Subungual melanoma | 580 | ||
| Disorders of the head and neck | 581 | ||
| 47 Lumps in the head and neck and salivary calculi | 581 | ||
| Introduction | 581 | ||
| History and examination in the head and neck | 581 | ||
| Special points in the history and examination | 581 | ||
| Examination of the oral cavity | 581 | ||
| Tumours of salivary glands | 581 | ||
| Salivary gland tumours | 582 | ||
| Pleomorphic adenoma | 582 | ||
| Treatment | 583 | ||
| Complications of parotid surgery | 583 | ||
| Adenolymphoma (Warthin’s tumour) | 583 | ||
| Malignant primary salivary tumours | 584 | ||
| Secondary tumours in salivary glands | 584 | ||
| Salivary gland stone disease (sialolithiasis) | 584 | ||
| Pathophysiology | 584 | ||
| Clinical features | 585 | ||
| Management of salivary calculi | 585 | ||
| Inflammatory disorders of salivary glands | 585 | ||
| Acute bacterial sialadenitis | 585 | ||
| Chronic sialadenitis | 586 | ||
| Recurrent sialadenitis | 587 | ||
| Autoimmune salivary gland disorders | 587 | ||
| Salivary retention cysts | 587 | ||
| Lymph node disorders of the head and neck | 587 | ||
| Cervical tuberculosis | 588 | ||
| Lymphomas | 588 | ||
| Secondary (metastatic) tumours | 588 | ||
| Miscellaneous causes of a lump in the neck | 588 | ||
| Congenital cysts and sinuses | 588 | ||
| Branchial cysts, sinuses and fistulae | 589 | ||
| Fusion-line dermoid cysts | 589 | ||
| Pre-auricular cysts and sinuses | 589 | ||
| Cystic hygromas (lymphatic malformations) | 589 | ||
| Actinomycosis | 589 | ||
| 48 Disorders of the mouth | 590 | ||
| Disorders of the oral cavity (excluding salivary calculi) | 590 | ||
| Dental caries | 590 | ||
| Pathophysiology and clinical features | 590 | ||
| Management of dental caries | 590 | ||
| Management of dental abscesses | 590 | ||
| Tooth extraction and post-extraction problems | 591 | ||
| Bleeding tooth socket after extraction | 591 | ||
| Pain after tooth extraction | 592 | ||
| Swelling after tooth extraction | 592 | ||
| Inflammation of the periodontal tissues | 593 | ||
| Gingivitis and periodontitis | 593 | ||
| Management of gingivitis and periodontitis | 594 | ||
| Pericoronitis | 594 | ||
| Management of pericoronitis | 595 | ||
| Acute ulcerative gingivitis (vincent’s infection) | 595 | ||
| Management of acute ulcerative gingivitis | 595 | ||
| Tumours of the oral mucosa | 595 | ||
| Pathophysiology and aetiology | 595 | ||
| Clinical features of oral cancer | 595 | ||
| Management of oral cancer | 595 | ||
| Leukoplakia | 595 | ||
| Epulis | 596 | ||
| Miscellaneous disorders causing intraoral swelling | 597 | ||
| Retention cysts of accessory salivary glands | 597 | ||
| Tumours of accessory salivary glands | 597 | ||
| Bony exostoses | 597 | ||
| Cysts and tumours of the jaws | 598 | ||
| 49 Disorders of the thyroid and parathyroid glands | 599 | ||
| Introduction | 599 | ||
| Thyroid disorders | 599 | ||
| Main clinical presentations of thyroid disease in surgical practice | 599 | ||
| Diffuse or generalised enlargement of the thyroid | 599 | ||
| Solitary thyroid nodule | 599 | ||
| Other features associated with thyroid enlargement | 601 | ||
| Hyperthyroidism | 602 | ||
| Hypothyroidism | 602 | ||
| Special points in examining a thyroid swelling | 602 | ||
| Approach to investigation of a thyroid mass | 603 | ||
| General thyroid status | 603 | ||
| Morphology of the gland | 603 | ||
| Tissue diagnosis | 603 | ||
| Functional activity of glandular tissue | 603 | ||
| Specific clinical problems of the thyroid and their management | 604 | ||
| Hyperthyroidism (thyrotoxicosis) | 604 | ||
| Treatment of hyperthyroidism | 604 | ||
| Thyrotoxic eye disease | 604 | ||
| Radioactive iodide therapy | 604 | ||
| Unwanted effects | 605 | ||
| Anti-thyroid drugs | 605 | ||
| Surgical management | 606 | ||
| Indications for surgery | 606 | ||
| Preoperative assessment and management of thyrotoxicosis | 606 | ||
| Subtotal thyroidectomy | 606 | ||
| Thyroid malignancies (Table 49.2) | 606 | ||
| Papillary carcinoma | 606 | ||
| Symptoms and signs | 607 | ||
| Management | 607 | ||
| Follicular carcinoma | 608 | ||
| Anaplastic carcinoma | 608 | ||
| Medullary carcinoma | 609 | ||
| Thyroid lymphoma | 609 | ||
| Goitres and thyroid nodules | 609 | ||
| Idiopathic non-toxic hyperplasia | 609 | ||
| Surgical management of goitre | 609 | ||
| Congenital thyroid disorders | 610 | ||
| Embryology | 610 | ||
| Thyroglossal cyst and ‘fistula’ | 610 | ||
| Ectopic thyroid tissue | 610 | ||
| Disorders of parathyroid glands | 610 | ||
| Hyperparathyroidism | 610 | ||
| Symptoms and signs | 610 | ||
| Control of plasma calcium (Fig. 49.10) | 611 | ||
| Types of hyperparathyroidism | 611 | ||
| Primary hyperparathyroidism | 611 | ||
| a. Single parathyroid adenoma | 611 | ||
| b. Diffuse parathyroid hyperplasia | 611 | ||
| c. Parathyroid carcinoma | 612 | ||
| Secondary and tertiary hyperparathyroidism | 612 | ||
| Malignant hypercalcaemia | 612 | ||
| Management of hyperparathyroidism | 612 | ||
| Surgical management | 612 | ||
| Hypoparathyroidism | 613 | ||
| Neonatal and paediatric surgery | 614 | ||
| 50 Acute surgical problems in children | 614 | ||
| Introduction | 614 | ||
| Physiological differences between infants and adults | 614 | ||
| Fluid and electrolyte problems | 614 | ||
| Blood glucose | 614 | ||
| Temperature regulation | 614 | ||
| Liver function | 615 | ||
| Immunity | 615 | ||
| Managing surgery in infants | 615 | ||
| Abdominal emergencies in the newborn | 615 | ||
| Intestinal obstruction | 615 | ||
| Gastrointestinal atresias and stenoses | 616 | ||
| Oesophageal abnormalities | 616 | ||
| Duodenal obstruction | 617 | ||
| Jejuno-ileal atresias | 618 | ||
| Midgut malrotation with volvulus | 618 | ||
| Pathophysiology | 618 | ||
| Acute volvulus | 618 | ||
| Intermittent obstruction | 618 | ||
| Anorectal abnormalities | 618 | ||
| Failure to pass meconium | 619 | ||
| Meconium ileus | 619 | ||
| Hirschsprung’s disease (congenital aganglionosis) | 619 | ||
| Congenital diaphragmatic hernia | 620 | ||
| Other surgical conditions causing respiratory problems in the newborn | 621 | ||
| Vascular ring | 621 | ||
| Congenital pulmonary airway malformations | 621 | ||
| Congenital lobar emphysema | 621 | ||
| Abdominal wall defects | 621 | ||
| Exomphalos | 622 | ||
| Gastroschisis | 622 | ||
| Treatment of exomphalos major and gastroschisis | 622 | ||
| Ectopia vesicae (bladder exstrophy) | 622 | ||
| Necrotising enterocolitis | 622 | ||
| Abdominal emergencies in infants and young children | 622 | ||
| Incarcerated inguinal hernia | 622 | ||
| Pathophysiology | 622 | ||
| Clinical features | 623 | ||
| Management | 623 | ||
| Congenital hypertrophic pyloric stenosis | 623 | ||
| Pathophysiology | 623 | ||
| Clinical features | 624 | ||
| Diagnosis | 624 | ||
| Treatment | 624 | ||
| Intussusception | 624 | ||
| Pathophysiology | 624 | ||
| Clinical features | 625 | ||
| Management | 625 | ||
| Swallowed foreign body | 626 | ||
| Abdominal emergencies in older children | 626 | ||
| The acute abdomen | 626 | ||
| Differential diagnosis (Box 50.2) | 626 | ||
| Principles of management | 626 | ||
| Acute appendicitis (see also Ch. 26) | 626 | ||
| Torsion of the testis | 627 | ||
| 51 Non-acute abdominal and urological problems in children | 628 | ||
| Introduction | 628 | ||
| Problems with the groin and male genitalia | 628 | ||
| Embryology | 628 | ||
| Hernias and associated problems | 628 | ||
| Patent processus vaginalis (PPV) | 628 | ||
| Hydrocoele | 628 | ||
| Inguinal hernia | 629 | ||
| Femoral hernia | 630 | ||
| Umbilical hernia | 630 | ||
| Testicular maldescent | 630 | ||
| Surgery for testicular maldescent | 631 | ||
| Foreskin problems | 631 | ||
| Phimosis | 631 | ||
| Paraphimosis | 632 | ||
| Renal, vesical and urethral abnormalities | 632 | ||
| Renal dysplasia | 632 | ||
| Neonatal hydronephrosis | 632 | ||
| Vesicoureteric reflux (VUR) | 632 | ||
| Pathophysiology | 633 | ||
| Clinical presentation and investigation | 633 | ||
| Management of vesicoureteric reflux | 634 | ||
| Pelviureteric junction dysfunction | 634 | ||
| Pathophysiology | 634 | ||
| Clinical presentation and diagnosis | 634 | ||
| Management | 635 | ||
| Hypospadias and epispadias | 635 | ||
| Posterior urethral valves (PUV) | 635 | ||
| Abdominal problems | 635 | ||
| Chronic and recurrent abdominal pain | 635 | ||
| Chronic constipation | 635 | ||
| Gastrointestinal bleeding in children (Table 51.2) | 636 | ||
| Upper gastrointestinal bleeding | 636 | ||
| Lower gastrointestinal bleeding | 636 | ||
| Anal fissure | 636 | ||
| Polyps | 636 | ||
| Rectal prolapse | 636 | ||
| Perianal abscess | 637 | ||
| Meckel’s diverticulum | 637 | ||
| Inflammatory bowel disease (see Ch. 28 for adult disease) | 637 | ||
| Abdominal mass | 637 | ||
| Nephroblastoma (wilms’ tumour) | 637 | ||
| Neuroblastoma | 638 | ||
| Index | 639 | ||
| A | 639 | ||
| B | 642 | ||
| C | 645 | ||
| D | 648 | ||
| E | 649 | ||
| F | 651 | ||
| G | 652 | ||
| H | 653 | ||
| I | 655 | ||
| J | 657 | ||
| K | 657 | ||
| L | 657 | ||
| M | 658 | ||
| N | 660 | ||
| O | 660 | ||
| P | 661 | ||
| Q | 665 | ||
| R | 665 | ||
| S | 666 | ||
| T | 669 | ||
| U | 671 | ||
| V | 672 | ||
| W | 673 | ||
| X | 673 | ||
| Y | 673 | ||
| Z | 673 |