BOOK
Sabiston Textbook of Surgery E-Book
Courtney M. Townsend | R. Daniel Beauchamp | B. Mark Evers | Kenneth L. Mattox
(2016)
Additional Information
Book Details
Abstract
Since its first publication in 1936, Sabiston Textbook of Surgery has been regarded as the preeminent source for definitive guidance in all areas of general surgery. The 20th edition continues the rich tradition of quality that has made this classic text synonymous with the specialty and a part of generations of surgery residents and practitioners. Meticulously updated throughout, this classic text concisely covers the breadth of material needed for certification and practice of general surgery. Detailed, full-color intraoperative illustrations capture key teaching moments, allowing you to better understand the basic science of surgery, make the most informed decisions and achieve optimal outcomes for every patient.
- Understand the underlying science and its clinical application to make informed surgical decisions and achieve optimal outcomes.
- Overcome tough challenges, manage unusual situations, and avoid complications with the most trusted advice in your field.
- Get the depth of coverage you need in an easily accessible, single volume organized by organ and along traditional lines beginning with principles common to surgical specialties including fluid and electrolyte management, metabolic support, and wound healing. Subsequent sections review the management of injury, transplantation, oncology, breast, endocrine, and abdominal procedures.
- Explore topics encountered by general surgery residents in training as well as in-depth coverage of subspecialty areas including head and neck, thoracic, vascular, urology, neurosurgery, pediatrics, and gynecology.
- Visually grasp and retain difficult concepts thanks to a full-color design featuring an abundance of illustrations, intraoperative photographs, and tables as well as more schematic diagrams that facilitate the comprehension of surgical techniques and procedures.
- Glean all essential, up-to-date, need-to-know information about the latest surgical perspectives and approaches to treatment including innovations in minimally invasive surgery and percutaneous devices.
- Streamline clinical decision making with an increased number of schematic diagrams and key data on surgical outcomes.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Sabiston Textbook of Surgery | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| A Score of Scores | xvii | ||
| Preface | xix | ||
| Acknowledgments | xxi | ||
| Table Of Contents | xxiii | ||
| Video Contents | xxv | ||
| I Surgical Basic Principles | 1 | ||
| 1 The Rise of Modern Surgery: | 2 | ||
| Chapter Outline | 2 | ||
| The Beginnings | 2 | ||
| Knowledge of Anatomy | 3 | ||
| Control of Bleeding | 4 | ||
| Control of Pain | 5 | ||
| Control of Infection | 6 | ||
| Other Advances That Furthered the Rise of Modern Surgery | 8 | ||
| X-Rays | 8 | ||
| Blood Transfusion | 8 | ||
| Frozen Section | 8 | ||
| Ascent of Scientific Surgery | 9 | ||
| Standardized Postgraduate Surgical Education and Training Programs | 10 | ||
| Experimental Surgical Research Laboratories | 11 | ||
| Specialty Journals, Textbooks, Monographs, and Treatises | 12 | ||
| Professional Societies and Licensing Organizations | 13 | ||
| The Modern Era | 14 | ||
| Diversity | 17 | ||
| The Future | 18 | ||
| Selected References | 18 | ||
| 2 Ethics and Professionalism in Surgery | 20 | ||
| Outline | 20 | ||
| The Importance of Ethics in Surgery | 20 | ||
| End-of-Life Care | 21 | ||
| Resuscitation in the Operating Room | 21 | ||
| Cultural Sensitivity | 21 | ||
| Shared Decision Making | 22 | ||
| Professionalism | 22 | ||
| Conclusion | 23 | ||
| Selected References | 23 | ||
| References | 23 | ||
| 3 The Inflammatory Response | 25 | ||
| Outline | 25 | ||
| Components of the Immune System | 25 | ||
| Acute Inflammation | 25 | ||
| Recognition of Stimuli and Activation of the Acute Inflammatory Response | 25 | ||
| Early Manifestations of Acute Inflammation | 27 | ||
| Tumor Necrosis Factor-α and Interleukin-1 | 27 | ||
| High-Mobility Group Box 1 | 30 | ||
| Interleukin-18 | 30 | ||
| Interleukin-6 | 30 | ||
| Interleukin-8 | 30 | ||
| Interleukin-12 | 31 | ||
| Interleukin-17 | 31 | ||
| Interferon-Îł | 31 | ||
| Macrophage Migration Inhibitory Factor | 31 | ||
| Interleukin-4 | 32 | ||
| Interleukin-10 | 32 | ||
| Transforming Growth Factor-β | 32 | ||
| Complement | 33 | ||
| Immunotherapy for Sepsis | 33 | ||
| Chronic Inflammation | 35 | ||
| Chronic Inflammation by Organ System | 35 | ||
| Pulmonary | 35 | ||
| Pathophysiologic changes and immune reactions. | 35 | ||
| Diagnosis of chronic obstructive pulmonary disease. | 36 | ||
| Therapeutic approaches to chronic obstructive pulmonary disease. | 36 | ||
| Pancreas | 36 | ||
| Inflammatory Bowel Disease | 36 | ||
| Pathophysiologic Changes | 36 | ||
| Clinical Presentation and Diagnosis | 37 | ||
| Immune Activation in Inflammatory Bowel Disease | 37 | ||
| Immune Therapy for Inflammatory Bowel Disease | 37 | ||
| Chronic Gastritis | 37 | ||
| Histologic Changes | 37 | ||
| Clinical Manifestations | 37 | ||
| Immunologic Changes | 38 | ||
| Treatment | 38 | ||
| Chronic Vascular Inflammation | 38 | ||
| Cellular Differentiation Involved in Chronic Vascular Inflammation | 38 | ||
| Indirect Mechanism of Activation | 38 | ||
| Therapeutic Options | 39 | ||
| Chronic Hepatic Inflammation and Cirrhosis | 39 | ||
| Overview of Cirrhosis and Hepatic Immune Cell Organization | 39 | ||
| Immune-Mediated Hepatic Degradation | 39 | ||
| Systemic Immune System Effects of Cirrhosis | 39 | ||
| Clinical Manifestations of Cirrhosis | 39 | ||
| Chronic Renal Inflammation | 40 | ||
| Role of Innate Immunity in the Development of Chronic Renal Disease | 40 | ||
| Adaptive Immunity in Renal Inflammation | 40 | ||
| Pathophysiologic Changes Caused by Chronic Renal Inflammation | 40 | ||
| Immune Therapy for Chronic Renal Disease | 41 | ||
| Sterile Inflammation | 41 | ||
| Examples of Sterile Inflammation | 41 | ||
| Pathways Involved in Sterile Inflammation | 41 | ||
| Natural Progression of Sterile Inflammation | 41 | ||
| Selected References | 41 | ||
| References | 42 | ||
| 4 Shock, Electrolytes, and Fluid | 44 | ||
| Outline | 44 | ||
| History | 44 | ||
| Resuscitation | 44 | ||
| Shock | 45 | ||
| Fluids | 48 | ||
| Blood Transfusions | 49 | ||
| Physiology of Shock | 50 | ||
| Bleeding | 50 | ||
| Shock Index | 52 | ||
| Lactate and Base Deficit | 52 | ||
| Compensatory Mechanisms | 53 | ||
| Lethal Triad | 53 | ||
| Acidosis | 54 | ||
| Hypothermia | 54 | ||
| Coagulopathy | 56 | ||
| Oxygen Delivery | 58 | ||
| Optimization (Supernormalization) | 59 | ||
| Global Perfusion versus Regional Perfusion | 61 | ||
| Septic Shock | 63 | ||
| Problems with Resuscitation | 63 | ||
| Bleeding | 64 | ||
| Trauma Immunology and Inflammation | 65 | ||
| Evolution of Modern Resuscitation | 67 | ||
| Detrimental Impact of Fluids | 67 | ||
| Damage Control Resuscitation | 70 | ||
| Whole Blood Resuscitation | 70 | ||
| Resuscitation With 1 : 1 : 1 | 71 | ||
| Massive Transfusion Protocol | 71 | ||
| Current Status of Fluid Types | 73 | ||
| Crystalloids | 73 | ||
| Hypertonic Saline | 74 | ||
| Colloids | 76 | ||
| Future Resuscitation Research | 77 | ||
| Blood Substitutes | 77 | ||
| Perfluorocarbons | 78 | ||
| Novel Fluids | 79 | ||
| Dried Plasma | 79 | ||
| Pharmacologic Agents | 80 | ||
| Suspended Animation | 81 | ||
| Perioperative Fluid Management | 81 | ||
| Body Water | 81 | ||
| Maintenance Fluids | 82 | ||
| Adrenal Gland | 84 | ||
| Antidiuretic Hormone and Water | 85 | ||
| Electrolytes | 85 | ||
| Sodium | 85 | ||
| Hyponatremia | 86 | ||
| Hypernatremia | 87 | ||
| Potassium | 87 | ||
| Hypokalemia | 88 | ||
| Treatment of acute hypokalemia. | 88 | ||
| Hyperkalemia | 88 | ||
| Treatment of hyperkalemia. | 89 | ||
| Calcium | 89 | ||
| Hypocalcemia | 90 | ||
| Treatment of hypocalcemia. | 91 | ||
| Hypercalcemia | 91 | ||
| Treatment of hypercalcemia. | 92 | ||
| Magnesium | 92 | ||
| Hypomagnesemia | 93 | ||
| Treatment of hypomagnesemia. | 93 | ||
| Hypermagnesemia | 93 | ||
| Treatment of hypermagnesemia. | 94 | ||
| Selected References | 94 | ||
| References | 95 | ||
| 5 Metabolism in Surgical Patients | 98 | ||
| Outline | 98 | ||
| Videos | 98.e1 | ||
| Substrate Metabolism | 98 | ||
| Carbohydrate Metabolism | 99 | ||
| Lipid Metabolism | 100 | ||
| Protein Metabolism | 101 | ||
| Regulation of the Amino Acid Pool | 101 | ||
| Glucose-Alanine and Glucose-Lactate Amino Acid Cycles | 102 | ||
| Protein Turnover | 102 | ||
| Proteolysis | 102 | ||
| Vitamins and Micronutrients | 103 | ||
| Malnutrition and Starvation | 103 | ||
| Malnutrition Subtypes | 105 | ||
| Starvation | 105 | ||
| Kwashiorkor and Marasmus | 105 | ||
| Stress-Induced Changes in Substrate Metabolism | 106 | ||
| Nutritional Assessment and Monitoring | 107 | ||
| Global Assessment and Nutritional Risk Screening | 107 | ||
| Anthropometry | 107 | ||
| Body Weight | 107 | ||
| Ideal Body Weight | 107 | ||
| Lean Body Mass | 107 | ||
| Body Mass Index | 107 | ||
| Clinical Imaging | 108 | ||
| Dual-Energy X-Ray Absorptiometry | 108 | ||
| Computed Tomography and Ultrasound | 108 | ||
| Serum Albumin Level | 108 | ||
| Pediatric Assessment | 108 | ||
| Evaluating Metabolism and Energy Requirements | 108 | ||
| Energy Expenditure Equations | 110 | ||
| Harris-Benedict Equation | 110 | ||
| Indirect Calorimetry | 110 | ||
| Nitrogen Balance | 110 | ||
| Serum Proteins | 110 | ||
| Nutritional Support | 110 | ||
| Preoperative Nutrition | 111 | ||
| Nonmalnourished Patients | 111 | ||
| Malnourished Patients | 111 | ||
| Principles Guiding Routes of Nutrition: Enteral, Parenteral, or Both | 111 | ||
| Enteral Nutrition | 112 | ||
| Benefits of Enteral Nutrition (Trophic Feeding) | 112 | ||
| Early Initiation of Enteral Nutrition | 112 | ||
| Delivering Enteral Nutrition | 112 | ||
| Oral Feeding | 112 | ||
| Enteral Access for Feeding | 113 | ||
| Ileus and Enteral Feeding Intolerance | 114 | ||
| Early Initiation of Enteral Feeding | 114 | ||
| Formulations | 115 | ||
| Immunonutrition | 117 | ||
| Complications | 117 | ||
| Parenteral Nutrition | 117 | ||
| Formulations | 118 | ||
| Ordering Parenteral Nutrition | 119 | ||
| Complications | 121 | ||
| Carbohydrate Content | 121 | ||
| Lipid Content | 122 | ||
| Protein Content | 122 | ||
| Fluid and Electrolytes | 122 | ||
| Disease-Specific Concerns | 122 | ||
| Antioxidant Therapy | 122 | ||
| Burn Injury and the Metabolic Stress Response | 122 | ||
| Organ Transplantation | 124 | ||
| Inflammatory Bowel Disease | 124 | ||
| Short Bowel Syndrome | 124 | ||
| Hepatic Insufficiency | 124 | ||
| Gastric Bypass Surgery | 125 | ||
| Intensive Insulin and Glycemic Control | 125 | ||
| Pancreatitis | 125 | ||
| Obesity | 125 | ||
| Comorbidities and Preexisting Conditions | 126 | ||
| Type 2 Diabetes Mellitus | 126 | ||
| Cardiovascular Disease | 126 | ||
| Deep Vein Thrombosis and Embolism | 126 | ||
| Hepatobiliary Disease | 126 | ||
| Osteoarthritis | 127 | ||
| Metabolic Syndrome | 127 | ||
| Obese Surgical Patients | 127 | ||
| Summary | 127 | ||
| Selected References | 127 | ||
| References | 128 | ||
| 6 Wound Healing | 130 | ||
| Outline | 130 | ||
| Tissue Injury and Response | 130 | ||
| Wound-Healing Phases | 130 | ||
| Inflammatory Phase | 130 | ||
| Hemostasis and Inflammation | 130 | ||
| Increased Vascular Permeability | 130 | ||
| Chemokines | 131 | ||
| Polymorphonuclear Cells | 132 | ||
| Macrophages | 132 | ||
| Lymphocytes | 136 | ||
| Proliferative Phase | 136 | ||
| Angiogenesis | 136 | ||
| Fibroplasia | 137 | ||
| Epithelialization | 137 | ||
| Extracellular Matrix | 137 | ||
| Collagen structure. | 138 | ||
| Collagen synthesis. | 138 | ||
| Elastic fibers. | 139 | ||
| Glycosaminoglycans and proteoglycans. | 140 | ||
| Basal lamina. | 140 | ||
| Degradation of the extracellular matrix. | 141 | ||
| Maturational Phase | 141 | ||
| Remodeling | 141 | ||
| Abnormal Wound Healing | 141 | ||
| Hypertrophic Scars and Keloids | 141 | ||
| Prevention of Hypertrophic or Keloid Scars | 142 | ||
| Linear Hypertrophic Scars | 142 | ||
| Widespread Hypertrophic Scars | 143 | ||
| Keloids | 143 | ||
| Chronic Nonhealing Wounds | 143 | ||
| Infection | 146 | ||
| Other Causes of Abnormal Wound Healing | 146 | ||
| Hypoxia | 146 | ||
| Diabetes | 146 | ||
| Ionizing Radiation | 147 | ||
| Aging | 147 | ||
| Malnutrition | 148 | ||
| Drugs | 148 | ||
| Treatment of Chronic Wounds | 148 | ||
| Wound Dressings | 148 | ||
| Other Therapies | 149 | ||
| Hyperbaric Oxygen Therapy | 149 | ||
| Negative Pressure–Assisted Wound Therapy | 152 | ||
| Fetal Wound Healing | 153 | ||
| New Horizons | 154 | ||
| Tissue Engineering | 154 | ||
| Bioengineered Skin Substitutes | 154 | ||
| Epidermal Substitutes | 154 | ||
| Dermal Substitutes | 155 | ||
| Bilayer Substitutes | 156 | ||
| Evidence for the Use of Skin Substitutes in Chronic Wounds | 156 | ||
| Risks Associated With Skin Substitutes | 156 | ||
| Future of Bioengineered Skin Substitutes | 157 | ||
| Gene and Stem Cell Therapy | 157 | ||
| Selected References | 160 | ||
| References | 161 | ||
| 7 Regenerative Medicine | 163 | ||
| Outline | 163 | ||
| Stem Cell Sources | 163 | ||
| Embryonic Stem Cells | 163 | ||
| Somatic Cell Nuclear Transfer | 165 | ||
| Induced Pluripotent Stem Cells | 165 | ||
| Fetal Stem Cells | 165 | ||
| Adult Stem Cells | 166 | ||
| Hematopoietic Stem Cells | 167 | ||
| Skeletal Stem Cells | 167 | ||
| Mesenchymal Stem Cells | 167 | ||
| Adipose-Derived Stromal Cells | 167 | ||
| Endothelial Progenitor Cells | 167 | ||
| Miscellaneous Adult Stem Cells | 168 | ||
| Stem Cells and Cancer | 168 | ||
| Bioengineering for Regenerative Medicine | 168 | ||
| Research Applications | 168 | ||
| Biomaterials as Constructs for Cell Delivery and Directed Differentiation | 168 | ||
| Organ-Level Tissue Engineering | 169 | ||
| Clinical Applications of Stem Cells | 169 | ||
| Embryonic Stem Cells | 169 | ||
| Induced Pluripotent Stem Cells | 169 | ||
| Multipotent Adult Stem Cells | 169 | ||
| Selected References | 170 | ||
| References | 171 | ||
| 8 Evidence-Based Surgery | 173 | ||
| Outline | 173 | ||
| What is the Purpose of the Study? | 173 | ||
| Is the Study Using the Right Data? | 173 | ||
| Is the Study Making a Fair Comparison? | 174 | ||
| Misclassification | 174 | ||
| Time-Varying Exposures | 174 | ||
| What is the Outcome of Interest? | 175 | ||
| Patient-Reported Outcomes | 176 | ||
| Costs, Charges, and Resource Utilization | 176 | ||
| Safety | 176 | ||
| Appropriateness | 176 | ||
| Surrogate End Points | 177 | ||
| Composite End Points | 177 | ||
| What is the Study Design? | 177 | ||
| Randomized Controlled Trials | 178 | ||
| Efficacy and Effectiveness | 178 | ||
| Variations on Randomized Trials | 178 | ||
| Meta-Analysis | 179 | ||
| Cross-Sectional Study | 179 | ||
| Cohort Study | 179 | ||
| Case-Control Study | 179 | ||
| Case Reports and Case Series | 180 | ||
| Was the Right Analysis Performed? | 180 | ||
| Variable Types and Descriptive Statistics | 180 | ||
| Hypothesis Testing | 181 | ||
| Multivariable Analysis | 181 | ||
| Propensity Score Analysis | 181 | ||
| Instrumental Variable Analysis | 182 | ||
| Missing Data | 182 | ||
| Correlated Data | 182 | ||
| How Should I Use This Information in My Practice? | 183 | ||
| Confounding | 183 | ||
| Generalizability | 183 | ||
| Determining Causality Using Observational Data | 184 | ||
| Is There Conflict of Interest? | 184 | ||
| Evolving With the Evidence | 184 | ||
| Conclusions | 184 | ||
| Selected References | 184 | ||
| References | 185 | ||
| 9 Safety in the Surgical Environment | 187 | ||
| Outline | 187 | ||
| Fostering a Culture of Safety Through Leadership | 188 | ||
| Local Organizational Structures to Promote Perioperative Safety | 188 | ||
| National and Health Care System–Level Safety Initiatives | 190 | ||
| System-Level Interventions Improve Safety | 195 | ||
| Conclusions | 197 | ||
| Selected References | 199 | ||
| References | 199 | ||
| II Perioperative Management | 201 | ||
| 10 Principles of Preoperative and Operative Surgery | 202 | ||
| Outline | 202 | ||
| Preoperative Preparation of the Patient | 202 | ||
| Principles of and Preparation for Surgery | 202 | ||
| Determining the Need for Surgery | 202 | ||
| Perioperative Decision Making | 202 | ||
| Preoperative Evaluation | 202 | ||
| Universal Surgical Risk Calculator | 204 | ||
| Perioperative Mortality Predictor | 205 | ||
| Optimal Preoperative Assessment of Geriatric Surgical Patients | 206 | ||
| Cognitive Impairment and Dementia | 206 | ||
| Depression | 206 | ||
| Postoperative Delirium | 206 | ||
| Alcohol and Substance Abuse | 207 | ||
| Cardiac Evaluation | 207 | ||
| Pulmonary Evaluation | 207 | ||
| Functional Status, Mobility, and Fall Risk | 209 | ||
| Frailty | 209 | ||
| Nutritional Status | 210 | ||
| Medication Management | 210 | ||
| Patient Counseling | 210 | ||
| Preoperative Testing | 210 | ||
| Systems Approach to Preoperative Evaluation | 210 | ||
| Cardiovascular System | 210 | ||
| Perioperative Beta Blocker Therapy Recommendation | 212 | ||
| Pulmonary System | 212 | ||
| Renal System | 213 | ||
| Hepatobiliary System | 213 | ||
| Endocrine System | 216 | ||
| Perioperative Diabetic Management | 216 | ||
| Management of Other Endocrinopathies | 217 | ||
| Immune System | 218 | ||
| HIV-Infected Patients and Surgery | 218 | ||
| Hematologic System | 218 | ||
| Acute Bleeding and Trauma | 218 | ||
| Antiplatelet Management in Noncardiac Surgery Patients | 219 | ||
| Anticoagulation Management in Noncardiac Surgery Patients | 219 | ||
| Oral Direct Thrombin and Factor Xa Inhibitors | 220 | ||
| Dabigatran | 220 | ||
| Rivaroxaban | 221 | ||
| Apixaban | 221 | ||
| Venous Thromboembolism Prophylaxis in Surgical Patients | 221 | ||
| Additional Preoperative Considerations | 222 | ||
| Nutritional Status | 222 | ||
| Nutritional Interventions | 223 | ||
| Obesity | 224 | ||
| Preoperative Checklist | 224 | ||
| Antibiotic Prophylaxis | 224 | ||
| Review of Medications | 225 | ||
| Preoperative Fasting | 228 | ||
| Potential Causes of Intraoperative Instability | 230 | ||
| Myocardial Infarction | 230 | ||
| Pulmonary Embolism | 230 | ||
| Pneumothorax | 230 | ||
| Anaphylaxis and Latex Allergy | 231 | ||
| Malignant Hyperthermia | 231 | ||
| Wrong-Site Surgery and Universal Protocol | 231 | ||
| Operating Room | 231 | ||
| Maintenance of Normothermia | 231 | ||
| Preoperative Skin Preparation | 232 | ||
| Hemostasis | 232 | ||
| Wound Closure | 233 | ||
| Staplers | 234 | ||
| Surgical Adhesives | 235 | ||
| Surgical Devices and Energy Sources | 235 | ||
| Electrosurgery and Electrocautery | 235 | ||
| Lasers | 235 | ||
| Argon Beam Coagulator | 236 | ||
| Photodynamic Therapy | 236 | ||
| High-Frequency Sound Wave Techniques | 236 | ||
| Harmonic Scalpel | 236 | ||
| Ultrasonic Cavitation Devices | 236 | ||
| Radiofrequency Ablation | 236 | ||
| Cryoablation | 237 | ||
| Microwave Ablation and Radiosurgery | 237 | ||
| Outpatient Surgery | 237 | ||
| Selected References | 238 | ||
| References | 238 | ||
| 11 Surgical Infections and Antibiotic Use | 241 | ||
| Outline | 241 | ||
| Risk Factors for Infection | 241 | ||
| Host Factors | 241 | ||
| Genetics and Genomics of Trauma and Sepsis | 242 | ||
| Interactions Between the Host and Therapy | 243 | ||
| Blood Transfusion | 243 | ||
| Control of Blood Glucose Concentration | 243 | ||
| Infection Control | 244 | ||
| Catheter Care | 244 | ||
| Specific Infections | 245 | ||
| Surgical Site Infection | 245 | ||
| Postoperative Pneumonia | 247 | ||
| Central Line–Associated Bloodstream Infection | 249 | ||
| Urinary Tract Infection | 250 | ||
| Intra-abdominal Infection | 250 | ||
| Antibiotic Use | 251 | ||
| Pharmacokinetic and Pharmacodynamic Principles | 251 | ||
| Antibiotic Prophylaxis | 251 | ||
| Principles of Antibiotic Therapy | 253 | ||
| Evaluation of Possible Infection | 253 | ||
| Blood Cultures | 255 | ||
| Empirical Antibiotic Therapy | 255 | ||
| Choice of Antibiotic | 255 | ||
| Duration of Therapy | 255 | ||
| Disease-, Pathogen-, and Antibiotic-Specific Considerations | 256 | ||
| Pneumonia | 256 | ||
| Central Line–Associated Bloodstream Infection | 256 | ||
| Intra-abdominal Infection | 257 | ||
| Clostridium difficile–Associated Disease | 257 | ||
| Complicated Skin and Soft Tissue Infections | 257 | ||
| Antibiotic Activity Spectra | 258 | ||
| Cell Wall–Active Agents | 258 | ||
| β-Lactam antibiotics. | 258 | ||
| Penicillins. | 258 | ||
| Cephalosporins. | 259 | ||
| Third-generation cephalosporins. | 259 | ||
| Fourth-generation cephalosporins. | 259 | ||
| Monobactams. | 259 | ||
| Carbapenems. | 259 | ||
| Lipoglycopeptides. | 260 | ||
| Cyclic lipopeptides. | 260 | ||
| Polymyxins. | 260 | ||
| Protein Synthesis Inhibitors | 261 | ||
| Aminoglycosides. | 261 | ||
| Tetracyclines. | 261 | ||
| Oxazolidinones. | 261 | ||
| Macrolide-lincosamide-streptogramin family | 261 | ||
| Clindamycin. | 261 | ||
| Drugs That Disrupt Nucleic Acids | 262 | ||
| Fluoroquinolones. | 262 | ||
| Cytotoxic Antibiotics | 262 | ||
| Metronidazole. | 262 | ||
| Trimethoprim-sulfamethoxazole. | 262 | ||
| Antibiotic Toxicities | 262 | ||
| β-Lactam Allergy | 262 | ||
| Red Man Syndrome | 262 | ||
| Nephrotoxicity | 262 | ||
| Ototoxicity | 263 | ||
| Avoiding Toxicity: Adjustment of Antibiotic Dosage | 263 | ||
| Hepatic Insufficiency | 263 | ||
| Renal Insufficiency | 263 | ||
| Important Pathogens of Critically Ill Patients | 263 | ||
| Vancomycin-Resistant Enterococci | 263 | ||
| Staphylococcus aureus | 264 | ||
| Pseudomonas aeruginosa | 264 | ||
| Multidrug-Resistant Enterobacteriaceae, Including Klebsiella Species | 264 | ||
| Stenotrophomonas maltophilia | 264 | ||
| Acinetobacter baumannii Complex | 264 | ||
| Fungal Infections | 265 | ||
| Risk Factors | 265 | ||
| Diabetes Mellitus | 265 | ||
| Neutropenia | 265 | ||
| Organ Transplantation and Immunosuppression | 265 | ||
| Malignant Disease | 265 | ||
| Central Venous Catheters | 265 | ||
| Prediction of Invasive Candida Infection | 266 | ||
| Intensive Care Unit and Invasive Mechanical Ventilation | 267 | ||
| Fungal Pathogens | 267 | ||
| Candida albicans | 267 | ||
| Non-albicans Candida | 267 | ||
| Aspergillus | 267 | ||
| Other Emerging Fungal Pathogens | 267 | ||
| Prophylaxis | 268 | ||
| Antifungal Prophylaxis of Solid Organ Transplant Recipients | 268 | ||
| Antifungal Therapy | 268 | ||
| References | 271 | ||
| 12 Surgical Complications | 281 | ||
| Outline | 281 | ||
| Surgical Wound Complications | 281 | ||
| Seroma | 281 | ||
| Causes | 281 | ||
| III Trauma and Critical Care | 407 | ||
| 16 Management of Acute Trauma | 408 | ||
| Outline | 408 | ||
| Overview and History | 408 | ||
| Trauma Systems | 409 | ||
| Injury Scoring | 410 | ||
| Prehospital Trauma Care | 411 | ||
| Initial Assessment and Management | 413 | ||
| Airway | 413 | ||
| Breathing | 415 | ||
| Circulation | 415 | ||
| Disability and Exposure | 416 | ||
| Resuscitative Thoracotomy | 416 | ||
| Secondary Survey | 417 | ||
| Management of Specific Injuries | 417 | ||
| Damage Control Principles | 417 | ||
| Injuries to the Brain | 417 | ||
| Immediate Management | 418 | ||
| Evaluation | 418 | ||
| Management | 419 | ||
| Injuries to the Spinal Cord and the Vertebral Column | 420 | ||
| Immediate Management | 420 | ||
| Evaluation | 420 | ||
| Management | 421 | ||
| Injury to the Maxillofacial Region | 421 | ||
| Immediate Management | 422 | ||
| Evaluation | 422 | ||
| Management | 422 | ||
| Injuries to the Neck | 423 | ||
| Immediate Management | 423 | ||
| Evaluation | 423 | ||
| Management | 424 | ||
| Injuries to the Chest | 424 | ||
| Immediate Management | 425 | ||
| Evaluation | 426 | ||
| Management | 427 | ||
| Chest wall and pleural space injuries. | 428 | ||
| Pulmonary injuries. | 428 | ||
| Cardiac injuries. | 429 | ||
| Thoracic aortic injuries. | 430 | ||
| Tracheobronchial injuries. | 431 | ||
| Esophageal injuries. | 431 | ||
| Diaphragmatic injuries. | 432 | ||
| Injuries to the Abdomen | 432 | ||
| Immediate Management | 432 | ||
| Blunt Abdominal Trauma Evaluation | 432 | ||
| Penetrating Abdominal Trauma Evaluation | 434 | ||
| Management | 434 | ||
| Splenic injuries. | 435 | ||
| Hepatic injuries. | 437 | ||
| Gastric injuries. | 439 | ||
| Duodenal injuries. | 439 | ||
| Pancreatic injuries. | 440 | ||
| Small bowel injuries. | 441 | ||
| Colon injuries. | 442 | ||
| Abdominal great vessel injuries. | 443 | ||
| Genitourinary injuries. | 444 | ||
| Injuries to the Pelvis and Extremities | 444 | ||
| Rehabilitation | 446 | ||
| Selected References | 446 | ||
| References | 447 | ||
| 17 The Difficult Abdominal Wall | 449 | ||
| Outline | 449 | ||
| Video | 449.e1 | ||
| Suture Material | 449 | ||
| Closure Technique | 449 | ||
| Abdominal Fascial Dehiscence | 449 | ||
| Temporary Abdominal Closure | 450 | ||
| Assessing Readiness for Abdominal Closure | 452 | ||
| Timing of Reoperation | 452 | ||
| Synthetic Mesh Failure | 453 | ||
| Biologic Mesh | 453 | ||
| Seroma and Skin Necrosis | 454 | ||
| Preparation for Abdominal Wall Reconstruction | 455 | ||
| Definitive Repair: Creating a Dynamic Abdominal Wall | 455 | ||
| Modified Rives-Stoppa and Transversus Abdominis Release Techniques | 456 | ||
| Adjuncts to Repair | 456 | ||
| Summary | 458 | ||
| Selected References | 458 | ||
| References | 459 | ||
| 18 Emergency Care of Musculoskeletal Injuries | 462 | ||
| Outline | 462 | ||
| Epidemiology of Orthopedic Injuries | 462 | ||
| Terminology | 462 | ||
| Fracture Types | 462 | ||
| Other Injuries | 465 | ||
| Fixation Principles | 467 | ||
| External Fixation | 467 | ||
| Internal Fixation | 468 | ||
| Pins and Screws | 468 | ||
| Plates | 468 | ||
| Tension Bands | 470 | ||
| Intramedullary Nails | 470 | ||
| Patient Evaluation | 470 | ||
| History | 470 | ||
| Trauma Room Evaluation | 470 | ||
| Diagnostic Imaging | 474 | ||
| Shoulder | 474 | ||
| Elbow | 475 | ||
| Pelvis and Acetabulum | 475 | ||
| Hip | 475 | ||
| Knee | 476 | ||
| Ankle | 476 | ||
| Foot | 477 | ||
| Spine | 477 | ||
| Intra-Articular Fractures | 478 | ||
| Stress Radiographs | 478 | ||
| Vascular Injuries | 478 | ||
| Initial Management | 478 | ||
| Wound Management | 478 | ||
| Reduction and Immobilization | 478 | ||
| Traction | 479 | ||
| Prioritization of Surgical Care | 479 | ||
| Orthopedic Emergencies | 481 | ||
| Open Fractures | 481 | ||
| Classification | 482 | ||
| Initial Management | 483 | ||
| Limb Salvage versus Primary Amputation | 483 | ||
| Fractures Secondary to Firearm Injury | 484 | ||
| Skeletal Stabilization | 485 | ||
| Acute Compartment Syndrome | 485 | ||
| Pathogenesis | 486 | ||
| Diagnosis | 486 | ||
| Tissue Pressure Measurement Technique | 486 | ||
| Surgical Treatment | 487 | ||
| Pelvic Ring Disruption | 487 | ||
| Classification | 488 | ||
| Management | 489 | ||
| Initial stabilization. | 491 | ||
| Definitive management. | 491 | ||
| Spinal Injuries | 491 | ||
| Evaluation | 491 | ||
| Management | 492 | ||
| Dislocations | 493 | ||
| Patient Evaluation | 493 | ||
| Treatment | 494 | ||
| Vascular Injuries | 495 | ||
| Incidence | 495 | ||
| Management | 496 | ||
| Common Long Bone Fractures | 497 | ||
| Femur Fractures | 497 | ||
| Epidemiology and Significance | 497 | ||
| Initial Management | 497 | ||
| Definitive Stabilization | 497 | ||
| Tibial Shaft Fractures | 498 | ||
| IV Transplantation and Immunology | 597 | ||
| 24 Transplantation Immunobiology and Immunosuppression | 598 | ||
| Outline | 598 | ||
| Video | 598.e1 | ||
| The Immune Response | 598 | ||
| Innate Immunity | 599 | ||
| Monocytes | 600 | ||
| Dendritic Cells | 600 | ||
| Natural Killer Cells | 601 | ||
| Acquired Immunity | 601 | ||
| Major Histocompatibility Locus: Transplant Antigens | 601 | ||
| Human Histocompatibility Complex | 601 | ||
| Class I Major Histocompatibility Complex | 602 | ||
| Class II MHC | 603 | ||
| HLA Typing: Implications for Transplantation | 603 | ||
| Cellular Components of the Acquired Immune System | 604 | ||
| T Cell Receptor | 604 | ||
| T Cell Activation | 607 | ||
| Costimulation | 609 | ||
| T Cell Effector Functions | 612 | ||
| Cytokines | 614 | ||
| B Cells | 614 | ||
| B cell receptor or antibody. | 614 | ||
| B cell activation. | 616 | ||
| Transplant Immunity | 616 | ||
| Rejection | 617 | ||
| Hyperacute Rejection | 617 | ||
| Acute Rejection | 620 | ||
| Chronic Rejection | 622 | ||
| Immunosuppression | 622 | ||
| Corticosteroids | 622 | ||
| Antiproliferative Agents | 624 | ||
| Azathioprine | 624 | ||
| Mycophenolate Mofetil | 624 | ||
| Calcineurin Inhibitors | 624 | ||
| Cyclosporine | 624 | ||
| Tacrolimus | 624 | ||
| Lymphocyte Depletion Preparations | 625 | ||
| Antilymphocyte Globulin | 625 | ||
| OKT3 | 626 | ||
| Anti–IL-2 Receptor Antibodies | 626 | ||
| Other Immunoglobulin Therapies | 627 | ||
| Rituximab | 627 | ||
| Alemtuzumab | 627 | ||
| Intravenous Immune Globulin | 627 | ||
| Mammalian Target of Rapamycin Inhibitors | 627 | ||
| Newer Immunosuppressive Agents | 627 | ||
| Belatacept | 627 | ||
| Fingolimod (FTY720) | 628 | ||
| Eculizumab | 628 | ||
| JAK3 Kinase Inhibition | 628 | ||
| Protein Kinase C Inhibition | 628 | ||
| Complications of Immunosuppression | 629 | ||
| Risk of Infection | 629 | ||
| Risk for Malignant Disease | 629 | ||
| Nonimmune Side Effects | 629 | ||
| Tolerance | 630 | ||
| T Cell Ablation | 630 | ||
| Costimulation Blockade | 630 | ||
| Mixed Chimerism | 631 | ||
| Xenotransplantation | 631 | ||
| Concordant Xenografts | 631 | ||
| Discordant Xenografts | 632 | ||
| New Areas of Transplantation | 632 | ||
| Islet Cell Transplantation | 632 | ||
| Vascularized Composite Tissue Transplantation | 633 | ||
| Conclusion | 633 | ||
| Selected References | 633 | ||
| References | 635 | ||
| 25 Liver Transplantation | 637 | ||
| Outline | 637 | ||
| History | 637 | ||
| Indications and Contraindications | 637 | ||
| Indications | 637 | ||
| Fulminant Hepatic Failure | 638 | ||
| Hepatitis C and Liver Transplantation | 638 | ||
| Hepatitis B | 638 | ||
| Primary Biliary Cirrhosis | 639 | ||
| Primary Sclerosing Cholangitis | 639 | ||
| Alcoholic Liver Disease | 639 | ||
| Nonalcoholic Steatohepatitis | 639 | ||
| Biliary Atresia | 639 | ||
| Contraindications | 639 | ||
| Organ Shortage, Model for End-Stage Liver Disease, and Liver Distribution | 640 | ||
| Model for End-Stage Liver Disease Formula | 640 | ||
| Live Donor Liver Transplantation | 640 | ||
| Technical Aspects of Liver Transplantation | 641 | ||
| Split Liver Transplant | 642 | ||
| Live Donor Operation | 642 | ||
| Right Lobe Dissection for Live Donor Liver Transplantation | 642 | ||
| Left Lobe Dissection for Live Donor Liver Transplantation | 643 | ||
| Implantation of Partial Liver Graft | 643 | ||
| Early Complications of Liver Transplantation | 643 | ||
| Outcome | 644 | ||
| Extended Criteria Donors | 644 | ||
| Evaluation of Abnormal Liver | 644 | ||
| Function Test Results | 644 | ||
| Immunosuppression after Liver Transplantation | 645 | ||
| Retransplantation and Recurrent Disease | 645 | ||
| Role of Liver Transplantation for Hepatocellular Carcinoma | 645 | ||
| Role of Cellular Transplantation in Liver Replacement | 646 | ||
| Selected References | 646 | ||
| References | 646 | ||
| 26 Kidney and Pancreas Transplantation | 649 | ||
| Outline | 649 | ||
| Historical Perspective | 649 | ||
| Kidney Transplantation | 649 | ||
| Indications | 649 | ||
| Patient Selection | 649 | ||
| Living Donor Selection | 651 | ||
| Laparoscopic Surgical Technique | 652 | ||
| Open Surgical Technique | 653 | ||
| Postoperative Care and Follow-up | 653 | ||
| Deceased Donors | 653 | ||
| Kidney Procurement and Preparation | 654 | ||
| Preservation and Storage | 655 | ||
| Recipient Operation | 655 | ||
| Postoperative Surgical Complications | 655 | ||
| Hemorrhage | 655 | ||
| Venous Thrombosis | 656 | ||
| Arterial Thrombosis | 656 | ||
| Arterial Stenosis | 656 | ||
| Urologic Complications | 656 | ||
| Lymphocele | 657 | ||
| Infections | 657 | ||
| Outcomes | 657 | ||
| Kidney Allocation | 658 | ||
| Pancreas Transplantation | 658 | ||
| Patient Selection | 658 | ||
| Pancreas Donor | 658 | ||
| Pancreas Procurement, Preparation, and Transplantation | 659 | ||
| Drainage Techniques: Endocrine and Exocrine Secretions | 660 | ||
| Enteric Drainage or Bladder Drainage | 660 | ||
| Systemic Drainage versus Portal Drainage | 660 | ||
| Surgical Complications | 660 | ||
| Leak | 660 | ||
| Vascular Complications | 660 | ||
| Thrombosis. | 660 | ||
| Bleeding. | 661 | ||
| Other Considerations | 661 | ||
| Infection. | 661 | ||
| Pancreatitis. | 661 | ||
| Bowel obstruction. | 662 | ||
| V Surgical Oncology | 676 | ||
| 28 Tumor Biology and Tumor Markers | 677 | ||
| Outline | 677 | ||
| Epidemiology | 677 | ||
| Global Burden of Cancer | 677 | ||
| Aging and Cancer | 677 | ||
| Obesity and Cancer | 678 | ||
| Tumor Biology | 679 | ||
| Sustaining Proliferative Signaling | 679 | ||
| Evading Growth Suppressors | 681 | ||
| Resisting Cell Death | 683 | ||
| Enabling Replicative Immortality | 684 | ||
| Inducing Angiogenesis | 685 | ||
| Activating Invasion and Metastasis | 685 | ||
| Avoiding Immune Destruction | 687 | ||
| Deregulating Cellular Energetics | 689 | ||
| Genomic Instability and Mutation | 689 | ||
| Tumor-Promoting Inflammation | 689 | ||
| Carcinogenesis | 689 | ||
| Cancer Genetics | 689 | ||
| Selected Familial Cancer Syndromes | 690 | ||
| Retinoblastoma | 690 | ||
| Li-Fraumeni Syndrome | 690 | ||
| Familial Adenomatous Polyposis | 691 | ||
| Hereditary Nonpolyposis Colorectal Cancer | 692 | ||
| BRCA1 and BRCA2 | 693 | ||
| Multiple Endocrine Neoplasia Type 1 | 693 | ||
| Multiple Endocrine Neoplasia Type 2 | 693 | ||
| Von Hippel–Lindau Syndrome | 693 | ||
| Cancer Epigenetics | 694 | ||
| Carcinogens | 694 | ||
| Chemical Carcinogens | 694 | ||
| Radiation Carcinogenesis | 695 | ||
| Infectious Carcinogens | 696 | ||
| Viral carcinogenesis. | 696 | ||
| Tenets of viral carcinogenesis (Box 28-1). | 696 | ||
| Small DNA tumor viruses. | 696 | ||
| Hepatitis B virus. | 696 | ||
| RNA viruses. | 697 | ||
| Hepatitis C virus. | 697 | ||
| Helicobacter pylori. | 697 | ||
| Chronic Inflammation | 697 | ||
| Tumor Markers | 697 | ||
| Protein Tumor Markers | 698 | ||
| Carcinoembryonic Antigen | 698 | ||
| VI Head and Neck | 788 | ||
| 33 Head and Neck | 789 | ||
| Outline | 789 | ||
| Normal Histology | 789 | ||
| Epidemiology | 789 | ||
| Carcinogenesis | 790 | ||
| Staging | 791 | ||
| Clinical Overview | 792 | ||
| Evaluation | 792 | ||
| Positron Emission Tomography | 792 | ||
| Lymphatic Spread | 792 | ||
| Therapeutic Options | 793 | ||
| Anatomic Sites | 794 | ||
| Lip | 794 | ||
| Oral Cavity | 795 | ||
| Oral Tongue | 795 | ||
| Floor of the Mouth | 796 | ||
| Alveolus | 796 | ||
| Buccal Mucosa | 796 | ||
| Palate | 797 | ||
| Oropharynx | 797 | ||
| Hypopharynx | 797 | ||
| Larynx | 798 | ||
| Nasal Cavity and Paranasal Sinuses | 802 | ||
| Nasopharynx | 803 | ||
| Pituitary Surgery | 805 | ||
| Ear and Temporal Bone | 805 | ||
| Salivary Gland Neoplasms | 807 | ||
| Neck and Unknown Primary | 809 | ||
| Tracheotomy | 810 | ||
| Vocal Cord Paralysis | 811 | ||
| Reconstruction | 812 | ||
| Selected References | 816 | ||
| References | 816 | ||
| VII Breast | 819 | ||
| 34 Diseases of the Breast | 820 | ||
| Outline | 820 | ||
| Anatomy | 820 | ||
| Microscopic Anatomy | 821 | ||
| Breast Development and Physiology | 822 | ||
| Normal Development and Physiology | 822 | ||
| Fibrocystic Changes and Breast Pain | 824 | ||
| Abnormal Development and Physiology | 824 | ||
| Absent or Accessory Breast Tissue | 824 | ||
| Gynecomastia | 824 | ||
| Nipple Discharge | 824 | ||
| Galactocele | 826 | ||
| Diagnosis of Breast Disease | 826 | ||
| Patient History | 826 | ||
| Physical Examination | 826 | ||
| Biopsy | 826 | ||
| Fine-Needle Aspiration Biopsy | 826 | ||
| Core Needle Biopsy | 827 | ||
| Excisional Biopsy | 827 | ||
| Breast Imaging | 827 | ||
| Screening Mammography | 828 | ||
| Ultrasonography | 828 | ||
| Magnetic Resonance Imaging | 828 | ||
| Nonpalpable Mammographic Abnormalities | 829 | ||
| Image-Localized Surgical Excision of Nonpalpable Breast Lesions | 829 | ||
| Identification and Care of High-Risk Patients | 830 | ||
| Risk Factors for Breast Cancer | 830 | ||
| Age and Sex | 830 | ||
| Personal History of Breast Cancer | 831 | ||
| Histologic Risk Factors | 831 | ||
| Family History of Breast Cancer and Genetic Risk Factors | 832 | ||
| Reproductive Risk Factors | 833 | ||
| Exogenous Hormone Use | 833 | ||
| Risk Assessment | 833 | ||
| Care of High-Risk Patients | 833 | ||
| Close Surveillance | 834 | ||
| Chemoprevention for Breast Cancer | 834 | ||
| Prophylactic Mastectomy | 835 | ||
| Summary: Risk Assessment and Management | 835 | ||
| Benign Breast Tumors and Related Diseases | 835 | ||
| Breast Cysts | 835 | ||
| Fibroadenomas and Other Benign Tumors | 836 | ||
| Hamartomas and Adenomas | 836 | ||
| Breast Infections and Abscess | 836 | ||
| Papillomas and Papillomatosis | 836 | ||
| Sclerosing Adenosis | 836 | ||
| Radial Scars | 837 | ||
| Fat Necrosis | 837 | ||
| Epidemiology and Pathology of Breast Cancer | 837 | ||
| Epidemiology | 837 | ||
| Pathology | 837 | ||
| Noninvasive Breast Cancer | 837 | ||
| Invasive Breast Cancer | 838 | ||
| Molecular Markers and Breast Cancer Subtypes | 840 | ||
| Other Tumors of the Breast | 841 | ||
| Phyllodes tumors. | 841 | ||
| Angiosarcoma. | 842 | ||
| Staging of Breast Cancer | 842 | ||
| Surgical Treatment of Breast Cancer | 843 | ||
| Historical Perspective | 843 | ||
| Surgical Trials of Local Therapy for Operable Breast Cancer | 844 | ||
| Radical Mastectomy versus Total Mastectomy, With or Without Radiation Therapy | 844 | ||
| Mastectomy versus Breast-Conserving Therapy | 844 | ||
| Planning Surgical Treatments | 845 | ||
| Selection of Surgical Therapy | 846 | ||
| Factors Influencing Eligibility for Breast Conservation | 846 | ||
| Tumor Size | 846 | ||
| Margins | 846 | ||
| Histology | 846 | ||
| Patient Age | 846 | ||
| Breast-Conserving Surgery | 846 | ||
| Technical Aspects | 846 | ||
| Cosmetic Challenges | 847 | ||
| Extent of breast resection. | 848 | ||
| Breast size and body habitus. | 848 | ||
| Tumor location. | 848 | ||
| Timing of Oncoplastic Surgery | 848 | ||
| Mastectomy | 848 | ||
| Indications | 848 | ||
| Postmastectomy Breast Reconstruction | 848 | ||
| Technical Details | 848 | ||
| Lymph Node Staging | 848 | ||
| Historical Perspective | 849 | ||
| Sentinel Lymph Node Dissection | 849 | ||
| Lymphatic Mapping Technique and Selection of Patients for Sentinel Lymph Node Dissection | 850 | ||
| Outcomes of Sentinel Lymph Node Dissection | 851 | ||
| Treatment of Ductal Carcinoma in Situ | 851 | ||
| Mastectomy | 852 | ||
| Breast-Conserving Therapy | 852 | ||
| Role of Tamoxifen | 853 | ||
| Sentinel Node Surgery | 853 | ||
| Radiation Therapy for Breast Cancer | 853 | ||
| Radiation Therapy After Breast-Conserving Surgery | 853 | ||
| Postmastectomy Radiation Therapy | 854 | ||
| Systemic Therapy for Breast Cancer | 854 | ||
| Goals of Therapy and Assessment of Potential Benefits and Risks from Therapy | 855 | ||
| Chemotherapy | 856 | ||
| Trastuzumab-Based Targeted Therapy | 857 | ||
| Endocrine Therapy | 857 | ||
| Tamoxifen | 857 | ||
| Aromatase Inhibitors | 858 | ||
| Ovarian Ablation | 858 | ||
| Neoadjuvant Systemic Therapy for Operable Breast Cancer | 858 | ||
| Systemic Therapy for Early-Stage Breast Cancer | 860 | ||
| Treatment of Locally Advanced and Inflammatory Breast Cancer | 860 | ||
| Treatment of Special Conditions | 860 | ||
| Breast Cancer in Older Adults | 860 | ||
| Paget Disease | 860 | ||
| Breast Cancer in Men | 861 | ||
| Selected References | 861 | ||
| References | 862 | ||
| 35 Breast Reconstruction | 865 | ||
| Outline | 865 | ||
| Role of the General Surgeon in Breast Reconstruction | 865 | ||
| History | 865 | ||
| Patient Selection | 866 | ||
| Timing | 866 | ||
| Procedure Selection and Surgical Planning | 866 | ||
| Implant-Based Reconstructions | 867 | ||
| Combination Reconstruction | 868 | ||
| Autologous Reconstruction | 868 | ||
| Pedicled Flap | 868 | ||
| Abdominal-Based, Gluteal-Based, and Inner Thigh–Based Flaps | 870 | ||
| Abdominal-based flaps. | 870 | ||
| Gluteal-based flaps. | 872 | ||
| Inner thigh–based flaps. | 872 | ||
| Oncoplastic Surgery | 873 | ||
| Complications | 873 | ||
| Nipple-Areolar Reconstruction | 875 | ||
| Management of the Contralateral Breast | 877 | ||
| Surveillance | 877 | ||
| Conclusions | 877 | ||
| Selected References | 877 | ||
| References | 878 | ||
| VIII Endocrine | 880 | ||
| 36 Thyroid | 881 | ||
| Outline | 881 | ||
| Historical Perspective | 881 | ||
| Anatomy | 881 | ||
| Embryology | 881 | ||
| Adult Surgical Anatomy | 882 | ||
| Innervation | 882 | ||
| Superior Laryngeal Nerve | 882 | ||
| Recurrent Laryngeal Nerve | 882 | ||
| Blood Supply | 884 | ||
| Lymphatic System | 884 | ||
| Parathyroid Glands | 885 | ||
| Physiology of the Thyroid Gland | 885 | ||
| Iodine Metabolism | 886 | ||
| Thyroid Hormone Synthesis | 886 | ||
| Thyroglobulin | 886 | ||
| Calcitonin | 887 | ||
| Regulation of Thyroid Hormone Secretion | 887 | ||
| Peripheral Action of Thyroid Hormones | 888 | ||
| Tests of Thyroid Function | 889 | ||
| Evaluation of the Pituitary-Thyroid Feedback Loop | 889 | ||
| Serum Triiodothyronine and Thyroxine Levels | 889 | ||
| Calcitonin | 889 | ||
| Radioactive Iodine Uptake | 889 | ||
| Thyroid Autoantibody Levels | 889 | ||
| Disorders of Thyroid Metabolism— Benign Thyroid Disease | 889 | ||
| Hypothyroidism | 889 | ||
| Metabolic Consequences of Iodine Deficiency | 889 | ||
| Postradiation Hypothyroidism | 890 | ||
| Postsurgical Hypothyroidism | 890 | ||
| Pharmacologic Hypothyroidism | 891 | ||
| Antithyroid drugs. | 891 | ||
| Amiodarone, lithium, interferon-α, interleukin-2, antineoplastic drugs. | 891 | ||
| Diagnosis | 891 | ||
| Treatment | 891 | ||
| Thyroiditis | 891 | ||
| Hashimoto Thyroiditis | 891 | ||
| Acute Suppurative Thyroiditis | 891 | ||
| Subacute Thyroiditis | 891 | ||
| Riedel Struma | 891 | ||
| Hyperthyroidism | 892 | ||
| Hyperthyroid Disorders | 892 | ||
| Graves disease. | 892 | ||
| Toxic nodular goiter and toxic adenoma. | 892 | ||
| Diagnosis. | 892 | ||
| Treatment. | 892 | ||
| Nonfunctioning Goiter | 893 | ||
| Multinodular Goiter | 893 | ||
| Substernal Goiter | 893 | ||
| Evaluation of a Thyroid Nodule | 894 | ||
| Incidence | 894 | ||
| Initial Evaluation | 894 | ||
| Laboratory Evaluation | 895 | ||
| Thyroid Imaging | 895 | ||
| Ultrasound | 895 | ||
| Radioisotope Scanning | 897 | ||
| Computed Tomography and Magnetic Resonance Imaging | 897 | ||
| Fine-Needle Aspiration Biopsy | 897 | ||
| Decision Making and Treatment | 899 | ||
| Thyroid Malignancies | 900 | ||
| Thyroid Oncogenesis | 900 | ||
| Genetic Alterations | 900 | ||
| Ionizing Radiation | 902 | ||
| Papillary Thyroid Carcinoma | 902 | ||
| Pathologic Classification | 902 | ||
| Clinical Features | 903 | ||
| Follicular Thyroid Carcinoma | 904 | ||
| Pathologic Classification | 904 | ||
| Clinical Features | 905 | ||
| Treatment of Differentiated Thyroid Carcinoma (Papillary and Follicular) | 906 | ||
| Extent of Thyroid Resection | 906 | ||
| Lymph Node Dissection | 907 | ||
| Completion Thyroidectomy | 908 | ||
| Radioactive Iodine Therapy | 908 | ||
| Thyroid-Stimulating Hormone Suppression | 908 | ||
| Medullary Thyroid Carcinoma | 909 | ||
| Clinical Features | 909 | ||
| Treatment | 909 | ||
| Poorly Differentiated Thyroid Carcinoma | 910 | ||
| Anaplastic Thyroid Carcinoma | 910 | ||
| Pathology | 910 | ||
| Treatment | 910 | ||
| Thyroid Lymphoma | 910 | ||
| Workup and Diagnosis | 911 | ||
| Treatment | 911 | ||
| Thyroid Disease in Pregnancy | 911 | ||
| Physiologic Changes of the Thyroid Gland During Pregnancy | 912 | ||
| Hypothyroidism in Pregnancy | 912 | ||
| Hyperthyroidism in Pregnancy | 912 | ||
| Thyroid Nodules and Thyroid Carcinoma in Pregnancy | 912 | ||
| Surgical Approaches to the Thyroid | 912 | ||
| Standard Cervical Thyroidectomy | 912 | ||
| Lateral Neck Dissection | 917 | ||
| Substernal Goiter | 918 | ||
| Intraoperative Neuromonitoring | 918 | ||
| Postoperative Care | 919 | ||
| Alternative Approaches to Thyroid Surgery | 919 | ||
| Complications of Thyroid Surgery | 920 | ||
| Hypocalcemia and Hypoparathyroidism | 920 | ||
| Nerve Injury | 920 | ||
| Superior Laryngeal Nerve | 920 | ||
| Recurrent Laryngeal Nerve | 920 | ||
| Bleeding | 920 | ||
| Selected References | 920 | ||
| References | 921 | ||
| 37 The Parathyroid Glands | 923 | ||
| Outline | 923 | ||
| History | 923 | ||
| Anatomy | 923 | ||
| Embryology | 923 | ||
| Surgical Anatomy | 923 | ||
| Physiology of the Parathyroid Glands | 924 | ||
| Calcium Homeostasis | 924 | ||
| Calcium Regulation | 925 | ||
| Disorders of Parathyroid Metabolism | 925 | ||
| Hypoparathyroidism | 925 | ||
| Congenital Hypoparathyroidism | 925 | ||
| Pseudohypoparathyroidism | 925 | ||
| Hyperparathyroidism | 925 | ||
| Nonparathyroidal Hypercalcemia | 926 | ||
| Primary Hyperparathyroidism | 927 | ||
| Secondary and Tertiary Hyperparathyroidism | 927 | ||
| Hypercalcemic Crisis | 928 | ||
| Calciphylaxis | 928 | ||
| Diagnosis of Primary Hyperparathyroidism | 929 | ||
| Parathyroid Gland Localization | 929 | ||
| Noninvasive Preoperative Localization | 930 | ||
| Invasive Preoperative Localization | 931 | ||
| Negative Imaging | 931 | ||
| Parathyroidectomy—Surgical Options | 931 | ||
| Bilateral Neck Exploration | 931 | ||
| Minimally Invasive (Open) Parathyroidectomy | 932 | ||
| Endoscopic Parathyroidectomy | 932 | ||
| Video-Assisted Parathyroidectomy | 933 | ||
| Other Minimally Invasive Techniques | 934 | ||
| Ectopic Parathyroid Glands | 934 | ||
| Remedial Parathyroidectomy | 934 | ||
| Operative Adjuncts | 934 | ||
| Intraoperative PTH Assessment | 934 | ||
| Gamma Probe Localization | 935 | ||
| Recurrent Laryngeal Nerve Monitoring | 935 | ||
| Outcomes after Parathyroid Surgery | 935 | ||
| Cure Rates | 935 | ||
| Nerve Injury—Recurrent Laryngeal Nerve Injury, Bilateral Nerve Injury, Injury to External Branch of the Superior Laryngeal Nerve | 935 | ||
| Postoperative Hypocalcemia | 936 | ||
| Bleeding or Hematoma | 936 | ||
| Inherited Parathyroid Disease | 936 | ||
| Multiple Endocrine Neoplasia | 936 | ||
| Multiple Endocrine Neoplasia Type 1 | 936 | ||
| Multiple Endocrine Neoplasia Type 2A | 936 | ||
| Other Familial Hyperparathyroidism Disorders | 936 | ||
| Parathyroid Carcinoma | 937 | ||
| Medical Alternatives | 937 | ||
| Controversies in Parathyroid Surgery | 938 | ||
| Unilateral versus Bilateral Neck Exploration | 938 | ||
| Does Asymptomatic Primary Hyperparathyroidism Really Exist? | 938 | ||
| Selected References | 938 | ||
| References | 939 | ||
| 38 Endocrine Pancreas | 941 | ||
| Outline | 941 | ||
| Histomorphology of Islets | 941 | ||
| Embryology of the Endocrine Pancreas | 942 | ||
| Endocrine Physiology | 942 | ||
| Glucose Homeostasis: Insulin and Glucagon | 942 | ||
| Insulin | 942 | ||
| Glucagon | 942 | ||
| Other Influences on Glucose Homeostasis | 943 | ||
| Somatostatin | 944 | ||
| Pancreatic Polypeptide | 944 | ||
| Other Peptide Hormones | 944 | ||
| Pancreatic Neuroendocrine Tumors | 944 | ||
| Overview and History | 944 | ||
| Histopathology and Staging | 944 | ||
| Molecular Genetics of Islet Cell Tumors | 945 | ||
| General Principles of Diagnosis and Treatment of Pancreatic Neuroendocrine Tumors | 947 | ||
| Diagnosis and Evaluation | 947 | ||
| Screening for Functional Tumors | 947 | ||
| Localization | 947 | ||
| Treatment | 950 | ||
| Nonmetastatic disease localized preoperatively. | 950 | ||
| Nonmetastatic disease not localized preoperatively. | 950 | ||
| Metastatic disease. | 950 | ||
| Incidentally found, small pancreatic neuroendocrine tumors. | 951 | ||
| Diagnosis and Treatment of Specific Functional Pancreatic Neuroendocrine Tumors | 952 | ||
| Insulin-Secreting Pancreatic Neuroendocrine Tumor (Insulinoma) | 952 | ||
| Diagnosis. | 952 | ||
| Localization and treatment. | 952 | ||
| Gastrin-Secreting Pancreatic Neuroendocrine Tumor (Gastrinoma) | 954 | ||
| Diagnosis. | 954 | ||
| Localization and treatment. | 955 | ||
| Vasoactive Intestinal Peptide–Secreting Pancreatic Neuroendocrine Tumor | 956 | ||
| Diagnosis and treatment. | 956 | ||
| Glucagon-Secreting Pancreatic Neuroendocrine Tumor (Glucagonoma) | 957 | ||
| Somatostatin-Secreting Pancreatic Neuroendocrine Tumor (Somatostatinoma) | 957 | ||
| Other Functional Pancreatic Endocrine Tumors | 958 | ||
| Pancreatic Neuroendocrine Tumor Associated With Multiple Endocrine Neoplasia Type 1 | 958 | ||
| Noninsulinoma Pancreatogenous Hypoglycemia Syndrome | 959 | ||
| Endocrine Complications of Surgical Therapy | 959 | ||
| Post–Gastric Bypass Noninsulinoma Pancreatogenous Hypoglycemia Syndrome | 959 | ||
| Endocrine Insufficiency After Surgical Resection | 959 | ||
| Surgical Treatment of Diabetes | 959 | ||
| Autologous Islet Cell Transplantation | 959 | ||
| Immune Therapy, Pancreatic Transplantation, and Islet Allotransplantation | 960 | ||
| Selected References | 960 | ||
| References | 961 | ||
| 39 The Adrenal Glands | 963 | ||
| Outline | 963 | ||
| History | 963 | ||
| Anatomy and Embryology | 963 | ||
| General and Developmental Aspects | 963 | ||
| Relationships | 963 | ||
| Vasculature | 964 | ||
| Normal Histopathology | 964 | ||
| Biochemistry and Physiology | 965 | ||
| Adrenal Steroid Biosynthesis | 965 | ||
| Steroid Hormone Physiology and Metabolism | 966 | ||
| Glucocorticoids | 967 | ||
| Mineralocorticoids | 968 | ||
| Adrenal Sex Steroids | 968 | ||
| Catecholamine Biosynthesis and Physiology | 968 | ||
| Catecholamine Clearance | 970 | ||
| Adrenal Insufficiency | 971 | ||
| Types of Adrenal Insufficiency | 971 | ||
| Primary Adrenal Insufficiency (Addison Disease) | 971 | ||
| Secondary Adrenal Insufficiency | 971 | ||
| Adrenal Insufficiency in the Critically Ill | 971 | ||
| Adrenal Crisis | 971 | ||
| Diagnosis and Treatment | 972 | ||
| Diagnosis | 972 | ||
| Treatment | 972 | ||
| Perioperative Steroid Administration | 972 | ||
| Diseases of the Adrenal Cortex | 972 | ||
| Primary Hyperaldosteronism | 972 | ||
| Epidemiology and Clinical Features | 972 | ||
| Diagnosis and Localization | 973 | ||
| Biochemical diagnosis. | 973 | ||
| Localization. | 975 | ||
| Surgical Management and Outcomes | 975 | ||
| Cushing Syndrome | 976 | ||
| Epidemiology and Clinical Features | 976 | ||
| Biochemical Diagnosis and Localization | 977 | ||
| Surgical Management and Outcomes | 979 | ||
| Special Case: Subclinical Cushing Syndrome | 979 | ||
| Sex Steroid Excess | 979 | ||
| Adrenocortical Carcinoma | 979 | ||
| Diseases of the Adrenal Medulla | 980 | ||
| Pheochromocytoma | 980 | ||
| Epidemiology and Clinical Features | 980 | ||
| Biochemical Diagnosis and Localization | 980 | ||
| Perioperative Care | 983 | ||
| Surgical Management and Outcomes | 984 | ||
| Molecular Genetics of Pheochromocytoma | 984 | ||
| Malignant Pheochromocytoma | 985 | ||
| Other Adrenal Diseases | 985 | ||
| Incidentally Discovered Adrenal Mass (Incidentaloma) | 985 | ||
| Epidemiology and Differential Diagnosis | 985 | ||
| Clinical Evaluation and Surgical Management | 986 | ||
| Metastases to the Adrenal Gland | 986 | ||
| Epidemiology and Clinical Features | 986 | ||
| Clinical Evaluation and Surgical Management | 987 | ||
| Technical Aspects of Adrenalectomy | 987 | ||
| Choice of Operative Approach | 987 | ||
| Laparoscopic Lateral Transabdominal Adrenalectomy | 988 | ||
| Patient Preparation and Positioning | 988 | ||
| Technique | 988 | ||
| Left adrenal. | 988 | ||
| Right adrenal. | 989 | ||
| Posterior Retroperitoneoscopic Adrenalectomy | 990 | ||
| Complications and Postoperative Care | 991 | ||
| Open Anterior Transabdominal Adrenalectomy | 991 | ||
| Patient Preparation and Positioning | 991 | ||
| Technique | 991 | ||
| Left adrenal. | 991 | ||
| Right adrenal. | 992 | ||
| Complications and Postoperative Care | 992 | ||
| Selected References | 993 | ||
| References | 994 | ||
| 40 The Multiple Endocrine Neoplasia Syndromes | 996 | ||
| Outline | 996 | ||
| Videos | 996.e1 | ||
| Multiple Endocrine Neoplasia Type 1 | 996 | ||
| Genetic Studies and Pathogenesis | 996 | ||
| Clinical Features and Management | 998 | ||
| Parathyroid Glands | 998 | ||
| Enteropancreatic Neuroendocrine Tumors | 1000 | ||
| Pituitary Gland | 1002 | ||
| Other Tumors | 1003 | ||
| Multiple Endocrine Neoplasia Type 2 Syndromes | 1003 | ||
| General | 1003 | ||
| RET Proto-Oncogene | 1004 | ||
| MEN2A and FMTC | 1004 | ||
| MEN2B | 1006 | ||
| RET Mutations in Sporadic Thyroid Carcinomas | 1006 | ||
| Screening and Genetic Testing for MEN2 | 1007 | ||
| Medullary Thyroid Carcinoma | 1007 | ||
| Surgery for Established Medullary Thyroid Carcinoma in MEN2 and FMTC | 1008 | ||
| Preventive Surgery | 1008 | ||
| Follow-Up | 1008 | ||
| Management of Recurrent and Metastatic Disease | 1009 | ||
| Pheochromocytoma | 1009 | ||
| Primary Hyperparathyroidism | 1009 | ||
| Conclusions | 1010 | ||
| Selected References | 1010 | ||
| References | 1010 | ||
| IX Esophagus | 1013 | ||
| 41 Esophagus | 1014 | ||
| Outline | 1014 | ||
| Diagnosis and Management of Esophageal Motility Disorders | 1014 | ||
| Diagnosis | 1014 | ||
| Motility Disorders of the Esophageal Body | 1015 | ||
| Diffuse Esophageal Spasm | 1015 | ||
| Nutcracker Esophagus | 1016 | ||
| Motility Disorders of the Lower Esophageal Sphincter | 1016 | ||
| Hypertensive Lower Esophageal Sphincter | 1016 | ||
| Motility Disorders Affecting Both Body and Lower Esophageal Sphincter | 1016 | ||
| Achalasia | 1016 | ||
| Ineffective Esophageal Motility | 1019 | ||
| Diverticular Disorders | 1019 | ||
| Pharyngoesophageal (Zenker) Diverticulum | 1019 | ||
| Midesophageal Diverticula | 1020 | ||
| Epiphrenic Diverticula | 1021 | ||
| Gastroesophageal Reflux Disease | 1021 | ||
| Medical Management | 1022 | ||
| Workup | 1022 | ||
| Surgical Therapy | 1023 | ||
| Complicated GERD | 1023 | ||
| Acquired Benign Disorders of the Esophagus | 1025 | ||
| Acquired Esophageal Disease | 1025 | ||
| Perforation | 1025 | ||
| Caustic Ingestion | 1026 | ||
| Foreign Body Ingestion, Benign Tracheoesophageal Fistula, and Schatzki Ring | 1026 | ||
| Esophageal Neoplasms and Diagnostic Approaches to Esophageal Cancer | 1027 | ||
| Epidemiology | 1027 | ||
| Diagnosis and Staging | 1028 | ||
| Benign Tumors of the Esophagus | 1032 | ||
| Other Malignant Tumors of the Esophagus | 1032 | ||
| Approach to Early-Stage Esophageal Cancer | 1033 | ||
| High-Grade Dysplasia and Superficial Cancers | 1033 | ||
| Therapeutics | 1033 | ||
| Ablation. | 1033 | ||
| Cryotherapy. | 1034 | ||
| Endoscopic mucosal resection. | 1034 | ||
| Esophagectomy. | 1035 | ||
| Locally Advanced Esophageal Cancer | 1036 | ||
| The Evolution and Principles of Multimodality Therapy for Locally Advanced Esophageal Carcinoma | 1036 | ||
| Treatment Modalities Used in Locally Advanced Esophageal Cancer | 1036 | ||
| Radiation therapy. | 1036 | ||
| Chemotherapy. | 1037 | ||
| Chemoradiation alone. | 1037 | ||
| Chemoradiation and surgery. | 1038 | ||
| The Role of Surgery in Trimodality Therapy and Salvage Surgery | 1039 | ||
| Surveillance | 1039 | ||
| Palliative Options for Esophageal Carcinoma | 1039 | ||
| Summary | 1040 | ||
| Selected References | 1040 | ||
| References | 1040 | ||
| 42 Gastroesophageal Reflux Disease and Hiatal Hernia | 1043 | ||
| Outline | 1043 | ||
| Gastroesophageal Reflux Disease | 1043 | ||
| Pathophysiology | 1043 | ||
| Clinical Presentation | 1045 | ||
| Typical Symptoms of GERD | 1045 | ||
| Extraesophageal Symptoms of GERD | 1045 | ||
| Pulmonary Disease, GERD, and Antireflux Surgery | 1046 | ||
| Physical Examination | 1046 | ||
| Preoperative Diagnostic Testing | 1046 | ||
| Ambulatory pH and Impedance Monitoring | 1046 | ||
| Esophageal Manometry | 1047 | ||
| Esophagogastroduodenoscopy | 1048 | ||
| Barium Esophagram | 1048 | ||
| Additional Preoperative Considerations | 1049 | ||
| Dysphagia | 1049 | ||
| Obesity | 1049 | ||
| Partial versus Complete Fundoplication | 1050 | ||
| Barrett Esophagus | 1050 | ||
| Treatment of Gastroesophageal Reflux Disease | 1050 | ||
| Medical Management | 1050 | ||
| Surgical Management | 1051 | ||
| Operative technique. | 1051 | ||
| Creation of a 360-degree fundoplication. | 1052 | ||
| Creation of a partial fundoplication. | 1053 | ||
| Intraoperative management of short esophagus. | 1053 | ||
| Postoperative Care and Recovery | 1054 | ||
| Clinical Outcomes of Antireflux Surgery | 1054 | ||
| Operative Complications and Side Effects of Antireflux Surgery | 1055 | ||
| Operative Complications | 1056 | ||
| Pneumothorax. | 1056 | ||
| Gastric and esophageal injuries. | 1056 | ||
| Splenic and liver injuries or bleeding. | 1056 | ||
| Side Effects | 1056 | ||
| Bloating. | 1056 | ||
| Dysphagia. | 1056 | ||
| Failed Antireflux Surgery | 1057 | ||
| Novel Therapies for GERD | 1057 | ||
| EsophyX | 1057 | ||
| LINX | 1058 | ||
| Paraesophageal Hernia | 1059 | ||
| Pathophysiology | 1059 | ||
| Clinical Presentation | 1059 | ||
| Preoperative Evaluation | 1059 | ||
| Operative Repair | 1059 | ||
| Acute Gastric Volvulus and Strangulation | 1061 | ||
| Summary | 1061 | ||
| Selected References | 1062 | ||
| References | 1062 | ||
| X Abdomen | 1065 | ||
| 43 Abdominal Wall, Umbilicus, Peritoneum, Mesenteries, Omentum, and Retroperitoneum | 1066 | ||
| Outline | 1066 | ||
| Abdominal Wall and Umbilicus | 1066 | ||
| Embryology | 1066 | ||
| Anatomy | 1066 | ||
| Subcutaneous Tissues | 1066 | ||
| Muscle and Investing Fasciae | 1066 | ||
| Preperitoneal Space and Peritoneum | 1068 | ||
| Vessels and Nerves of the Abdominal Wall | 1068 | ||
| Vascular Supply | 1068 | ||
| Innervation | 1069 | ||
| Abnormalities of the Abdominal Wall | 1071 | ||
| Congenital Abnormalities | 1071 | ||
| Umbilical hernias. | 1071 | ||
| Omphalocele. | 1071 | ||
| Gastroschisis. | 1071 | ||
| Infantile umbilical hernia. | 1071 | ||
| Acquired umbilical hernia. | 1071 | ||
| Abnormalities resulting from persistence of the omphalomesenteric duct. | 1071 | ||
| Abnormalities resulting from persistence of the allantois. | 1072 | ||
| Acquired Abnormalities | 1072 | ||
| Diastasis recti. | 1072 | ||
| Anterior abdominal wall hernias. | 1072 | ||
| Rectus sheath hematoma. | 1072 | ||
| Malignant Neoplasms of the Abdominal Wall | 1072 | ||
| Desmoid Tumor | 1072 | ||
| Abdominal Wall Sarcoma | 1074 | ||
| Metastatic Disease | 1074 | ||
| Symptoms of Intra-abdominal Disease Referred to the Abdominal Wall | 1074 | ||
| Peritoneum and Peritoneal Cavity | 1075 | ||
| Anatomy | 1075 | ||
| Physiology | 1075 | ||
| Peritoneal Disorders | 1076 | ||
| Ascites | 1076 | ||
| Pathophysiology and cause. | 1076 | ||
| Clinical presentation and diagnosis. | 1077 | ||
| Ascitic fluid analysis. | 1077 | ||
| Treatment of ascites in cirrhotic patients. | 1077 | ||
| Chylous ascites. | 1078 | ||
| Peritonitis | 1078 | ||
| Spontaneous bacterial peritonitis. | 1078 | ||
| Tuberculous peritonitis. | 1079 | ||
| Peritonitis associated with chronic ambulatory peritoneal dialysis. | 1079 | ||
| Malignant Neoplasms of the Peritoneum | 1080 | ||
| Pseudomyxoma peritonei. | 1080 | ||
| Malignant peritoneal mesothelioma. | 1080 | ||
| Mesentery and Omentum | 1081 | ||
| Embryology and Anatomy | 1081 | ||
| Physiology | 1081 | ||
| Diseases of the Omentum | 1081 | ||
| Omental Cysts | 1081 | ||
| Omental Torsion and Infarction | 1082 | ||
| Omental Neoplasms | 1082 | ||
| Omental Grafts and Transpositions | 1082 | ||
| Diseases of the Mesentery | 1082 | ||
| Mesenteric Cysts | 1082 | ||
| Acute Mesenteric Lymphadenitis | 1082 | ||
| Sclerosing Mesenteritis | 1083 | ||
| Intra-abdominal (Internal) Hernias | 1083 | ||
| Internal Hernias Caused by Developmental Defects | 1083 | ||
| Mesocolic (paraduodenal) hernias. | 1083 | ||
| Mesenteric hernias. | 1084 | ||
| Acquired Internal Hernias | 1084 | ||
| Malignant Neoplasms of the Mesentery | 1085 | ||
| Mesenteric and Intra-abdominal Desmoid Tumors | 1085 | ||
| Retroperitoneum | 1085 | ||
| Anatomy | 1085 | ||
| Operative Approaches | 1085 | ||
| Retroperitoneal Disorders | 1086 | ||
| Retroperitoneal Abscesses | 1086 | ||
| Retroperitoneal Hematomas | 1086 | ||
| Retroperitoneal Fibrosis | 1087 | ||
| Retroperitoneal Malignant Neoplasms | 1087 | ||
| Retroperitoneal sarcoma. | 1088 | ||
| Selected References | 1089 | ||
| References | 1090 | ||
| 44 Hernias | 1092 | ||
| Outline | 1092 | ||
| Inguinal Hernias | 1092 | ||
| Incidence | 1092 | ||
| Anatomy of the Groin | 1093 | ||
| External Oblique Muscle and Aponeurosis | 1094 | ||
| Internal Oblique Muscle and Aponeurosis | 1094 | ||
| Transversus Abdominis Muscle and Aponeurosis and Transversalis Fascia | 1094 | ||
| Pectineal (Cooper) Ligament | 1095 | ||
| Inguinal Canal | 1095 | ||
| Preperitoneal Space | 1096 | ||
| Femoral Canal | 1097 | ||
| Diagnosis | 1097 | ||
| Classification | 1097 | ||
| Treatment | 1097 | ||
| Nonoperative Management | 1097 | ||
| Operative Repair | 1098 | ||
| Anterior repairs. | 1098 | ||
| Tissue repairs. | 1098 | ||
| Tension-free anterior inguinal hernia repair. | 1100 | ||
| Preperitoneal repair. | 1101 | ||
| Laparoscopic repair. | 1101 | ||
| Results of Hernia Repair | 1103 | ||
| Femoral Hernias | 1104 | ||
| Special Problems | 1104 | ||
| Sliding Hernia | 1104 | ||
| Recurrent Hernia | 1104 | ||
| Strangulated Hernia | 1104 | ||
| Bilateral Hernias | 1104 | ||
| Complications | 1105 | ||
| Surgical Site Infection | 1105 | ||
| Nerve Injuries and Chronic Pain Syndromes | 1105 | ||
| Ischemic Orchitis and Testicular Atrophy | 1106 | ||
| Injury to the Vas Deferens and Viscera | 1106 | ||
| Hernia Recurrence | 1106 | ||
| Quality of Life | 1106 | ||
| Ventral Hernias | 1106 | ||
| Incidence | 1106 | ||
| Anatomy | 1107 | ||
| Diagnosis | 1107 | ||
| Classification | 1107 | ||
| Umbilical Hernia | 1107 | ||
| Epigastric Hernia | 1108 | ||
| Incisional Hernia | 1109 | ||
| Treatment: Operative Repair | 1109 | ||
| Prosthetic Materials for Ventral Hernia Repair | 1110 | ||
| Synthetic materials. | 1110 | ||
| Biologic materials. | 1110 | ||
| Operative Technique | 1110 | ||
| Ventral hernias. | 1110 | ||
| Intraperitoneal mesh placement. | 1111 | ||
| Myofascial releases. | 1112 | ||
| Posterior rectus sheath incision with retromuscular mesh placement. | 1112 | ||
| Posterior component separation. | 1112 | ||
| Anterior component separation. | 1112 | ||
| Endoscopic component separation. | 1112 | ||
| Results of Incisional Hernia Repairs | 1112 | ||
| Unusual Hernias | 1113 | ||
| Types | 1113 | ||
| Spigelian Hernia | 1113 | ||
| Obturator Hernia | 1113 | ||
| Lumbar Hernia | 1115 | ||
| Interparietal Hernia | 1115 | ||
| Sciatic Hernia | 1115 | ||
| Perineal Hernia | 1115 | ||
| Loss of Domain Hernias | 1115 | ||
| Parastomal Hernia Repair | 1115 | ||
| Complications | 1116 | ||
| Mesh Infection | 1116 | ||
| Seromas | 1116 | ||
| Enterotomy | 1116 | ||
| Selected References | 1116 | ||
| References | 1117 | ||
| 45 Acute Abdomen | 1120 | ||
| Outline | 1120 | ||
| Anatomy and Physiology | 1120 | ||
| History | 1121 | ||
| Physical Examination | 1124 | ||
| Laboratory Studies | 1126 | ||
| Imaging Studies | 1126 | ||
| Intra-Abdominal Pressure Monitoring | 1129 | ||
| Diagnostic Laparoscopy | 1130 | ||
| Differential Diagnosis | 1130 | ||
| Preparation for Emergency Operation | 1130 | ||
| Atypical Patients | 1131 | ||
| Pregnancy | 1131 | ||
| Pediatrics | 1132 | ||
| Acute Abdomen in the Critically Ill | 1133 | ||
| Immunocompromised Patients With Acute Abdomen | 1133 | ||
| Acute Abdomen in the Morbidly Obese | 1133 | ||
| Algorithms in the Acute Abdomen | 1134 | ||
| Summary | 1135 | ||
| Common Pitfalls | 1135 | ||
| Selected References | 1135 | ||
| References | 1137 | ||
| 46 Acute Gastrointestinal Hemorrhage | 1139 | ||
| Outline | 1139 | ||
| Management of Patients With Acute Gastrointestinal Hemorrhage | 1139 | ||
| Initial Assessment | 1140 | ||
| Resuscitation | 1140 | ||
| History and Physical Examination | 1140 | ||
| Localization | 1141 | ||
| Risk Stratification | 1142 | ||
| Acute Upper Gastrointestinal Hemorrhage | 1142 | ||
| Specific Causes of Upper Gastrointestinal Hemorrhage | 1143 | ||
| Nonvariceal Bleeding | 1143 | ||
| Peptic ulcer disease. | 1143 | ||
| Management. | 1143 | ||
| Medical management. | 1144 | ||
| Endoscopic management. | 1144 | ||
| Surgical management. | 1144 | ||
| Duodenal ulcer. | 1145 | ||
| Gastric ulcer. | 1145 | ||
| Mallory-Weiss tears. | 1145 | ||
| Stress gastritis. | 1145 | ||
| Esophagitis. | 1146 | ||
| Dieulafoy lesion. | 1146 | ||
| Gastric antral vascular ectasia. | 1146 | ||
| Malignancy. | 1147 | ||
| Aortoenteric fistula. | 1147 | ||
| Hemobilia. | 1148 | ||
| Hemosuccus pancreaticus. | 1148 | ||
| Iatrogenic bleeding. | 1148 | ||
| Bleeding Related to Portal Hypertension | 1148 | ||
| Management. | 1149 | ||
| Medical management. | 1149 | ||
| Endoscopic management. | 1149 | ||
| Other management. | 1150 | ||
| Prevention of rebleeding. | 1150 | ||
| Acute Lower Gastrointestinal Hemorrhage | 1151 | ||
| Diagnosis | 1151 | ||
| Colonoscopy | 1151 | ||
| Radionuclide Scanning | 1152 | ||
| Computed Tomography Angiography | 1152 | ||
| Mesenteric Angiography | 1153 | ||
| Treatment | 1153 | ||
| Specific Causes of Lower Gastrointestinal Tract Bleeding | 1153 | ||
| Colonic Bleeding | 1153 | ||
| Diverticular disease. | 1153 | ||
| Angiodysplasia. | 1153 | ||
| Neoplasia. | 1154 | ||
| Anorectal disease. | 1154 | ||
| Colitis. | 1154 | ||
| Mesenteric ischemia. | 1155 | ||
| Acute Gastrointestinal Hemorrhage from an Obscure Source | 1155 | ||
| Diagnosis | 1155 | ||
| Repeated Endoscopy | 1155 | ||
| Conventional Imaging | 1156 | ||
| Small Bowel Endoscopy | 1156 | ||
| Video Capsule Endoscopy | 1156 | ||
| Intraoperative Endoscopy | 1156 | ||
| Treatment | 1156 | ||
| Specific Causes of Small Bowel Bleeding | 1157 | ||
| Angiodysplasias | 1157 | ||
| Neoplasia | 1157 | ||
| Crohn’s Disease | 1157 | ||
| Meckel’s Diverticulum | 1157 | ||
| Diverticula | 1157 | ||
| Selected References | 1157 | ||
| References | 1157 | ||
| 47 Morbid Obesity | 1160 | ||
| Outline | 1160 | ||
| Videos | 1160.e1 | ||
| Obesity: the Magnitude of the Problem | 1160 | ||
| Pathophysiology and Associated Medical Problems | 1161 | ||
| Medical versus Surgical Therapy | 1161 | ||
| Mechanism of Action of Bariatric Surgery | 1164 | ||
| Preoperative Evaluation and Selection | 1165 | ||
| Eligibility | 1165 | ||
| General Bariatric Preoperative Evaluation and Preparation | 1166 | ||
| Evaluation of Specific Comorbid Conditions | 1167 | ||
| Special Equipment | 1168 | ||
| Clinic | 1168 | ||
| Operating Room | 1168 | ||
| Operative Procedures | 1168 | ||
| Vertical Banded Gastroplasty | 1168 | ||
| Laparoscopic Adjustable Gastric Banding | 1168 | ||
| Roux-en-Y Gastric Bypass | 1169 | ||
| Biliopancreatic Diversion | 1171 | ||
| Duodenal Switch | 1172 | ||
| Laparoscopic Sleeve Gastrectomy | 1173 | ||
| Postoperative Care and Follow-Up | 1174 | ||
| Results | 1177 | ||
| Laparoscopic Adjustable Gastric Banding | 1177 | ||
| Roux-en-Y Gastric Bypass | 1178 | ||
| Biliopancreatic Diversion and Duodenal Switch | 1178 | ||
| Laparoscopic Sleeve Gastrectomy | 1179 | ||
| Complications | 1179 | ||
| Laparoscopic Adjustable Gastric Banding | 1179 | ||
| Roux-en-Y Gastric Bypass | 1181 | ||
| Laparoscopic Sleeve Gastrectomy | 1182 | ||
| Biliopancreatic Diversion | 1182 | ||
| Reoperative Surgery | 1182 | ||
| Controversies in Bariatric Surgery | 1183 | ||
| Investigational Bariatric Procedures | 1183 | ||
| Conclusion | 1184 | ||
| Selected References | 1184 | ||
| References | 1186 | ||
| 48 Stomach | 1188 | ||
| Outline | 1188 | ||
| Anatomy | 1188 | ||
| Gross Anatomy | 1188 | ||
| Divisions | 1188 | ||
| Blood Supply | 1188 | ||
| Lymphatic Drainage | 1188 | ||
| Innervation | 1189 | ||
| Gastric Morphology | 1190 | ||
| Gastric Microscopic Anatomy | 1190 | ||
| Physiology | 1191 | ||
| Regulation of Gastric Function | 1191 | ||
| Gastric Peptides | 1191 | ||
| Gastrin | 1191 | ||
| Somatostatin | 1192 | ||
| Gastrin-Releasing Peptide | 1192 | ||
| Histamine | 1192 | ||
| Ghrelin | 1192 | ||
| Gastric Acid Secretion | 1192 | ||
| Stimulated Acid Secretion | 1193 | ||
| Cephalic phase. | 1193 | ||
| Gastric phase. | 1193 | ||
| Intestinal phase. | 1193 | ||
| Activation and Secretion by the Parietal Cell | 1193 | ||
| Pharmacologic Regulation | 1194 | ||
| Other Gastric Secretory Products | 1195 | ||
| Gastric juice. | 1195 | ||
| Intrinsic factor. | 1195 | ||
| Pepsinogen. | 1195 | ||
| Mucus and bicarbonate. | 1195 | ||
| Gastric Motility | 1195 | ||
| Fasting Gastric Motility | 1195 | ||
| Postprandial Gastric Motility | 1196 | ||
| Abnormal Gastric Motility | 1196 | ||
| Gastric-Emptying Studies | 1196 | ||
| Treatment | 1196 | ||
| Gastric Barrier Function | 1197 | ||
| Peptic Ulcer Disease | 1197 | ||
| Epidemiology | 1197 | ||
| Pathogenesis | 1197 | ||
| Helicobacter pylori Infection | 1197 | ||
| Nonsteroidal Anti-Inflammatory Drugs | 1198 | ||
| Acid | 1199 | ||
| Duodenal Ulcer | 1199 | ||
| Clinical Manifestations | 1199 | ||
| Abdominal pain. | 1199 | ||
| Diagnosis | 1199 | ||
| Upper gastrointestinal radiography. | 1199 | ||
| Flexible upper endoscopy. | 1199 | ||
| Helicobacter pylori testing. | 1200 | ||
| Invasive Tests | 1200 | ||
| Urease assay. | 1200 | ||
| Histology. | 1200 | ||
| Culture. | 1200 | ||
| Noninvasive Tests | 1200 | ||
| Serology. | 1200 | ||
| Urea breath test. | 1200 | ||
| Stool antigen. | 1200 | ||
| Treatment | 1200 | ||
| Medical management. | 1200 | ||
| Antacids. | 1200 | ||
| Sucralfate. | 1200 | ||
| H2 receptor antagonists. | 1201 | ||
| Proton pump inhibitors. | 1201 | ||
| Treatment of helicobacter pylori infection. | 1201 | ||
| Complicated Ulcer Disease | 1201 | ||
| Hemorrhage. | 1202 | ||
| Perforation. | 1204 | ||
| Gastric outlet obstruction. | 1205 | ||
| Intractable peptic ulcer disease. | 1205 | ||
| Surgical procedures for peptic ulcers. | 1205 | ||
| Truncal vagotomy. | 1205 | ||
| Selective vagotomy. | 1205 | ||
| Highly selective vagotomy (parietal cell vagotomy). | 1206 | ||
| Truncal vagotomy and antrectomy. | 1206 | ||
| Gastric Ulcers | 1207 | ||
| Clinical Manifestations | 1207 | ||
| Diagnosis and Treatment | 1208 | ||
| Type I gastric ulcers. | 1208 | ||
| Type II and type III gastric ulcers. | 1208 | ||
| Type IV gastric ulcers. | 1208 | ||
| Bleeding gastric ulcers. | 1208 | ||
| Perforated gastric ulcer. | 1209 | ||
| Giant gastric ulcers. | 1210 | ||
| Zollinger-ellison syndrome. | 1210 | ||
| Stress Gastritis | 1211 | ||
| Pathophysiology | 1211 | ||
| Presentation and Diagnosis | 1211 | ||
| Prophylaxis | 1211 | ||
| Treatment | 1211 | ||
| Postgastrectomy Syndromes | 1212 | ||
| Dumping Syndrome | 1212 | ||
| Metabolic Disturbances | 1212 | ||
| Afferent Loop Syndrome | 1213 | ||
| Efferent Loop Obstruction | 1213 | ||
| Alkaline Reflux Gastritis | 1213 | ||
| Gastric Atony | 1213 | ||
| Gastric Cancer | 1213 | ||
| Epidemiology and Risk Factors | 1213 | ||
| Incidence | 1213 | ||
| Risk Factors | 1214 | ||
| Helicobacter pylori Infection | 1214 | ||
| Dietary Factors | 1214 | ||
| Hereditary Risk Factors and Cancer Genetics | 1215 | ||
| Other Risk Factors | 1215 | ||
| Polyps. | 1215 | ||
| Proton pump inhibitors. | 1215 | ||
| Pathology | 1216 | ||
| Diagnosis and Workup | 1216 | ||
| Signs and Symptoms | 1216 | ||
| Staging | 1217 | ||
| Staging Workup | 1218 | ||
| Endoscopy and endoscopic ultrasound. | 1218 | ||
| Computed tomography. | 1221 | ||
| Positron emission tomography. | 1221 | ||
| Laparoscopy. | 1221 | ||
| Treatment | 1221 | ||
| Surgical Therapy | 1221 | ||
| Endoscopic Resection | 1222 | ||
| Clinical Decision Making | 1224 | ||
| Lymph node dissection. | 1224 | ||
| Adjuvant and Neoadjuvant Therapy | 1225 | ||
| Palliative Therapy and Systemic Therapy | 1226 | ||
| Complicated Gastric Cancer | 1226 | ||
| Locally advanced gastric cancer. | 1226 | ||
| Complications | 1227 | ||
| Outcomes | 1227 | ||
| Recurrence | 1227 | ||
| Surveillance. | 1227 | ||
| Gastric Lymphoma | 1227 | ||
| Epidemiology | 1227 | ||
| Pathology | 1227 | ||
| Evaluation | 1228 | ||
| Staging | 1228 | ||
| Treatment | 1228 | ||
| Mucosa-Associated Lymphoid Tissue Lymphomas | 1229 | ||
| Treatment | 1229 | ||
| Gastrointestinal Stromal Tumors | 1229 | ||
| Adjuvant Therapy | 1230 | ||
| Other Neoplasms | 1230 | ||
| Gastric Carcinoid | 1230 | ||
| Heterotopic Pancreas | 1231 | ||
| Other Gastric Lesions | 1231 | ||
| Hypertrophic Gastritis (Ménétrier Disease) | 1231 | ||
| Mallory-Weiss Tear | 1231 | ||
| Dieulafoy Gastric Lesion | 1231 | ||
| Gastric Varices | 1232 | ||
| Gastric Volvulus | 1232 | ||
| Bezoars | 1233 | ||
| Selected References | 1233 | ||
| References | 1234 | ||
| 49 Small Intestine | 1237 | ||
| Outline | 1237 | ||
| Embryology | 1237 | ||
| Anatomy | 1238 | ||
| Gross Anatomy | 1238 | ||
| Neurovascular-Lymphatic Supply | 1238 | ||
| Microscopic Anatomy | 1239 | ||
| Physiology | 1240 | ||
| Digestion and Absorption | 1240 | ||
| Carbohydrates | 1241 | ||
| Protein | 1242 | ||
| Fats | 1242 | ||
| Emulsification. | 1242 | ||
| Micelle formation. | 1243 | ||
| Intracellular processing. | 1243 | ||
| Enterohepatic circulation. | 1243 | ||
| Water, Electrolytes, and Vitamins | 1243 | ||
| Motility | 1244 | ||
| Endocrine Function | 1244 | ||
| Gastrointestinal Hormones | 1244 | ||
| Receptors | 1245 | ||
| Immune Function | 1245 | ||
| Obstruction | 1247 | ||
| Causes | 1247 | ||
| Pathophysiology | 1248 | ||
| Clinical Manifestations and Diagnosis | 1249 | ||
| History | 1249 | ||
| Physical Examination | 1249 | ||
| Radiologic and Laboratory Studies | 1249 | ||
| Simple Versus Strangulating Obstruction | 1252 | ||
| Treatment | 1252 | ||
| Fluid Resuscitation and Antibiotics | 1252 | ||
| Tube Decompression | 1252 | ||
| Operative Management | 1252 | ||
| Management of Specific Problems | 1253 | ||
| Recurrent Intestinal Obstruction | 1253 | ||
| Acute Postoperative Obstruction | 1254 | ||
| Ileus | 1254 | ||
| Inflammatory and Infectious Diseases | 1254 | ||
| Crohn’s Disease | 1254 | ||
| History | 1255 | ||
| Incidence and Epidemiology | 1255 | ||
| Causes | 1255 | ||
| Infectious agents. | 1255 | ||
| Immunologic factors. | 1255 | ||
| Genetic factors. | 1255 | ||
| Pathology | 1256 | ||
| Gross pathologic features. | 1256 | ||
| Microscopic features. | 1256 | ||
| Clinical Manifestations | 1257 | ||
| Diagnosis | 1257 | ||
| Management | 1260 | ||
| Medical therapy. | 1260 | ||
| Aminosalicylates. | 1261 | ||
| Corticosteroids. | 1261 | ||
| Antibiotics. | 1261 | ||
| Immunosuppressive agents. | 1261 | ||
| Anticytokine and cytokine therapies. | 1261 | ||
| Novel therapies. | 1262 | ||
| Nutritional therapy. | 1262 | ||
| Smoking cessation. | 1262 | ||
| Surgical treatment. | 1262 | ||
| Specific Problems | 1263 | ||
| Acute ileitis (nonstricturing, nonpenetrating). | 1263 | ||
| Stricturing disease. | 1263 | ||
| Penetrating disease. | 1264 | ||
| Perforation. | 1265 | ||
| Gastrointestinal bleeding. | 1265 | ||
| Urologic complications. | 1265 | ||
| Cancer. | 1265 | ||
| Colorectal disease. | 1265 | ||
| Perianal disease. | 1265 | ||
| Duodenal disease. | 1265 | ||
| Prognosis | 1265 | ||
| Typhoid Enteritis | 1266 | ||
| Enteritis in the Immunocompromised Host | 1267 | ||
| Protozoa | 1267 | ||
| Bacteria | 1267 | ||
| Mycobacteria | 1267 | ||
| Viruses | 1268 | ||
| Fungi | 1268 | ||
| Neoplasms | 1268 | ||
| General Considerations | 1268 | ||
| Clinical Manifestations | 1269 | ||
| Diagnosis | 1269 | ||
| Benign Neoplasms | 1270 | ||
| Stromal Tumors | 1270 | ||
| Adenomas. | 1270 | ||
| Lipomas. | 1271 | ||
| Peutz-Jeghers syndrome. | 1271 | ||
| Hemangiomas. | 1271 | ||
| Malignant Neoplasms | 1271 | ||
| Neuroendocrine Tumors | 1272 | ||
| Pathology. | 1272 | ||
| Clinical manifestations. | 1272 | ||
| Malignant carcinoid syndrome. | 1272 | ||
| Diagnosis. | 1273 | ||
| Treatment | 1275 | ||
| Surgical therapy. | 1275 | ||
| Medical therapy. | 1275 | ||
| Prognosis. | 1276 | ||
| Adenocarcinomas | 1276 | ||
| Lymphoma | 1278 | ||
| Gastrointestinal Stromal Tumors | 1278 | ||
| Metastatic Neoplasms | 1280 | ||
| Diverticular Disease | 1280 | ||
| Duodenal Diverticula | 1281 | ||
| Incidence and Cause | 1281 | ||
| Clinical Manifestations | 1281 | ||
| Treatment | 1282 | ||
| Jejunal and Ileal Diverticula | 1282 | ||
| Incidence and Cause | 1282 | ||
| Clinical Manifestations | 1282 | ||
| Treatment | 1283 | ||
| Meckel’s Diverticulum | 1284 | ||
| Incidence and Cause | 1284 | ||
| Clinical Manifestations | 1284 | ||
| Diagnostic Studies | 1285 | ||
| Treatment | 1285 | ||
| Miscellaneous Problems | 1286 | ||
| Small Bowel Ulcerations | 1286 | ||
| Ingested Foreign Bodies | 1286 | ||
| Small Bowel Fistulas | 1286 | ||
| Clinical Manifestations | 1287 | ||
| Treatment | 1287 | ||
| Stabilization. | 1287 | ||
| Staging and supportive care. | 1288 | ||
| Definitive management. | 1288 | ||
| Pneumatosis Intestinalis | 1289 | ||
| Blind Loop Syndrome | 1290 | ||
| Radiation Enteritis | 1290 | ||
| Short Bowel Syndrome | 1291 | ||
| Treatment | 1291 | ||
| Vascular Compression of the Duodenum | 1292 | ||
| Selected References | 1293 | ||
| References | 1293 | ||
| 50 The Appendix | 1296 | ||
| Outline | 1296 | ||
| Videos | 1296.e1 | ||
| Anatomy and Embryology | 1296 | ||
| Appendicitis | 1296 | ||
| History | 1296 | ||
| Pathophysiology and Bacteriology | 1297 | ||
| Differential Diagnosis | 1297 | ||
| Presentation | 1297 | ||
| History | 1297 | ||
| Physical Examination | 1298 | ||
| Laboratory Studies | 1299 | ||
| Imaging Studies | 1299 | ||
| Treatment of Appendicitis | 1300 | ||
| Acute Uncomplicated Appendicitis | 1300 | ||
| Perforated Appendicitis | 1302 | ||
| Laparoscopic versus Open Appendectomy | 1302 | ||
| Delayed Presentation of Appendicitis | 1303 | ||
| The Normal-Appearing Appendix at Operation | 1303 | ||
| Nonoperative Treatment of Uncomplicated Appendicitis | 1305 | ||
| “Chronic” Appendicitis as a Cause of Abdominal Pain | 1305 | ||
| Incidental Appendectomy | 1305 | ||
| Appendicitis in Special Populations | 1306 | ||
| Appendicitis in the Pregnant Patient | 1306 | ||
| Appendicitis in the Elderly | 1307 | ||
| Appendicitis in the Immunocompromised Patient | 1308 | ||
| Neoplasms of the Appendix | 1308 | ||
| Selected References | 1308 | ||
| References | 1310 | ||
| 51 Colon and Rectum | 1312 | ||
| Outline | 1312 | ||
| Embryology of the Colon and Rectum | 1312 | ||
| Anatomy of the Colon, Rectum, and Pelvic Floor | 1312 | ||
| Pararectal Fascia | 1314 | ||
| Pelvic Floor | 1314 | ||
| Arterial Supply and Venous and Lymphatic Drainage | 1314 | ||
| Nerves | 1318 | ||
| Physiology of the Colon | 1319 | ||
| Recycling of Nutrients | 1319 | ||
| Colonic Flora | 1319 | ||
| Prebiotics and Probiotics | 1320 | ||
| Fermentation | 1321 | ||
| Short-Chain Fatty Acids | 1323 | ||
| Urea Recycling | 1323 | ||
| Absorption | 1323 | ||
| Secretion | 1323 | ||
| Motility | 1324 | ||
| Formation of Stool | 1324 | ||
| Defecation | 1324 | ||
| Preoperative Workup and Stoma Planning | 1324 | ||
| Nutritional Assessment | 1325 | ||
| Preoperative Bowel Preparation | 1325 | ||
| Planning Intestinal Stomas | 1326 | ||
| Stoma Types | 1326 | ||
| Physiologic Considerations and Practical Implications | 1327 | ||
| Colostomy | 1327 | ||
| Ileostomy | 1327 | ||
| Technical Considerations | 1327 | ||
| End Descending Colostomy | 1327 | ||
| Loop Colostomy | 1328 | ||
| Ileostomy | 1328 | ||
| Postoperative Management Protocols | 1329 | ||
| Diverticular Disease | 1330 | ||
| Background | 1330 | ||
| Pathophysiology | 1330 | ||
| Evaluation | 1331 | ||
| Management | 1332 | ||
| Uncomplicated Diverticulitis | 1332 | ||
| Complicated Diverticulitis | 1333 | ||
| Abscess. | 1333 | ||
| Fistula. | 1333 | ||
| Obstruction. | 1333 | ||
| Special Considerations | 1334 | ||
| The Immunocompromised Patient | 1334 | ||
| Right-Sided Diverticulitis | 1334 | ||
| Diverticulitis in Young Patients | 1334 | ||
| Colonic Volvulus | 1334 | ||
| Large Bowel Obstruction and Pseudo-Obstruction | 1336 | ||
| Inflammatory Bowel Disease | 1339 | ||
| Ulcerative Colitis | 1339 | ||
| Epidemiology and Cause | 1339 | ||
| Pathologic Features | 1340 | ||
| Gross appearance. | 1340 | ||
| Histologic appearance. | 1340 | ||
| Clinical Presentation | 1341 | ||
| Extraintestinal Manifestations | 1341 | ||
| Diagnosis | 1341 | ||
| Risk for Carcinoma | 1342 | ||
| Treatment | 1343 | ||
| Medical therapy. | 1343 | ||
| Aminosalicylates. | 1343 | ||
| Corticosteroids. | 1343 | ||
| Immunomodulators | 1343 | ||
| Thiopurines. | 1343 | ||
| Methotrexate. | 1343 | ||
| Tacrolimus. | 1344 | ||
| Cyclosporine. | 1344 | ||
| Biologics. | 1344 | ||
| Indications for surgery. | 1344 | ||
| Fulminant colitis and toxic megacolon. | 1344 | ||
| Massive bleeding. | 1345 | ||
| Intractability. | 1345 | ||
| Dysplasia or carcinoma. | 1345 | ||
| Surgical procedures. | 1345 | ||
| Total proctocolectomy with end ileostomy. | 1345 | ||
| Total proctocolectomy with continent ileostomy. | 1346 | ||
| Total proctocolectomy with ileal pouch–anal anastomosis. | 1346 | ||
| Summary of elective operations. | 1348 | ||
| Postoperative care. | 1348 | ||
| Laparoscopic Approaches for Ulcerative Colitis | 1349 | ||
| Crohn’s Colitis | 1349 | ||
| Epidemiology and Cause | 1349 | ||
| Pathologic Features | 1350 | ||
| Gross appearance. | 1350 | ||
| Histologic appearance. | 1350 | ||
| Clinical Presentation | 1350 | ||
| Diagnosis | 1350 | ||
| Treatment | 1351 | ||
| Medical therapy. | 1351 | ||
| Indications for surgery. | 1351 | ||
| Intractability. | 1351 | ||
| Intestinal obstruction. | 1351 | ||
| Intra-abdominal abscess. | 1351 | ||
| Fistulas. | 1352 | ||
| Fulminant colitis and toxic megacolon. | 1352 | ||
| Massive bleeding. | 1352 | ||
| Cancer. | 1352 | ||
| Extracolonic manifestations. | 1352 | ||
| Growth retardation. | 1352 | ||
| Surgical procedures. | 1352 | ||
| Ileocecal resection. | 1353 | ||
| Total proctocolectomy with end ileostomy. | 1353 | ||
| Total abdominal colectomy with ileorectal anastomosis. | 1353 | ||
| Segmental colon resection. | 1353 | ||
| Postoperative recurrence. | 1353 | ||
| Minimally Invasive Approaches to Surgical Management of Crohn’s Disease | 1353 | ||
| Infectious Colitis | 1353 | ||
| Clostridium difficile Infection | 1353 | ||
| Other Colonic Infections | 1355 | ||
| Ischemic Colitis | 1356 | ||
| Anatomy | 1356 | ||
| Causes | 1356 | ||
| Classification | 1357 | ||
| Presentation and Diagnosis | 1357 | ||
| Treatment | 1358 | ||
| Neoplasia | 1359 | ||
| Colorectal Cancer Genetics | 1359 | ||
| Specific Genes and Mutations | 1360 | ||
| Tumor Suppressor Genes | 1360 | ||
| MYH Mutations and MYH-Associated Polyposis | 1361 | ||
| Mismatch Repair Genes | 1362 | ||
| Oncogenes | 1363 | ||
| Adenoma-Carcinoma Sequence | 1363 | ||
| Colorectal Polyps | 1363 | ||
| Hereditary Cancer Syndromes (Table 51-4) | 1366 | ||
| Familial Adenomatous Polyposis | 1366 | ||
| Lynch Syndrome | 1370 | ||
| Peutz-Jeghers Syndrome | 1372 | ||
| Juvenile Polyposis Syndrome | 1372 | ||
| Sporadic Colon Cancer | 1372 | ||
| Staging | 1372 | ||
| Rules for Classification | 1373 | ||
| Clinical staging. | 1373 | ||
| Pathologic staging. | 1373 | ||
| Tumor regression grade. | 1375 | ||
| Obstructing Colon Cancers | 1375 | ||
| Treatment and Follow-up | 1376 | ||
| Rectal Cancer | 1377 | ||
| Local Excision | 1378 | ||
| Transanal Endoscopic Microsurgery | 1379 | ||
| Fulguration | 1379 | ||
| Abdominal Perineal Resection | 1379 | ||
| Low Anterior Resection | 1379 | ||
| Sphincter-Sparing Abdominal Perineal Resection With Coloanal Anastomosis | 1380 | ||
| Pelvic Floor Disorders and Constipation | 1381 | ||
| Diagnosis: Testing and Evaluation | 1381 | ||
| Anorectal Physiology Laboratory Testing | 1381 | ||
| Defecography | 1382 | ||
| Rectal Prolapse (Procidentia) | 1382 | ||
| Causes and Symptoms | 1382 | ||
| Anatomy and Pathophysiology | 1382 | ||
| Differential Diagnosis and Investigation | 1382 | ||
| Operative Repair | 1383 | ||
| Abdominal approaches | 1383 | ||
| Ripstein repair and anterior mesh repairs. | 1383 | ||
| Resection rectopexy. | 1384 | ||
| Perineal approaches | 1384 | ||
| Perineal proctosigmoidectomy and the Altemeier procedure. | 1384 | ||
| Anal encirclement. | 1387 | ||
| Internal Prolapse and Solitary Rectal Ulcer Syndrome | 1387 | ||
| Rectocele | 1388 | ||
| Constipation | 1389 | ||
| Transit Studies | 1390 | ||
| Slow-transit constipation: colonic inertia. | 1390 | ||
| Slow-transit constipation: colonic inertia with megacolon. | 1390 | ||
| Selected References | 1391 | ||
| References | 1391 | ||
| 52 Anus | 1394 | ||
| Outline | 1394 | ||
| Disorders of the Anal Canal | 1394 | ||
| Anatomy | 1394 | ||
| Physiology | 1394 | ||
| Diagnostic Evaluation of the Anus | 1394 | ||
| History | 1395 | ||
| Physical Examination | 1395 | ||
| Pelvic Floor Disorders | 1395 | ||
| Incontinence | 1395 | ||
| Clinical Evaluation | 1396 | ||
| Treatment | 1396 | ||
| Medical management. | 1396 | ||
| Surgical repair. | 1396 | ||
| Prolapse of the Rectum | 1397 | ||
| Pathogenesis and Clinical Presentation | 1397 | ||
| Preoperative Evaluation | 1397 | ||
| Surgical Correction | 1397 | ||
| Perineal procedures. | 1397 | ||
| Abdominal procedures. | 1398 | ||
| Incontinence and Biofeedback | 1399 | ||
| Rectocele | 1399 | ||
| Clinical Evaluation | 1399 | ||
| XI Chest | 1572 | ||
| 57 Lung, Chest Wall, Pleura, and Mediastinum | 1573 | ||
| Outline | 1573 | ||
| Videos | 1573.e1 | ||
| Anatomy | 1573 | ||
| Selection of Patients for Thoracic Operations | 1576 | ||
| Physiologic Evaluation | 1577 | ||
| Cardiopulmonary Exercise Testing | 1578 | ||
| Thoracic Incisions | 1579 | ||
| Lung | 1579 | ||
| Congenital Lesions of the Lung | 1579 | ||
| Congenital Cystic Lesions | 1580 | ||
| Congenital Bronchopulmonary Malformations | 1581 | ||
| Congenital Abnormalities of the Trachea and Bronchi | 1581 | ||
| Congenital Vascular Disorders | 1581 | ||
| Lung Cancer | 1582 | ||
| Pathology | 1583 | ||
| Screening | 1583 | ||
| Diagnosis | 1584 | ||
| Staging | 1584 | ||
| Evaluation of Tumor (T) Stage | 1585 | ||
| Evaluation of Nodal (N) Stage | 1585 | ||
| Current American Joint Committee on Cancer Seventh Edition Staging System | 1586 | ||
| Tumor (T) | 1587 | ||
| Lymph Nodes (N) | 1588 | ||
| Metastases (M) | 1588 | ||
| Results of Treatment of Lung Cancer | 1588 | ||
| Local Therapy for Early-Stage Non–Small Cell Lung Cancer | 1590 | ||
| Neoadjuvant and Adjuvant Therapy | 1591 | ||
| Treatment of Metastatic Disease | 1591 | ||
| Trachea | 1592 | ||
| Tracheal Trauma | 1592 | ||
| Pulmonary Infections | 1595 | ||
| Bronchiectasis | 1595 | ||
| Lung Abscess | 1595 | ||
| Other Bronchopulmonary Disorders | 1595 | ||
| Mycobacterial Infections | 1595 | ||
| Fungal and Parasitic Infections | 1596 | ||
| Massive Hemoptysis | 1598 | ||
| Emphysema and Diffuse Lung Disease | 1598 | ||
| Emphysema | 1598 | ||
| Diffuse Lung Disease | 1598 | ||
| Adult Respiratory Distress Syndrome | 1599 | ||
| Pulmonary Metastases | 1599 | ||
| Surgical Treatment | 1600 | ||
| Miscellaneous Lung Tumors | 1600 | ||
| Chest Wall | 1601 | ||
| Pectus Excavatum | 1601 | ||
| Chest Wall Tumors | 1601 | ||
| Bone Tumors | 1601 | ||
| Soft Tissue Tumors | 1602 | ||
| Metastatic Tumors | 1603 | ||
| Reconstruction | 1603 | ||
| Chest Wall Infections | 1603 | ||
| Chest Wall Trauma | 1603 | ||
| Thoracic Outlet Syndrome | 1603 | ||
| Diagnosis | 1603 | ||
| Management | 1604 | ||
| Pleura | 1604 | ||
| Pleural Effusions | 1604 | ||
| Benign Pleural Effusions | 1605 | ||
| Malignant Pleural Effusion | 1605 | ||
| Empyema | 1605 | ||
| Chylothorax | 1606 | ||
| Pneumothorax | 1607 | ||
| Mesothelioma | 1607 | ||
| Mediastinum | 1607 | ||
| Anterosuperior Compartment | 1608 | ||
| Middle Compartment | 1609 | ||
| Posterior or Paravertebral Sulci Compartment | 1609 | ||
| Clinical Manifestations and Diagnosis | 1609 | ||
| Evaluation and Diagnostic Imaging | 1609 | ||
| Histologic Diagnosis | 1609 | ||
| Primary Mediastinal Cysts | 1610 | ||
| Primary Mediastinal Neoplasms | 1610 | ||
| Thymoma | 1610 | ||
| Germ Cell Tumors | 1611 | ||
| Teratomas | 1611 | ||
| Malignant Nonteratomatous Germ Cell Tumors | 1611 | ||
| Seminomas | 1611 | ||
| Nonseminomatous Tumors | 1611 | ||
| Neurogenic Tumors | 1612 | ||
| Neuroblastoma | 1612 | ||
| Ganglion Tumors | 1612 | ||
| Paraganglioma (Pheochromocytoma) | 1612 | ||
| Lymphomas | 1613 | ||
| Endocrine Tumors | 1613 | ||
| Thyroid Tumors | 1613 | ||
| Parathyroid Tumors | 1613 | ||
| Neuroendocrine Tumors | 1613 | ||
| Selected References | 1613 | ||
| References | 1614 | ||
| 58 Congenital Heart Disease | 1619 | ||
| Outline | 1619 | ||
| History and Other Considerations | 1619 | ||
| Pathways for Practicing Congenital Heart Surgery | 1619 | ||
| Anatomy, Terminology, and Diagnosis | 1620 | ||
| Anatomy and Terminology | 1620 | ||
| Diagnosis | 1621 | ||
| Physical Examination | 1621 | ||
| Diagnostic Tests | 1622 | ||
| Pulse oximetry. | 1622 | ||
| Plain radiography. | 1622 | ||
| Electrocardiography. | 1622 | ||
| Echocardiography. | 1622 | ||
| Magnetic resonance imaging and computed tomography. | 1622 | ||
| Cardiac catheterization. | 1623 | ||
| Perioperative Care | 1624 | ||
| Anesthesia Pitfalls | 1624 | ||
| Neurologic Outcomes | 1625 | ||
| Lesion Overview | 1625 | ||
| Defects Associated With Increased Pulmonary Blood Flow | 1625 | ||
| Persistent Arterial Duct (Patent Ductus Arteriosus) | 1625 | ||
| Aortopulmonary Septal Defect (Aortopulmonary Window) | 1626 | ||
| Atrial Septal Defect | 1626 | ||
| Ventricular Septal Defect | 1627 | ||
| Perimembranous Ventricular Septal Defect | 1628 | ||
| Muscular Ventricular Septal Defect | 1628 | ||
| Subarterial (Supracristal or Outlet) Ventricular Septal Defect | 1628 | ||
| Atrioventricular Septal Defect (Atrioventricular Canal Defect) | 1629 | ||
| Adult Patients With Atrioventricular Septal Defect | 1630 | ||
| Persistent Arterial Trunk (Truncus Arteriosus) | 1630 | ||
| Abnormalities of Venous Drainage | 1632 | ||
| Total Anomalous Pulmonary Venous Return | 1632 | ||
| Obstructed total anomalous pulmonary venous return. | 1632 | ||
| Cor triatriatum. | 1632 | ||
| Anomalous Systemic Venous Drainage | 1633 | ||
| Cyanotic Congenital Heart Disease | 1634 | ||
| Tetralogy of Fallot | 1634 | ||
| Pulmonary Atresia and Intact Ventricular Septum | 1636 | ||
| Pulmonary Atresia With Ventricular Septal Defect | 1637 | ||
| Valvular Pulmonic Stenosis | 1637 | ||
| Conotruncal Anomalies | 1637 | ||
| Transposition of the Great Arteries | 1637 | ||
| Transposition of the great arteries–intact ventricular septum. | 1638 | ||
| Transposition of the great arteries–ventricular septal defect with or without arch hypoplasia. | 1638 | ||
| Transposition of the great arteries–ventricular septal defect with pulmonary stenosis–left ventricular outflow tract obstruction or pulmonary atresia. | 1639 | ||
| Transposition of the great arteries in adults. | 1639 | ||
| Double-Outlet Right Ventricle | 1640 | ||
| Congenitally Corrected Transposition of the Great Arteries (l-Transposition) | 1640 | ||
| Congenitally corrected transposition of the great arteries with intact ventricular septum. | 1640 | ||
| Congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonic stenosis. | 1640 | ||
| Left Ventricular Outflow Tract Obstruction | 1640 | ||
| Valvular Aortic Stenosis | 1641 | ||
| Fibromuscular Subaortic Stenosis | 1643 | ||
| Tunnel Subaortic Stenosis | 1643 | ||
| Aortic Arch Anomalies | 1643 | ||
| Aortic Coarctation | 1643 | ||
| Interrupted Aortic Arch | 1644 | ||
| Single Ventricle | 1645 | ||
| Tricuspid Atresia | 1645 | ||
| Hypoplastic Left Heart Syndrome | 1647 | ||
| Neonatal Cardiac Transplantation | 1647 | ||
| Norwood Reconstruction | 1648 | ||
| Sano Modification of the Norwood Operation | 1648 | ||
| Hybrid Procedure | 1649 | ||
| Fontan Operation | 1649 | ||
| Miscellaneous Anomalies | 1650 | ||
| Vascular Rings and Pulmonary Artery Slings | 1650 | ||
| Vascular Rings | 1650 | ||
| Pulmonary Artery Slings | 1651 | ||
| Diagnosis and Indications for Intervention | 1651 | ||
| Surgery | 1652 | ||
| Coronary Artery Anomalies | 1652 | ||
| Anomalous Left Coronary Artery Rising From the Pulmonary Artery | 1652 | ||
| Anatomy and pathophysiology. | 1652 | ||
| Diagnosis and indications for intervention. | 1652 | ||
| XII Vascular | 1721 | ||
| 61 The Aorta | 1722 | ||
| Outline | 1722 | ||
| Video | 1722.e1 | ||
| Aneurysmal Disease | 1722 | ||
| Risk of Rupture | 1723 | ||
| Diagnosis | 1723 | ||
| Screening and Surveillance Recommendations | 1724 | ||
| Medical Therapy | 1724 | ||
| Surgical Treatment | 1725 | ||
| Preoperative Evaluation | 1725 | ||
| Technique of Open Surgical Repair of Abdominal Aortic Aneurysms | 1727 | ||
| Management of the Ruptured Aneurysm | 1731 | ||
| Postoperative Management | 1731 | ||
| Endovascular Repair | 1733 | ||
| Thoracic Aortic Aneurysm | 1735 | ||
| Open Repair of Thoracic and Thoracoabdominal Aneurysms | 1735 | ||
| Endovascular Management of Thoracic Aneurysms | 1735 | ||
| Endovascular Repair of Aneurysms Involving the Visceral Segment: Snorkels, Fenestrations, and Branched Grafts | 1737 | ||
| Blunt Thoracic Aortic Injury | 1738 | ||
| Aortoiliac Occlusive Disease | 1738 | ||
| Presentation and Evaluation | 1739 | ||
| Technique of Open Reconstruction | 1740 | ||
| Aortofemoral Bypass Grafting | 1740 | ||
| Axillofemoral Bypass Grafting | 1741 | ||
| Femoral-Femoral Artery Bypass Grafting | 1741 | ||
| Iliofemoral Artery Bypass Grafting | 1741 | ||
| Aortoiliac Endarterectomy | 1741 | ||
| Complications of Open Aortic Surgery | 1741 | ||
| Surgical Treatment of Aortic Graft Infection | 1744 | ||
| Aortic Dissection | 1746 | ||
| References | 1750 | ||
| 62 Peripheral Arterial Disease | 1754 | ||
| Outline | 1754 | ||
| Epidemiology | 1754 | ||
| Basic Science of Vascular Disease | 1755 | ||
| Vascular Wall Microanatomy | 1755 | ||
| Atherosclerosis | 1755 | ||
| Evaluating and Treating the Patient with Peripheral Arterial Disease | 1756 | ||
| History and Physical Examination | 1756 | ||
| Chronic Arterial Insufficiency | 1756 | ||
| Physiologic Testing and Imaging | 1758 | ||
| Imaging Studies | 1760 | ||
| Angiography. | 1762 | ||
| Computed tomography angiography. | 1762 | ||
| Magnetic resonance angiography. | 1764 | ||
| Carbon dioxide angiography. | 1764 | ||
| Intravascular ultrasound. | 1764 | ||
| Treatment | 1764 | ||
| Medical Treatment | 1764 | ||
| Revascularization: Surgical Treatment | 1765 | ||
| Intermittent claudication. | 1765 | ||
| Critical limb ischemia. | 1767 | ||
| Diabetic foot. | 1767 | ||
| Lower Extremity Amputations | 1769 | ||
| Ray amputation. | 1770 | ||
| Transmetatarsal amputation. | 1770 | ||
| Below-knee amputation. | 1771 | ||
| Above-knee amputation. | 1771 | ||
| Surgical Revascularization Procedures | 1771 | ||
| Open Surgical Management | 1772 | ||
| Aortoiliac disease. | 1772 | ||
| Lower extremity occlusive disease. | 1774 | ||
| Femoropopliteal bypass. | 1775 | ||
| Infrapopliteal bypass. | 1775 | ||
| Complications. | 1775 | ||
| Endovascular Management | 1775 | ||
| Subintimal angioplasty. | 1775 | ||
| Balloon angioplasty. | 1776 | ||
| Stenting. | 1776 | ||
| Stent graft. | 1777 | ||
| Cutting balloon. | 1777 | ||
| Atherectomy. | 1777 | ||
| Acute Limb Ischemia | 1777 | ||
| Other Causes of Acute and Chronic Limb Ischemia | 1779 | ||
| Nonatherosclerotic Arteriopathies | 1779 | ||
| Raynaud Syndrome | 1779 | ||
| Buerger Disease | 1780 | ||
| Vasculitis | 1780 | ||
| Large-Vessel Vasculitis | 1780 | ||
| Giant cell arteritis (temporal arteritis). | 1780 | ||
| Takayasu disease. | 1780 | ||
| Medium-Vessel Vasculitis | 1780 | ||
| Polyarteritis nodosa. | 1780 | ||
| Kawasaki disease. | 1780 | ||
| Behçet disease. | 1781 | ||
| Cogan syndrome. | 1781 | ||
| Small-Vessel Vasculitis | 1781 | ||
| Antineutrophil cytoplasmic antibody–associated vasculitides. | 1781 | ||
| Vasculitis Associated With Connective Tissue Diseases | 1781 | ||
| Heritable Arteriopathies | 1781 | ||
| Cystic Medial Necrosis | 1781 | ||
| Pseudoxanthoma Elasticum | 1781 | ||
| Arteria Magna Syndrome | 1781 | ||
| Congenital Conditions Affecting the Arteries | 1781 | ||
| Persistent Sciatic Artery | 1781 | ||
| Popliteal Entrapment Syndromes | 1782 | ||
| Adventitial Cystic Disease | 1782 | ||
| Peripheral Artery Aneurysms | 1782 | ||
| Femoral and Popliteal Artery Aneurysms | 1782 | ||
| Evaluating the Success of Revascularization Procedures | 1782 | ||
| Renal Artery Disease | 1784 | ||
| Diagnosis | 1785 | ||
| Magnetic Resonance Angiography | 1785 | ||
| Treatment | 1785 | ||
| Open Renal Artery Bypass | 1785 | ||
| Renal Artery Stenting | 1785 | ||
| Value, limitations, and techniques. | 1785 | ||
| Renal Angioplasty and Stent Procedure | 1786 | ||
| Renal artery access and guide sheath positioning. | 1786 | ||
| Renal angioplasty. | 1787 | ||
| Stent placement. | 1787 | ||
| Completion angiography. | 1787 | ||
| Technical Tips | 1787 | ||
| Splanchnic Aneurysms: Splenic, Mesenteric, and Renal Artery Aneuryms | 1788 | ||
| Carotid Artery Disease | 1789 | ||
| Pathophysiology | 1789 | ||
| Clinical Presentation | 1789 | ||
| Diagnosis | 1790 | ||
| Treatment | 1790 | ||
| Carotid Endarterectomy | 1790 | ||
| Indications. | 1790 | ||
| Proven indications | 1792 | ||
| Acceptable but not proven indications | 1792 | ||
| Uncertain indications | 1792 | ||
| Proven inappropriate indications | 1792 | ||
| Technique. | 1792 | ||
| Postoperative care. | 1793 | ||
| Complications. | 1794 | ||
| Carotid Angioplasty and Stent Procedure | 1794 | ||
| Indications and contraindications. | 1795 | ||
| Technique | 1795 | ||
| Carotid artery access and guide sheath positioning. | 1795 | ||
| Placement of embolic protection device. | 1795 | ||
| Carotid stent placement. | 1795 | ||
| Carotid angioplasty. | 1795 | ||
| Completion angiogram. | 1795 | ||
| Conclusions. | 1796 | ||
| Dialysis Access | 1796 | ||
| Dialysis Outcomes Quality Initiative Guidelines | 1796 | ||
| Nomenclature | 1797 | ||
| Superficial Venous System of the Upper Extremity | 1797 | ||
| Cephalic Vein | 1797 | ||
| Basilic Vein | 1798 | ||
| Median Antebrachial Vein | 1798 | ||
| Initial Evaluation for New Access | 1798 | ||
| Central Venous Catheters | 1798 | ||
| Types of Venous Transpositions | 1799 | ||
| Upper Arm Venous Transposition | 1799 | ||
| Forearm Venous Transpositions | 1799 | ||
| Lower Extremity Venous Transpositions | 1799 | ||
| Techniques of Venous Transposition | 1800 | ||
| Assessment of the Patient and Selection of Optimal Site | 1800 | ||
| Superficial Venous Transposition of the Forearm | 1800 | ||
| Superficial Venous Transposition of the Arm | 1801 | ||
| Follow-Up | 1801 | ||
| Patients With Failing or Failed Access | 1801 | ||
| Secondary Interventions in Autogenous Fistulas | 1802 | ||
| Complex Access | 1803 | ||
| Vascular Access Complications | 1803 | ||
| Conclusion | 1804 | ||
| Selected References | 1804 | ||
| References | 1805 | ||
| 63 Vascular Trauma | 1808 | ||
| Outline | 1808 | ||
| Mechanism of Injury and Pathophysiology | 1808 | ||
| Clinical Presentation | 1809 | ||
| Diagnosis | 1809 | ||
| Physical Examination | 1809 | ||
| Minimal Vascular Injury and Nonoperative Management | 1811 | ||
| Endovascular Management | 1811 | ||
| Endovascular Operating Rooms | 1811 | ||
| Endovascular Management of Torso Vascular Injuries | 1811 | ||
| Endovascular Management of Cerebrovascular Vascular Injuries | 1812 | ||
| Endovascular Management of Extremity Vascular Injuries | 1812 | ||
| Who Should Perform Endovascular Repairs? | 1812 | ||
| Open Surgical Management | 1813 | ||
| Preparation for Operative Management | 1813 | ||
| Vascular Exposure and Control | 1814 | ||
| Vascular Damage Control | 1815 | ||
| Choice of Repair and Graft Material | 1815 | ||
| Intraoperative Imaging and Noninvasive Evaluation | 1816 | ||
| Role of Tissue Coverage | 1816 | ||
| Role of Fasciotomy | 1816 | ||
| Role of Immediate Amputation | 1816 | ||
| Common Errors and Pitfalls | 1816 | ||
| Specific Injuries | 1817 | ||
| Head, Neck, and Thoracic Outlet | 1817 | ||
| Intrathoracic Great Vessels | 1817 | ||
| Abdominal Vascular Injury | 1818 | ||
| Upper Extremity | 1820 | ||
| Lower Extremity | 1821 | ||
| Operative Techniques for Extremity Fasciotomy | 1821 | ||
| Postoperative Management | 1822 | ||
| Outcomes and Follow-up | 1822 | ||
| Training and Preparation for Successful Management | 1823 | ||
| General Surgery Training | 1823 | ||
| Vascular Fellowship Training | 1823 | ||
| Vascular Trauma Realities | 1823 | ||
| Need for Remedial Training and Review | 1824 | ||
| The Need for Action | 1824 | ||
| Selected References | 1824 | ||
| References | 1825 | ||
| 64 Venous Disease | 1827 | ||
| Outline | 1827 | ||
| Videos | 1827.e1 | ||
| Anatomy | 1827 | ||
| Superficial Venous System | 1827 | ||
| Deep Venous System | 1827 | ||
| Venous System Perforators | 1828 | ||
| Normal Venous Histology and Function | 1828 | ||
| Venous Insufficiency | 1830 | ||
| Primary Venous Insufficiency | 1830 | ||
| Pathology | 1830 | ||
| Mechanical abnormalities. | 1830 | ||
| Risk Factors | 1831 | ||
| Symptoms | 1831 | ||
| Physical Examination | 1831 | ||
| Diagnostic Evaluation of Venous Dysfunction | 1832 | ||
| Phlebography and venography. | 1833 | ||
| Magnetic resonance venous imaging. | 1833 | ||
| Classification Systems | 1833 | ||
| Treatment of Superficial Venous Insufficiency | 1833 | ||
| Nonoperative management. | 1833 | ||
| Treatment options for telangiectasias. | 1833 | ||
| Surgery for axial venous incompetence | 1836 | ||
| Vein stripping. | 1836 | ||
| Complications. | 1836 | ||
| Endovenous thermal ablation | 1837 | ||
| Percutaneous vein ablation. | 1837 | ||
| Technique. | 1838 | ||
| Ultrasound-guided sclerotherapy. | 1839 | ||
| Nontumescent ablation and future modalities for axial vein incompetence. | 1839 | ||
| Treatment of branch varicosities. | 1839 | ||
| Secondary Venous Insufficiency | 1840 | ||
| Treatment | 1840 | ||
| Surgery for deep venous insufficiency. | 1840 | ||
| Direct venous reconstruction. | 1841 | ||
| Deep Venous Thrombosis | 1841 | ||
| Lower Extremity Deep Venous Thrombosis | 1841 | ||
| Causes | 1841 | ||
| Stasis. | 1841 | ||
| Hypercoagulable state. | 1841 | ||
| Venous injury. | 1842 | ||
| Diagnostic Considerations | 1842 | ||
| Incidence. | 1842 | ||
| Clinical diagnosis. | 1842 | ||
| Imaging Studies and Laboratory Tests | 1842 | ||
| Venography. | 1842 | ||
| Impedance plethysmography. | 1843 | ||
| Fibrin and fibrinogen assays. | 1843 | ||
| Duplex ultrasound. | 1843 | ||
| Magnetic resonance venous imaging. | 1843 | ||
| Prophylaxis | 1843 | ||
| XIII Specialties In General Surgery | 1857 | ||
| 66 Pediatric Surgery | 1858 | ||
| Outline | 1858 | ||
| Newborn Physiology | 1858 | ||
| Cardiovascular | 1858 | ||
| Pulmonary | 1858 | ||
| Immunology | 1859 | ||
| Fluids, Electrolytes, and Nutrition | 1859 | ||
| Fluid and Electrolytes | 1859 | ||
| Nutrition | 1859 | ||
| Calorie Requirements | 1859 | ||
| Carbohydrate | 1860 | ||
| Protein | 1860 | ||
| Fat | 1860 | ||
| Total Parenteral Nutrition | 1860 | ||
| Head and Neck Lesions | 1860 | ||
| Dermoid and Epidermoid Cysts | 1860 | ||
| Lymphadenopathy | 1860 | ||
| Cystic Hygroma | 1860 | ||
| Thyroglossal Duct Cyst | 1861 | ||
| Branchial Cleft Remnants | 1861 | ||
| Torticollis | 1862 | ||
| Extracorporeal Life Support | 1862 | ||
| Indications | 1862 | ||
| Physiology | 1862 | ||
| Complications | 1863 | ||
| Congenital Diaphragmatic Hernia | 1863 | ||
| Pathogenesis | 1863 | ||
| Clinical Presentation and Diagnosis | 1863 | ||
| Treatment | 1864 | ||
| Surgical Repair | 1864 | ||
| Bronchopulmonary Malformations | 1865 | ||
| Bronchogenic Cyst | 1865 | ||
| Congenital Pulmonary Airway Malformation | 1865 | ||
| Pulmonary Sequestration | 1865 | ||
| Congenital Lobar Emphysema | 1866 | ||
| Alimentary Tract Conditions | 1866 | ||
| Esophageal Atresia and Tracheoesophageal Fistula | 1866 | ||
| Clinical Presentation and Diagnosis | 1866 | ||
| Management | 1867 | ||
| Gastroesophageal Reflux | 1868 | ||
| Clinical Presentation | 1868 | ||
| Diagnosis | 1868 | ||
| Treatment | 1869 | ||
| Hypertrophic Pyloric Stenosis | 1869 | ||
| Clinical Presentation | 1869 | ||
| Management | 1869 | ||
| Intestinal Atresia | 1870 | ||
| Intestinal Malrotation and Midgut Volvulus | 1871 | ||
| Abnormal Intestinal Rotation | 1871 | ||
| Clinical Presentation | 1871 | ||
| Diagnosis | 1872 | ||
| Surgical Management | 1872 | ||
| Necrotizing Enterocolitis | 1873 | ||
| Clinical Presentation and Diagnosis | 1873 | ||
| Medical Management | 1873 | ||
| Surgical Management | 1873 | ||
| Short Bowel Syndrome | 1874 | ||
| Surgical Management | 1874 | ||
| Bianchi procedure. | 1874 | ||
| Serial transverse enteroplasty. | 1875 | ||
| Meconium Ileus | 1875 | ||
| Clinical Presentation | 1875 | ||
| Simple Meconium Ileus | 1875 | ||
| Surgical management. | 1875 | ||
| Complicated Meconium Ileus | 1876 | ||
| Meconium Plug Syndrome | 1876 | ||
| Hirschsprung’s Disease | 1876 | ||
| Clinical Presentation | 1876 | ||
| Diagnosis | 1876 | ||
| Index | 2107 | ||
| A | 2107 | ||
| B | 2110 | ||
| C | 2113 | ||
| D | 2117 | ||
| E | 2118 | ||
| F | 2120 | ||
| G | 2121 | ||
| H | 2122 | ||
| I | 2124 | ||
| J | 2126 | ||
| K | 2126 | ||
| L | 2126 | ||
| M | 2128 | ||
| N | 2130 | ||
| O | 2131 | ||
| P | 2132 | ||
| Q | 2136 | ||
| R | 2136 | ||
| S | 2137 | ||
| T | 2141 | ||
| U | 2143 | ||
| V | 2144 | ||
| W | 2145 | ||
| X | 2146 | ||
| Y | 2146 | ||
| Z | 2146 | ||
| Inside Back Cover | ibc1 |