BOOK
Churchill's Pocketbook of Surgery E-Book
Andrew T Raftery | Michael S. Delbridge | Marcus J. D. Wagstaff | Katherine I. Bridge
(2016)
Additional Information
Book Details
Abstract
The Fifth Edition of this highly-praised and bestselling pocketbook continues to deliver a concise and didactic account of the essential features of all common surgical disorders. The book covers fundamental principles as well as providing basic information on aetiology, diagnosis and management, including pre-operative and post-operative care. The text includes an overview of history-taking, relevant physical signs, differential diagnosis, investigations and practical treatment.
The book provides comprehensive coverage of general surgery but in addition covers the basic needs of the medical student and those in the early years of postgraduate training as far as the surgical specialities are concerned.
- Presented in portable small format in two colours with line drawings and radiological images. The text is succinct and clearly structured with extensive use of headings to guide the reader.
- Covers all the major surgical specialties.
- Contains outlines of common operations such as appendicectomy and thyroidectomy.
- Contains an introductory chapter on consent, medicolegal issues, statistics and clinical audit.
- Contains a checklist of emergency situations for quick reference.
- The text has been extensively re-written by a team of senior specialist surgical registrars or newly appointed consultants.
- Over 50 new illustrations of line drawings are included as well as updated radiological images.
- New hints and tips sections have been added.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | IFC1 | ||
| Churchill's Pocketbook of Surgery | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface | vi | ||
| Acknowledgements | vii | ||
| Contributors | viii | ||
| Abbreviations | x | ||
| Terms and Definitions | xvii | ||
| Terms | xvii | ||
| Some Important Definitions | xviii | ||
| Biochemical Values | xix | ||
| Venous Blood: Adult Reference Values | xix | ||
| Haematological Values | xxi | ||
| Emergencies | xxii | ||
| 1 Introduction to Surgery | 1 | ||
| Chapter Outline | 1 | ||
| Approach to the Patient | 1 | ||
| Taking a History | 2 | ||
| History of Pain | 4 | ||
| Examination of a Lump | 4 | ||
| History | 4 | ||
| Examination | 5 | ||
| Consistency. | 5 | ||
| Fluctuation. | 5 | ||
| Fluid Thrill. | 5 | ||
| Translucency. | 5 | ||
| Resonance. | 5 | ||
| Pulsatility. | 5 | ||
| Compressibility. | 5 | ||
| Bruit. | 5 | ||
| Reducibility. | 6 | ||
| Relation to Surrounding Structures. | 6 | ||
| Regional Lymph Nodes. | 6 | ||
| Surrounding Tissues and Extremities. | 6 | ||
| General Examination | 6 | ||
| Examination of an Ulcer | 6 | ||
| Definition | 6 | ||
| History | 6 | ||
| Examination | 7 | ||
| Base. | 7 | ||
| Edge. | 7 | ||
| Depth. | 7 | ||
| Discharge. | 7 | ||
| Surrounding Tissues. | 7 | ||
| Examine the Local Lymph Nodes | 7 | ||
| Classification of Disease | 7 | ||
| Evidence-Based Medicine | 8 | ||
| Clinical Governance in Surgical Practice | 9 | ||
| Clinical Audit | 9 | ||
| Medicolegal Issues | 11 | ||
| Consent | 12 | ||
| Breaking Bad News | 13 | ||
| Death and the Certification of Death | 14 | ||
| Bereavement Counselling | 15 | ||
| 2 An Introduction to Surgical Techniques and Practical Procedures | 16 | ||
| Chapter Outline | 16 | ||
| Surgical Incisions | 16 | ||
| Sutures | 17 | ||
| Absorbable | 17 | ||
| Nonabsorbable | 18 | ||
| Natural Sutures | 18 | ||
| Synthetic Sutures | 18 | ||
| Monofilament | 18 | ||
| Braided (Polyfilament) | 18 | ||
| Wire | 18 | ||
| Gauge | 18 | ||
| Needles | 18 | ||
| Methods of Suturing | 18 | ||
| Removal of Sutures | 19 | ||
| Alternatives to Sutures | 19 | ||
| Drains | 20 | ||
| Open Drainage | 20 | ||
| Closed Drainage | 20 | ||
| Suction Drains | 20 | ||
| Nonsuction Drains | 20 | ||
| Complications of Drains | 20 | ||
| Stomas (-Ostomies) | 21 | ||
| Colostomy | 21 | ||
| Ileostomy | 21 | ||
| Urostomy (Ileal Bladder) | 21 | ||
| Mucous Fistula | 21 | ||
| Local Anaesthesia | 21 | ||
| Types of Local Anaesthetic | 22 | ||
| Lidocaine. | 22 | ||
| Bupivacaine. | 22 | ||
| Prilocaine. | 22 | ||
| Complications | 23 | ||
| Toxicity | 23 | ||
| Tourniquets | 23 | ||
| Diathermy | 24 | ||
| Laser | 26 | ||
| Laparoscopic Surgery | 27 | ||
| Diagnostic Laparoscopy. | 27 | ||
| Therapeutic Laparoscopy. | 27 | ||
| Technique | 27 | ||
| Complications | 28 | ||
| Venous Access | 29 | ||
| Central Venous Catheterization – Internal Jugular Vein | 30 | ||
| Blood Gas Sampling | 30 | ||
| Urinary Catheterization (Male) | 31 | ||
| 3 Investigative Procedures | 32 | ||
| Chapter Outline | 32 | ||
| Conventional Radiology | 32 | ||
| Plain Films | 32 | ||
| Chest X-ray (CXR) | 32 | ||
| Abdominal X-ray (AXR) | 33 | ||
| Contrast Studies | 33 | ||
| Gastrointestinal Tract | 33 | ||
| Barium Meal. | 33 | ||
| Barium Enema. | 34 | ||
| Barium Follow-Through or Small Bowel Enema. | 34 | ||
| Biliary Tree | 34 | ||
| Ultrasound. | 34 | ||
| Magnetic Resonance Cholangiopancreatography (MRCP). | 34 | ||
| Endoscopic Retrograde Cholangiopancreatography (ERCP). | 35 | ||
| Percutaneous Transhepatic Cholangiography (PTC). | 35 | ||
| Operative Cholangiogram. | 35 | ||
| T-Tube Cholangiogram. | 35 | ||
| Urinary Tract | 35 | ||
| Intravenous Urography (IVU). | 35 | ||
| Cystography. | 36 | ||
| Urethrography. | 36 | ||
| Retrograde Pyelography. | 36 | ||
| Antegrade Pyelography. | 36 | ||
| Vascular System | 36 | ||
| Arteriography. | 36 | ||
| Digital Subtraction Angiography (DSA). | 36 | ||
| Venography. | 36 | ||
| Ultrasonography | 36 | ||
| Advantages | 37 | ||
| Disadvantages | 37 | ||
| Doppler Ultrasound | 37 | ||
| Uses of Doppler Ultrasound | 38 | ||
| Measurement of Systolic Pressure in Peripheral Arteries. | 38 | ||
| Duplex Scanning | 38 | ||
| Computerized Tomography (CT) | 38 | ||
| Advantages | 38 | ||
| CT Angiography. | 38 | ||
| CT Urography. | 39 | ||
| CT Colonography (CTC). | 39 | ||
| Magnetic Resonance Imaging (MRI) | 39 | ||
| Advantages | 39 | ||
| Disadvantages | 39 | ||
| Positron Emission Tomography (PET) | 39 | ||
| Advantages | 40 | ||
| Disadvantages | 40 | ||
| Mammography | 40 | ||
| Radioisotope Scanning | 40 | ||
| Bone Scans | 41 | ||
| Renal Scans | 41 | ||
| Lung Scanning | 41 | ||
| Scanning for Infection | 41 | ||
| Screening for GI Bleeding | 41 | ||
| Endoscopy | 41 | ||
| Use of Endoscopes | 42 | ||
| Rigid Endoscopes | 42 | ||
| Sigmoidoscopy. | 42 | ||
| Oesophagoscopy. | 42 | ||
| Cystoscopy. | 42 | ||
| Laparoscopy. | 42 | ||
| Flexible Endoscopes | 42 | ||
| Gastroscope (Oesophago-Gastro-Duodenoscope). | 42 | ||
| Colonoscopy. | 42 | ||
| Bronchoscopy. | 42 | ||
| Other Flexible Scopes. | 42 | ||
| Advantages and Disadvantages of Endoscopy | 42 | ||
| Advantages | 42 | ||
| Disadvantages | 43 | ||
| Complications | 43 | ||
| Tissue Diagnosis | 43 | ||
| Biopsy | 43 | ||
| Cytology | 44 | ||
| Interventional Radiology | 44 | ||
| Tissue Diagnosis | 44 | ||
| Biliary Tract | 44 | ||
| Urinary Tract | 44 | ||
| Vascular System | 44 | ||
| Percutaneous Transluminal Angioplasty (PTA) and Stenting. | 44 | ||
| Thrombolysis. | 45 | ||
| Embolization. | 45 | ||
| Prevention of Pulmonary Emboli. | 45 | ||
| Endovascular Aneurysm Repair. | 45 | ||
| 4 Shock and Trauma | 46 | ||
| Chapter Outline | 46 | ||
| Shock | 46 | ||
| Hypovolaemic Shock | 46 | ||
| Causes. | 46 | ||
| Classification. | 46 | ||
| Symptoms and Signs. | 46 | ||
| Management. | 46 | ||
| Septic Shock | 47 | ||
| Causes. | 47 | ||
| Symptoms and Signs. | 47 | ||
| Management. | 48 | ||
| Complications. | 48 | ||
| Cardiogenic Shock | 48 | ||
| Causes. | 49 | ||
| Symptoms and Signs. | 49 | ||
| Investigations. | 49 | ||
| Management | 49 | ||
| Neurogenic Shock | 49 | ||
| 5 Preoperative and Postoperative Care | 70 | ||
| Chapter Outline | 70 | ||
| Preoperative Preparation | 70 | ||
| Assessment | 70 | ||
| Principles of Preoperative Preparation | 71 | ||
| Postoperative Care | 72 | ||
| Progress | 73 | ||
| Conditions Affecting Surgical Risk | 73 | ||
| General Problems in Surgical Patients | 73 | ||
| Age | 73 | ||
| Obesity | 73 | ||
| Compromised Host | 73 | ||
| Allergies | 73 | ||
| Drugs | 73 | ||
| Medical Problems in Surgical Patients | 73 | ||
| Cardiovascular | 73 | ||
| Myocardial Infarction and Angina. | 74 | ||
| Cardiac Failure. | 74 | ||
| Arrhythmias. | 74 | ||
| Valvular Heart Disease. | 74 | ||
| Hypertension. | 74 | ||
| Cerebrovascular Disease. | 74 | ||
| Peripheral Vascular Disease (PVD). | 74 | ||
| Respiratory Disease | 74 | ||
| Perioperative Management of Respiratory Disease | 74 | ||
| Renal Disease | 75 | ||
| Mild Impairment of Renal Function. | 75 | ||
| Grossly Impaired Renal Function (Nondialysis Dependent). | 75 | ||
| Dialysis-Dependent Renal Failure | 75 | ||
| Haemodialysis. | 75 | ||
| Continuous Ambulatory Peritoneal Dialysis (CAPD). | 75 | ||
| Hepatic Disease | 75 | ||
| Hepatitis. | 75 | ||
| Obstructive Jaundice. | 75 | ||
| Haemolytic Disease. | 75 | ||
| Perioperative Management of Patients with Liver Disease/Obstructive Jaundice | 75 | ||
| Haematological Disease | 76 | ||
| Anaemia. | 76 | ||
| Polycythaemia. | 76 | ||
| Bleeding Disorders | 76 | ||
| 6 Infection and Surgery | 98 | ||
| Chapter Outline | 98 | ||
| Principles of Wound Management | 98 | ||
| Healing by Primary Intention | 98 | ||
| Healing by Secondary Intention | 98 | ||
| Delayed Primary Closure | 98 | ||
| Factors Affecting Wound Healing | 98 | ||
| Age. | 98 | ||
| Nutritional State. | 98 | ||
| Drugs. | 99 | ||
| Tissue Oxygenation and Vascularity. | 99 | ||
| Radiotherapy. | 99 | ||
| Local Sepsis. | 99 | ||
| Factors Predisposing to Infection in Surgery | 99 | ||
| Age. | 99 | ||
| Underlying Illness. | 99 | ||
| Obesity and Smoking. | 99 | ||
| Wound Classification. | 99 | ||
| Classification of Surgical Wounds | 99 | ||
| Clean. | 99 | ||
| Clean Contaminated. | 99 | ||
| Contaminated. | 99 | ||
| Dirty. | 99 | ||
| Prevention of Surgical Site Infection (Incorporating Nice Guidelines 2008) | 99 | ||
| Preoperative Precautions | 99 | ||
| Perioperative Precautions | 99 | ||
| Postoperative Precautions | 100 | ||
| Antibiotics in Surgery | 100 | ||
| Principles of Antibiotic Therapy | 100 | ||
| Selection of Antibiotic | 100 | ||
| Route of Administration | 101 | ||
| Duration of Therapy | 101 | ||
| Dosage | 101 | ||
| Complications of Antibiotic Therapy | 101 | ||
| Prophylactic Antibiotics | 101 | ||
| Indications for Prophylactic Antibiotics | 101 | ||
| Specific Antibiotics | 102 | ||
| Surgical Infections | 102 | ||
| Sepsis | 102 | ||
| Management of Sirs | 107 | ||
| Cellulitis | 107 | ||
| Symptoms and SIRS. | 107 | ||
| Investigations | 107 | ||
| Treatment. | 107 | ||
| Necrotizing Fasciitis | 107 | ||
| Symptoms and Signs. | 108 | ||
| Investigations | 108 | ||
| Treatment. | 108 | ||
| Gas Gangrene | 108 | ||
| Symptoms and Signs. | 109 | ||
| Investigations | 109 | ||
| Treatment | 109 | ||
| Prophylactic. | 109 | ||
| Therapeutic. | 109 | ||
| Tetanus | 109 | ||
| Symptoms and Signs | 109 | ||
| History of Injury. | 109 | ||
| Differential Diagnosis | 110 | ||
| Treatment | 110 | ||
| Prophylactic | 110 | ||
| Therapeutic | 110 | ||
| Prognosis. | 110 | ||
| Methicillin-Resistant Staphylococcus Aureus (MRSA) | 110 | ||
| Risk Factors for Colonization. | 111 | ||
| Clinical Presentation. | 111 | ||
| Infection Control. | 111 | ||
| Management | 111 | ||
| Carriers. | 111 | ||
| Patients with MRSA Infection. | 111 | ||
| Infection and the Surgeon | 111 | ||
| HIV | 111 | ||
| Risk Categories | 111 | ||
| Prevention of HIV | 111 | ||
| Hepatitis B | 112 | ||
| Hepatitis C | 112 | ||
| Precautions for the Care of Known and Suspected HIV, HBV and HCV Carriers | 112 | ||
| Universal Precautions | 112 | ||
| Special Precautions | 113 | ||
| Management of Sharps Injuries | 113 | ||
| Procedure at Occupational Health or Emergency Department | 113 | ||
| Postexposure Prophylaxis | 114 | ||
| Hepatitis B | 114 | ||
| Hepatitis C | 114 | ||
| HIV | 114 | ||
| 7 Management of Malignant Disease | 115 | ||
| Chapter Outline | 115 | ||
| Screening | 115 | ||
| Premalignant Conditions | 116 | ||
| General Symptoms and Signs of Malignant Disease | 116 | ||
| Primary Tumour | 116 | ||
| Palpable Swelling. | 116 | ||
| Obstruction. | 116 | ||
| Bleeding | 116 | ||
| Symptoms Due to Compression or Invasion of Local Structures. | 116 | ||
| Metastases | 116 | ||
| Generalized Manifestations. | 117 | ||
| Asymptomatic Incidental Findings. | 117 | ||
| Staging and Grading of Cancer | 117 | ||
| Clinical and Pathological Staging | 117 | ||
| Grading of Tumours | 118 | ||
| Diagnostic Procedures | 118 | ||
| Biopsy. | 118 | ||
| Imaging (e.g. Ultrasound, CT or MRI). | 118 | ||
| Positron Emission Tomography (PET). | 118 | ||
| Tumour Markers | 118 | ||
| α-Fetoprotein (AFP). | 118 | ||
| Carcinoembryonic Antigen (CEA). | 118 | ||
| Human Chorionic Gonadotrophin (hCG). | 119 | ||
| Prostate-Specific Antigen (PSA). | 119 | ||
| CA19-9. | 119 | ||
| CA125. | 119 | ||
| CA15-3. | 119 | ||
| The Multidisciplinary Team (MDT) Meeting | 119 | ||
| Treatment of Cancer | 120 | ||
| Surgery | 120 | ||
| Curative | 120 | ||
| Palliative | 120 | ||
| Radiotherapy | 121 | ||
| Delivery of Radiotherapy | 121 | ||
| External Beam Radiation. | 121 | ||
| Proton Beam Therapy. | 121 | ||
| Implantation Radiotherapy (e.g. Intracavitary or Intralesional). | 121 | ||
| Systemic Irradiation. | 121 | ||
| Use of Radiotherapy | 121 | ||
| Primary Treatment. | 122 | ||
| Adjuvant and Neoadjuvant Treatment. | 122 | ||
| Palliative Radiotherapy | 122 | ||
| Systemic. | 122 | ||
| Total Body Irradiation. | 122 | ||
| Radioactive Isotopes. | 122 | ||
| Chemotherapy | 123 | ||
| Side Effects | 123 | ||
| Chemoradiotherapy | 124 | ||
| Hormonal Manipulation | 124 | ||
| Breast | 124 | ||
| Inhibition of Ovarian Function. | 124 | ||
| Blocking the Binding of Oestrogen to Cancer Cells. | 124 | ||
| Blocking Peripheral Oestrogen Production. | 124 | ||
| Prostate | 124 | ||
| Surgical Orchidectomy. | 124 | ||
| Luteinizing Hormone Releasing Hormone (LHRH) Analogues, e.g. Goserelin. | 124 | ||
| Oestrogen, e.g. Diethylstilboestrol. | 125 | ||
| Antiandrogens. | 125 | ||
| Inhibition of Adrenal Enzyme Synthesis. | 125 | ||
| Biological Therapies | 125 | ||
| Palliative Care | 126 | ||
| Principles of Palliative Care | 127 | ||
| Treatment of Symptoms | 127 | ||
| Pain | 127 | ||
| Nausea and Vomiting | 127 | ||
| Constipation | 127 | ||
| Dysphagia | 127 | ||
| Mouth Care | 127 | ||
| Cough | 128 | ||
| Insomnia and Agitation | 128 | ||
| 8 Head, Neck and Otorhinolaryngology | 129 | ||
| Chapter Outline | 129 | ||
| Scalp and Facial Swellings | 129 | ||
| Neck Swellings | 129 | ||
| Superficial | 130 | ||
| Lymph Nodes | 130 | ||
| Investigation of Cervical Lymphadenopathy | 130 | ||
| Deep Swellings of the Anterior Triangle | 131 | ||
| Swellings That Move on Swallowing | 131 | ||
| Thyroid. | 131 | ||
| Thyroglossal Duct Cyst. | 131 | ||
| 9 Thorax | 156 | ||
| Chapter Outline | 156 | ||
| Heart and Great Vessels | 156 | ||
| Principles of Cardiac Surgery | 156 | ||
| Indications for Surgery | 156 | ||
| Contraindications for Surgery | 156 | ||
| Preoperative Preparation | 156 | ||
| Surgery | 157 | ||
| Cardiopulmonary Bypass (Fig. 9.1). | 157 | ||
| Postoperative Complications | 157 | ||
| Low Cardiac Output. | 157 | ||
| Respiratory Failure. | 157 | ||
| Renal Failure. | 157 | ||
| Jaundice. | 157 | ||
| Cerebral Damage. | 159 | ||
| Atrial Fibrillation (AF). | 159 | ||
| Postoperative Treatment | 159 | ||
| Maintenance of Cardiac Output. | 159 | ||
| Prevention of Respiratory Problems. | 159 | ||
| Maintenance of Urine Output. | 159 | ||
| Prevention of Cerebral Problems. | 159 | ||
| Prevention of Atrial Fibrillation. | 159 | ||
| Congenital Heart Disease | 160 | ||
| Acyanotic | 160 | ||
| Ventricular Septal Defect (VSD). | 160 | ||
| Atrial Septal Defect (ASD). | 160 | ||
| Patent Ductus Arteriosus (PDA). | 160 | ||
| Coarctation of the Aorta. | 160 | ||
| Congenital Valve Disease in Children. | 161 | ||
| Cyanotic | 161 | ||
| Tetralogy of Fallot. | 161 | ||
| Transposition of the Great Vessels | 161 | ||
| Acquired Valvular Heart Disease | 162 | ||
| Types of Valve | 162 | ||
| Mechanical Valves. | 162 | ||
| Tissue Valves. | 162 | ||
| Human Cryopreserved Allograft Valves. | 162 | ||
| Complications of Artificial Valves | 162 | ||
| Ischaemic Heart Disease | 163 | ||
| Aetiology. | 163 | ||
| Symptoms and Signs. | 163 | ||
| Investigations | 163 | ||
| Treatment | 163 | ||
| Conservative. | 163 | ||
| Percutaneous Transluminal Coronary Angioplasty (PTCA). | 163 | ||
| Coronary Artery Bypass Graft (CABG). | 164 | ||
| Surgery for Complications of Myocardial Infarction (MI) | 164 | ||
| Ventricular Aneurysm. | 164 | ||
| Mitral Regurgitation. | 164 | ||
| Ruptured Intraventricular Septum. | 164 | ||
| Pericarditis | 164 | ||
| Symptoms and Signs. | 164 | ||
| Investigations | 164 | ||
| 10 Breast | 177 | ||
| Chapter Outline | 177 | ||
| The Assessment of Breast Disease – Triple Assessment | 177 | ||
| Clinical Assessment | 177 | ||
| History | 177 | ||
| Examination | 177 | ||
| Look (Observation) | 177 | ||
| Feel (Palpation) | 178 | ||
| Move. | 180 | ||
| General Examination Findings. | 180 | ||
| Investigations | 180 | ||
| Pathology | 180 | ||
| The Multi-Disciplinary Team (MDT) | 180 | ||
| Carcinoma of the Breast | 181 | ||
| Risk Factors for Breast Cancer | 181 | ||
| Presentation | 181 | ||
| Investigations | 181 | ||
| Types of Primary Breast Cancer | 181 | ||
| Clinical Staging | 181 | ||
| Treatment of Breast Cancer | 181 | ||
| Local Treatments (Surgery and Radiotherapy) | 182 | ||
| Surgery | 182 | ||
| Breast Conservation Surgery (BCS). | 184 | ||
| Mastectomy. | 185 | ||
| Staging and Management of the Axilla. | 185 | ||
| Complications of Surgery | 186 | ||
| Radiotherapy | 186 | ||
| Complications of Radiotherapy. | 186 | ||
| Systemic Therapies (Chemotherapy, Endocrine Therapy and Biological Therapies, Plus Bisphosphonates) | 186 | ||
| Chemotherapy | 186 | ||
| Biological Therapies | 186 | ||
| Complications of Chemotherapy and Biological Therapies. | 186 | ||
| Bisphosphonates | 186 | ||
| Endocrine Therapy | 187 | ||
| Complications of Endocrine Therapies. | 187 | ||
| Follow-up | 187 | ||
| Locally Recurrent Disease. | 187 | ||
| Palliation | 187 | ||
| Palliation of locally advanced breast cancer | 187 | ||
| Palliation of metastatic breast cancer | 187 | ||
| Breast Reconstruction | 188 | ||
| Breast Screening | 189 | ||
| Ductal Carcinoma in Situ (DCIS) | 189 | ||
| Treatment. | 189 | ||
| Staging | 189 | ||
| Lobular Carcinoma in Situ (LCIS) | 189 | ||
| Paget’s Disease of the Nipple | 189 | ||
| 11 Endocrine Surgery | 200 | ||
| Chapter Outline | 200 | ||
| Thyroid | 200 | ||
| Congenital | 200 | ||
| Lingual Thyroid | 200 | ||
| Thyroglossal Cyst. | 200 | ||
| Thyroglossal Fistula | 200 | ||
| Examination of the Thyroid Gland | 200 | ||
| Symptoms of Thyroid Disease | 201 | ||
| Swelling in the Neck | 201 | ||
| Hoarse Voice. | 201 | ||
| Dysphagia. | 201 | ||
| Dyspnoea. | 201 | ||
| Pain. | 201 | ||
| Eye Symptoms. | 201 | ||
| Hyperthyroidism. | 202 | ||
| Hypothyroidism. | 202 | ||
| Incidental Finding on Imaging for Another Problem. | 202 | ||
| Investigation of Thyroid Dysfunction/Swellings | 202 | ||
| Laboratory Tests. | 202 | ||
| Fine Needle Aspiration. | 202 | ||
| Plain Radiograph of Chest (to Include Thoracic Inlet). | 202 | ||
| Ultrasound Scan. | 202 | ||
| Radioisotope Scan. | 202 | ||
| CT/MRI (→ Fig. 11.1). | 202 | ||
| The Patient with a Thyroid Swelling (Goitre) | 203 | ||
| Diffuse Enlargement | 203 | ||
| Simple Goitre. | 203 | ||
| 12 Abdominal Wall and Hernia | 216 | ||
| Chapter Outline | 216 | ||
| Herniae | 216 | ||
| General Description of a Hernia | 216 | ||
| Hernia (Fig. 12.1A) | 216 | ||
| Defect | 216 | ||
| Sac | 216 | ||
| Contents of the Sac | 216 | ||
| Reducible Hernia | 216 | ||
| Irreducible Hernia | 216 | ||
| Classification of Hernia | 217 | ||
| Congenital | 217 | ||
| Acquired | 218 | ||
| Types of Hernia (Fig. 12.2) | 218 | ||
| Groin Hernia | 218 | ||
| Inguinal Herniae | 218 | ||
| Femoral Hernia | 221 | ||
| Other Types of Hernia | 222 | ||
| Umbilical Hernia | 222 | ||
| Paraumbilical Hernia | 222 | ||
| Epigastric Hernia | 223 | ||
| Incisional Hernia | 223 | ||
| Richter’s Hernia (Fig. 12.3) | 223 | ||
| Spigelian Hernia | 224 | ||
| Sliding Hernia (Hernia-en-Glissade) (Fig. 12.4) | 224 | ||
| Obturator Hernia | 224 | ||
| Lumbar Hernia | 225 | ||
| Frequency of the Different Types of Hernia | 225 | ||
| Are Investigations Necessary to Support the Diagnosis of a Hernia? | 225 | ||
| Swellings in the Groin and Scrotum | 226 | ||
| Saphena Varix | 226 | ||
| Hydrocele of the Cord | 226 | ||
| Lipoma of the Cord | 227 | ||
| An Imperfectly Descended Testis | 227 | ||
| Inguinal Lymph Nodes | 227 | ||
| Malgaigne’s Bulges | 228 | ||
| Femoral Artery Aneurysm | 228 | ||
| Other Conditions of the Abdominal Wall | 228 | ||
| Umbilicus | 228 | ||
| Discharge | 228 | ||
| Patent Vitellointestinal Duct. | 228 | ||
| Patent Urachus. | 228 | ||
| Abscess in a Urachal Cyst. | 228 | ||
| Infection. | 228 | ||
| Umbilical Calculus. | 228 | ||
| Endometriosis. | 228 | ||
| Mass | 228 | ||
| Umbilical Hernia. | 228 | ||
| Secondary Carcinoma. | 228 | ||
| Rectus Sheath Haematoma | 229 | ||
| Symptoms and Signs. | 229 | ||
| Treatment. | 229 | ||
| Tumours of the Abdominal Wall | 229 | ||
| 13 Acute Abdomen | 230 | ||
| Chapter Outline | 230 | ||
| Basic Principles | 230 | ||
| History | 230 | ||
| Age. | 230 | ||
| Pain. | 230 | ||
| Vomiting | 231 | ||
| Defaecation | 232 | ||
| Fever. | 232 | ||
| Past History | 232 | ||
| Examination | 232 | ||
| General. | 232 | ||
| Pulse, Temperature, Respiration | 232 | ||
| Cervical Lymphadenopathy. | 232 | ||
| Chest. | 232 | ||
| Abdomen | 232 | ||
| Inspection. | 232 | ||
| Palpation. | 232 | ||
| Percussion. | 232 | ||
| Auscultation. | 232 | ||
| Rectal Examination. | 232 | ||
| Vaginal Examination. | 233 | ||
| Investigations | 233 | ||
| Causes | 234 | ||
| Diagnosis. | 234 | ||
| Management. | 235 | ||
| Treatment | 238 | ||
| Indications for Surgery in the Acute Abdomen. | 238 | ||
| Medical Causes of Acute Abdominal Pain | 238 | ||
| Referred Pain. | 238 | ||
| Haematological. | 238 | ||
| Infective and Inflammatory. | 238 | ||
| Endocrine and Metabolic. | 238 | ||
| Peritonitis | 238 | ||
| Symptoms and Signs. | 239 | ||
| Investigations | 239 | ||
| Complications | 240 | ||
| Systemic. | 240 | ||
| Local. | 240 | ||
| Prognosis. | 240 | ||
| Treatment. | 240 | ||
| Resuscitation. | 240 | ||
| Treatment of Causative Lesion. | 240 | ||
| Postoperative Care. | 240 | ||
| Intra-Abdominal Abscesses | 240 | ||
| Intraperitoneal Abscesses | 240 | ||
| Extraperitoneal Abscesses | 241 | ||
| Symptoms and Signs. | 241 | ||
| Investigations | 241 | ||
| Treatment. | 241 | ||
| 14 Alimentary Tract | 244 | ||
| Chapter Outline | 244 | ||
| Oesophagus | 244 | ||
| Investigation of Dysphagia | 244 | ||
| History | 244 | ||
| Examination. | 244 | ||
| Investigations | 244 | ||
| Treatment. | 245 | ||
| Foreign Body | 245 | ||
| Symptoms and Signs. | 245 | ||
| Investigations | 245 | ||
| Treatment. | 246 | ||
| Oesophageal Perforation | 246 | ||
| Symptoms and Signs. | 246 | ||
| Investigations | 246 | ||
| Complication. | 246 | ||
| Treatment | 246 | ||
| Conservative. | 246 | ||
| Surgical. | 246 | ||
| Oesophageal Stricture | 246 | ||
| Gastro-Oesophageal Reflux Disease | 247 | ||
| Hiatus Hernia | 247 | ||
| Sliding Hiatus Hernia. | 247 | ||
| Symptoms and Signs. | 248 | ||
| Investigations | 248 | ||
| Treatment | 248 | ||
| Conservative. | 248 | ||
| Surgical. | 248 | ||
| Rolling or Paraoesophageal Hiatus Hernia. | 248 | ||
| 15 Peripheral Vascular Disease | 320 | ||
| Chapter Outline | 320 | ||
| Arterial | 320 | ||
| History | 320 | ||
| Other Systems | 321 | ||
| Examination | 321 | ||
| Arterial Occlusive Disease | 322 | ||
| Acute Arterial Occlusion | 322 | ||
| Causes | 323 | ||
| Embolus. | 323 | ||
| Thrombosis. | 323 | ||
| Trauma. | 323 | ||
| Symptoms and Signs | 323 | ||
| Acute Embolus in a Normal Limb. | 323 | ||
| Acute-on-Chronic Ischaemia in a Limb with Peripheral Vascular Disease. | 324 | ||
| Investigations | 324 | ||
| Treatment. | 324 | ||
| Embolus in a Normal Limb. | 324 | ||
| Thrombosis in a Limb with Peripheral Vascular Disease. | 324 | ||
| Prognosis. | 325 | ||
| Chronic Arterial Occlusion | 325 | ||
| Lower Limb (Aorto-Ilio-Femoral Disease) | 325 | ||
| Causes. | 325 | ||
| Symptoms and Signs. | 325 | ||
| Investigations | 325 | ||
| Treatment | 327 | ||
| Medical. | 327 | ||
| Endovascular. | 327 | ||
| Surgical. | 327 | ||
| Prognosis. | 328 | ||
| Upper Limb | 328 | ||
| Causes. | 328 | ||
| 16 Urology | 354 | ||
| Chapter Outline | 354 | ||
| Taking a Urological History | 354 | ||
| Symptoms | 354 | ||
| Haematuria. | 354 | ||
| Lower Urinary Tract Symptoms (LUTS). | 354 | ||
| Storage Symptoms. | 354 | ||
| Voiding Symptoms. | 354 | ||
| Pain. | 354 | ||
| Incontinence. | 354 | ||
| Past Medical History | 355 | ||
| Drug History | 355 | ||
| Social History | 355 | ||
| Family History | 355 | ||
| Urological Investigations | 356 | ||
| Essential | 356 | ||
| If Appropriate to Presentation | 356 | ||
| Imaging | 356 | ||
| Congenital Disorders of the Urinary Tract | 357 | ||
| Kidney and Ureter | 357 | ||
| Congenital Absence of One Kidney. | 357 | ||
| Pelvic Kidney. | 357 | ||
| Horseshoe Kidney. | 357 | ||
| Congenital Hydronephrosis (PUJO). | 357 | ||
| Infantile Polycystic Disease. | 357 | ||
| Adult Polycystic Disease. | 357 | ||
| Medullary Sponge Kidney. | 357 | ||
| Ureteric Duplication. | 357 | ||
| Ureterocele. | 357 | ||
| Megaureter. | 357 | ||
| Vesicoureteric Reflux. | 358 | ||
| Diagnosis. | 358 | ||
| 17 Orthopaedics | 380 | ||
| Chapter Outline | 380 | ||
| Fractures | 380 | ||
| Causation | 380 | ||
| Trauma. | 380 | ||
| Stress Fractures. | 380 | ||
| Pathological Fractures. | 381 | ||
| Pattern (Fig. 17.1) | 381 | ||
| Transverse Fracture. | 381 | ||
| Spiral or Oblique Fracture. | 381 | ||
| Segmental Fracture. | 381 | ||
| Crush Fracture. | 381 | ||
| Burst Fracture. | 382 | ||
| Avulsion Fracture. | 382 | ||
| Fracture–Dislocation. | 382 | ||
| Greenstick Fracture. | 382 | ||
| Comminuted Fracture. | 382 | ||
| Relation to Surrounding Structures | 382 | ||
| Closed Fracture. | 382 | ||
| Open Fracture. | 382 | ||
| Intra-Articular Fracture. | 382 | ||
| Extra-Articular Fracture. | 382 | ||
| Complex Fracture. | 382 | ||
| Assessment of Fractures | 382 | ||
| Symptoms and Signs. | 382 | ||
| Investigations. | 383 | ||
| Principles of Fracture Treatment | 383 | ||
| First Aid | 383 | ||
| Treatment of Shock | 383 | ||
| Definitive Fracture Management | 383 | ||
| Reduction. | 384 | ||
| How Should It Be Done? | 384 | ||
| Closed Reduction. | 384 | ||
| Open Reduction. | 384 | ||
| How is Reduction Held? | 384 | ||
| Types of Stability | 384 | ||
| Absolute Stability. | 384 | ||
| Relative Stability. | 384 | ||
| Methods of Stabilizing a Fracture | 384 | ||
| External | 384 | ||
| Plaster of Paris or Synthetic Material Casts. | 384 | ||
| Traction. | 384 | ||
| Internal Fixation | 384 | ||
| Wires. | 384 | ||
| Screws. | 385 | ||
| Plating. | 385 | ||
| Intramedullary Nail. | 385 | ||
| External Fixation Devices. | 385 | ||
| Indications for Internal Fixation | 385 | ||
| Open Fractures. | 386 | ||
| Rehabilitation. | 386 | ||
| Complications of Fractures | 386 | ||
| Immediate (at Time of Fracture) | 386 | ||
| Early (during the Period of Initial Treatment) | 386 | ||
| Local | 386 | ||
| General | 387 | ||
| Venous Thromboembolism (VTE) (for DVT and PE → Ch. 5). | 387 | ||
| Compartment Syndrome. | 387 | ||
| Acute Urinary Retention. | 387 | ||
| Pneumonia | 387 | ||
| Fat Embolism. | 387 | ||
| Crush Syndrome. | 387 | ||
| Late (after the Period of Initial Treatment) | 387 | ||
| Delayed Union. | 387 | ||
| Nonunion. | 388 | ||
| Malunion. | 388 | ||
| Complex Regional Pain Syndrome (Causalgia, Reflex Sympathetic Osteodystrophy, Sudeck’s Atrophy). | 388 | ||
| Avascular Necrosis of Bone. | 388 | ||
| Myositis Ossificans. | 388 | ||
| Osteoarthritis (OA). | 388 | ||
| Post-Traumatic Stress Disorder. | 388 | ||
| Spinal Trauma | 388 | ||
| Management of Spinal Injuries | 389 | ||
| Whiplash Associated Disorder | 389 | ||
| Treatment. | 390 | ||
| Fractures and Dislocations of the Spine | 390 | ||
| Classification by Mechanism of Injury | 390 | ||
| Cervical Spine Fractures and Dislocations | 390 | ||
| Symptoms and Signs. | 390 | ||
| Investigations | 390 | ||
| Radiographs | 390 | ||
| Treatment | 390 | ||
| Fractures of the Atlas. | 390 | ||
| C1–C2 Subluxation. | 390 | ||
| Odontoid Peg Fracture. | 390 | ||
| Burst Fractures. | 390 | ||
| Anterior Wedge Fractures. | 391 | ||
| Facet Joint Dislocations. | 391 | ||
| Isolated Spinous Process Avulsion. | 391 | ||
| Thoracic Spine | 391 | ||
| 18 Neurosurgery | 444 | ||
| Chapter Outline | 444 | ||
| Head Injury | 444 | ||
| Assessment | 444 | ||
| Criteria for Urgent CT Scan and Consultation with a Neurosurgical Unit | 444 | ||
| Criteria for Hospital Admission after Recent Head Injury | 445 | ||
| Criteria for Involving the Neurosurgical Department | 445 | ||
| Types of Brain Injury | 446 | ||
| Primary | 446 | ||
| Secondary | 446 | ||
| Assessment of Head Injury | 446 | ||
| Emergency | 446 | ||
| Evaluate CNS Injury | 447 | ||
| Pulse, Respiration and Blood Pressure. | 447 | ||
| Check for CSF Rhinorrhoea or Otorrhoea | 447 | ||
| Scalp Lacerations or Depressed Fractures | 447 | ||
| Assess Amnesia | 447 | ||
| CT and MRI Brain Scanning | 447 | ||
| Assessing a CT Scan of the Head | 448 | ||
| Soft Tissue Window | 448 | ||
| Bone Window | 448 | ||
| Assessing an MRI Scan | 448 | ||
| Incidental Findings on MRI Cranial Imaging | 448 | ||
| Skull Fractures | 448 | ||
| Linear, Stellate or Comminuted Nondepressed. | 448 | ||
| Depressed Fracture (→ Fig. 18.1C). | 448 | ||
| Compound Fracture. | 448 | ||
| Compound Comminuted Fractures with Damage to the Underlying Brain. | 452 | ||
| Fractures of the Base of the Skull. | 452 | ||
| Summary | 452 | ||
| Management of CSF Leakage. | 452 | ||
| Intracranial Bleeding | 452 | ||
| Extradural | 452 | ||
| Symptoms and Signs. | 452 | ||
| Investigations. | 452 | ||
| Treatment. | 452 | ||
| Subdural | 453 | ||
| Acute. | 453 | ||
| Symptoms and Signs. | 453 | ||
| 19 Plastic Surgery and Skin | 466 | ||
| Chapter Outline | 466 | ||
| The Reconstructive Ladder (Fig. 19.1) | 466 | ||
| Providing Skin Cover | 467 | ||
| Direct Closure | 467 | ||
| Healing by Secondary Intention | 467 | ||
| Skin Graft | 468 | ||
| Split-Skin Graft (Fig. 19.2) | 468 | ||
| Full Thickness Graft (→ Fig. 19.2) | 468 | ||
| Flaps | 469 | ||
| Free Flaps | 469 | ||
| Tissue Expansion | 470 | ||
| Burns | 470 | ||
| Classification of Depth (→ Fig. 19.2) | 473 | ||
| Superficial | 473 | ||
| Superficial Partial Thickness | 473 | ||
| Deep Dermal | 473 | ||
| Full Thickness | 473 | ||
| Management of Burns | 473 | ||
| First Aid | 473 | ||
| Assessment and Immediate Management of the Patient with Significant Burns | 473 | ||
| Early Management of Burns | 475 | ||
| The Systemic Effects of Major Burns | 477 | ||
| Multidisciplinary Care and Follow-up | 477 | ||
| Hand Injuries | 477 | ||
| Principles of Management of Hand Trauma | 478 | ||
| First Aid | 478 | ||
| At Hospital | 478 | ||
| History | 478 | ||
| Examination (Compare with Contralateral Hand) | 478 | ||
| Investigations | 478 | ||
| Prophylaxis Against Infection. | 478 | ||
| Surgery | 478 | ||
| Approach to the Hand Wound. | 478 | ||
| Tendon Injury. | 479 | ||
| Nerve Injury. | 479 | ||
| Vessel Injury. | 479 | ||
| Bone Injury. | 479 | ||
| Secondary Reconstructive Surgery. | 479 | ||
| Reimplantation of Severed Part. | 479 | ||
| Rehabilitation. | 480 | ||
| Hand Infections | 480 | ||
| Paronychia (Whitlow) | 480 | ||
| Pulp Space Infection (Felon) | 480 | ||
| Suppurative Tenosynovitis | 480 | ||
| Symptoms and Signs. | 480 | ||
| Treatment. | 480 | ||
| Deep Palmar Space Infection | 481 | ||
| 20 Paediatric Surgery | 497 | ||
| Chapter Outline | 497 | ||
| Alimentary Tract Emergencies in the Newborn | 497 | ||
| Oesophageal Atresia | 497 | ||
| Symptoms and Signs. | 497 | ||
| Investigations | 498 | ||
| 21 Organ and Tissue Transplantation | 514 | ||
| Chapter Outline | 514 | ||
| Classification | 514 | ||
| Autograft. | 514 | ||
| Isografts. | 514 | ||
| Allografts. | 514 | ||
| Xenografts. | 514 | ||
| Organ and Tissue Donors | 514 | ||
| Deceased Donors | 515 | ||
| Donation after Brain Death (DBD) | 515 | ||
| General Criteria (→ Table 21.1). | 515 | ||
| Obtaining Permission for Deceased Organ Donation. | 515 | ||
| Donation after Circulatory Death (DCD) | 516 | ||
| Brainstem Death | 516 | ||
| Living Donors | 516 | ||
| Directed | 517 | ||
| Genetically and Emotionally Related. | 517 | ||
| Paired Donation. | 517 | ||
| Nondirected | 517 | ||
| Domino. | 517 | ||
| Altruistic. | 517 | ||
| Independent Assessors | 518 | ||
| Work-Up for a Living Donor | 518 | ||
| Living Donor Nephrectomy | 519 | ||
| Complications of Living Donor Nephrectomy. | 519 | ||
| Tissue Typing and Crossmatch | 519 | ||
| ABO Compatibility. | 519 | ||
| Histocompatibility Matching. | 519 | ||
| Cytotoxic Crossmatch. | 519 | ||
| ABO-Incompatible and Positive Crossmatch Living Donor Kidney Transplantation | 520 | ||
| Organ Preservation | 520 | ||
| Warm Ischaemic Time. | 520 | ||
| Cold Ischaemic Time. | 520 | ||
| Siting of the Transplant | 520 | ||
| Orthotopic. | 520 | ||
| Heterotopic. | 520 | ||
| Rejection | 520 | ||
| Hyperacute | 521 | ||
| Accelerated Acute Rejection | 521 | ||
| Acute Rejection | 521 | ||
| Cell-Mediated. | 521 | ||
| Antibody-Mediated. | 521 | ||
| Chronic Allograft Injury | 521 | ||
| Immunosuppression | 521 | ||
| Corticosteroids | 521 | ||
| Antiproliferative Drugs | 522 | ||
| Calcineurin Inhibitors | 522 | ||
| mTOR Inhibitors | 523 | ||
| Polyclonal Antibodies | 523 | ||
| Monoclonal Antibodies | 523 | ||
| Specific Organs | 524 | ||
| Kidney Transplant | 524 | ||
| Recipient. | 524 | ||
| Donor. | 524 | ||
| Operation. | 524 | ||
| Diagnosis of Rejection | 524 | ||
| Complications | 524 | ||
| Early | 524 | ||
| Late | 524 | ||
| Results | 524 | ||
| Liver Transplant | 525 | ||
| Recipient. | 525 | ||
| Donor. | 525 | ||
| Operation. | 525 | ||
| Diagnosis of Rejection. | 525 | ||
| Complications | 525 | ||
| Early | 525 | ||
| Late | 525 | ||
| Results | 526 | ||
| Heart and Heart/Lung Transplant | 526 | ||
| Recipient. | 526 | ||
| Donor. | 526 | ||
| Operation | 526 | ||
| 22 Gynaecology and Obstetrics | 530 | ||
| Chapter Outline | 530 | ||
| Ectopic Pregnancy | 530 | ||
| Symptoms and Signs. | 530 | ||
| Investigations | 530 | ||
| Treatment. | 530 | ||
| Ovary | 531 | ||
| Ovarian Cyst | 531 | ||
| Index | 535 | ||
| A | 535 | ||
| B | 538 | ||
| C | 541 | ||
| D | 544 | ||
| E | 545 | ||
| F | 546 | ||
| G | 548 | ||
| H | 549 | ||
| I | 551 | ||
| J | 552 | ||
| K | 553 | ||
| L | 553 | ||
| M | 554 | ||
| N | 556 | ||
| O | 557 | ||
| P | 558 | ||
| Q | 560 | ||
| R | 560 | ||
| S | 562 | ||
| T | 564 | ||
| U | 567 | ||
| V | 567 | ||
| W | 568 | ||
| X | 568 | ||
| Z | 568 |