BOOK
Core Topics in General & Emergency Surgery E-Book
Simon Paterson-Brown | Hugh M. Paterson
(2018)
Additional Information
Book Details
Abstract
Core Topics in General and Emergency Surgery meets the needs of surgeons in higher training and practising consultants for a contemporary and evidence-based account of general surgery in both elective and emergency situations. It is a practical reference source incorporating the most current information on recent developments, management issues and operative procedures. The text is thoroughly referenced and supported by evidence-based recommendations wherever possible, distinguishing between strong evidence to support a conclusion, and evidence suggesting that a recommendation can be reached on the balance of probabilities.
For this Sixth Edition the authorship team across the series has been expanded to include additional European and World experts, with an increased emphasis on global practice. Throughout all six volumes the contents have been extensively revised in line with recently published evidence. Detailed supportive key references are provided and are also included within the comprehensive list of references in the accompanying ebook. Links to recommended online videos have been added where appropriate.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within the major sub-specialties of general surgery.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
The extensive revisions to this edition of Core Topics in General and Emergency Surgery are intended to maximize its appeal to all those in general surgical practice. There are several entirely new chapters on subjects previously covered in other volumes of the series, while the remaining chapters have been revised, updated or re-written by new authors where appropriate. The new chapters include those on the Evaluation of surgical literature; Enhanced recovery; Organ donation and general surgery in transplant patients; and Principles of neck surgery for the general surgeon. For the first time this volume includes a chapter on Patient safety and human factors in surgery, which distills the core knowledge that is fundamental to achieving good outcomes (and avoiding bad ones) in practice for all grades of surgeon.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Core Topics in General and Emergency Surgery | i | ||
| Copyright | ii | ||
| Contents | iii | ||
| Series Editors' preface | v | ||
| Editors' preface | vii | ||
| Evidence-based practice in surgery | ix | ||
| Contributors | xi | ||
| Chapter 1: Evaluation of surgical evidence | 1 | ||
| Introduction to surgical evidence | 1 | ||
| Changing the world with evidence | 2 | ||
| Formulating a clinical question | 2 | ||
| Study population or target condition | 2 | ||
| Intervention or exposure | 2 | ||
| Comparison | 3 | ||
| Outcome | 3 | ||
| Study designs | 4 | ||
| Systematic reviews and meta-analyses | 4 | ||
| Randomised controlled trials | 6 | ||
| Randomisation | 7 | ||
| Simple randomisation | 7 | ||
| Block randomisation | 8 | ||
| Blinding | 8 | ||
| Open-label studies | 9 | ||
| Cluster randomisation | 9 | ||
| Allocation concealment | 9 | ||
| Phases of trials | 9 | ||
| Phase 0 trials | 9 | ||
| Phase I trials | 10 | ||
| Phase II trials | 10 | ||
| Phase III trials | 10 | ||
| Post-marketing studies | 10 | ||
| IDEAL framework | 10 | ||
| Cohort studies | 10 | ||
| Case-control studies | 11 | ||
| Cross-sectional studies | 12 | ||
| Case series and case reports | 12 | ||
| Single-centre or multicentre research | 12 | ||
| Finding the evidence | 12 | ||
| Journals | 12 | ||
| Books | 12 | ||
| Conferences | 12 | ||
| Social media | 12 | ||
| Medical literature databases | 13 | ||
| MEDLINE | 13 | ||
| EMBASE | 13 | ||
| Clinical trials databases | 13 | ||
| Search clients | 13 | ||
| PubMed | 13 | ||
| OvidSP | 13 | ||
| Google Scholar | 13 | ||
| Evidence-based medicine organisations | 13 | ||
| The Cochrane Library | 13 | ||
| Specialist registers | 13 | ||
| Constructing a systematic search | 14 | ||
| Defining search terms using PICOS | 14 | ||
| Population | 14 | ||
| Intervention or exposure | 14 | ||
| Comparison | 14 | ||
| Outcomes | 14 | ||
| Study design | 14 | ||
| Combining terms | 14 | ||
| Boolean operators | 14 | ||
| Wildcards | 15 | ||
| Critical appraisal | 15 | ||
| Systematic approaches for critical appraisal | 15 | ||
| Bias | 16 | ||
| Types of bias | 16 | ||
| Selection bias | 16 | ||
| Responder bias | 17 | ||
| Reporting bias | 17 | ||
| Attrition bias | 19 | ||
| Performance bias | 19 | ||
| Recall bias | 20 | ||
| Observer bias | 20 | ||
| Publication bias | 20 | ||
| Judging the risk of bias | 20 | ||
| Simple statistics | 21 | ||
| Summarising data | 21 | ||
| Summarising ordinal or categorical data | 21 | ||
| Summarising continuous data | 21 | ||
| Measuring dispersion | 22 | ||
| Standard deviation (SD or σ) | 22 | ||
| Confidence interval (CI) | 22 | ||
| Interquartile range (IQR) | 22 | ||
| Range | 22 | ||
| Missing data | 22 | ||
| Treatment effect | 23 | ||
| Risk | 23 | ||
| Odds | 23 | ||
| The 2 x 2 table, risk ratios and odds ratios | 23 | ||
| Risk ratio versus odds ratio | 24 | ||
| Hypothesis testing | 24 | ||
| Association and causation | 24 | ||
| Statistical significance | 25 | ||
| Adjusting for confounding factors | 25 | ||
| Example studies | 25 | ||
| MRC-CLASICC | 25 | ||
| EVAR-1 | 25 | ||
| ProtecT | 25 | ||
| Appendix | 26 | ||
| Further reading | 26 | ||
| Books | 26 | ||
| Websites | 26 | ||
| Journals | 27 | ||
| Databases | 27 | ||
| Sources of guidelines and integrated care pathways | 27 | ||
| Chapter 2: Perioperative care and enhanced recovery | 28 | ||
| Introduction | 28 | ||
| Before the operation | 28 | ||
| Patient counselling | 28 | ||
| Preoperative nutrition and immunonutrition | 29 | ||
| Cessation of smoking | 29 | ||
| Prehabilitation | 29 | ||
| Antithromboembolic drugs in the perioperative period | 29 | ||
| Vitamin-K antagonists (VKA) | 30 | ||
| Direct oral anticoagulants (DOAC) | 30 | ||
| Anti-platelet drugs | 30 | ||
| Immediate preoperative period | 30 | ||
| Preoperative bowel preparation | 30 | ||
| Prevention of thromboembolic events | 31 | ||
| Preoperative fasting | 31 | ||
| Preoperative carbohydrate loading | 31 | ||
| Antibiotic prophylaxis | 32 | ||
| Intraoperative care | 32 | ||
| Preventing postoperative nausea and vomiting (PONV) | 32 | ||
| Postoperative analgesia | 32 | ||
| Thoracic epidural | 32 | ||
| Transverse abdominal plane blocks | 32 | ||
| Intravenous analgesia | 32 | ||
| Oral non-opioid analgesics | 33 | ||
| Access and incision | 33 | ||
| Perioperative fluid balance, blood pressure, oedema and diuresis | 33 | ||
| Intraoperative fluid balance | 33 | ||
| Postoperative fluid balance | 34 | ||
| Postoperative care | 34 | ||
| Nasogastric drainage | 34 | ||
| Glycaemic control | 34 | ||
| Abdominal drains | 35 | ||
| Stimulation of bowel movement | 35 | ||
| Postoperative artificial nutrition | 36 | ||
| Early and scheduled mobilisation | 36 | ||
| Key references | 37 | ||
| Chapter 3: Organisation of emergency general surgical services | 38 | ||
| Introduction | 38 | ||
| Separation of elective and emergency surgery | 39 | ||
| Subspecialisation in emergency general surgery | 40 | ||
| Process and facilities | 41 | ||
| Emergency general surgery 'Hot Clinics' | 43 | ||
| Summary | 43 | ||
| Key references | 44 | ||
| Chapter 4: Patient assessment and surgical risk | 45 | ||
| Introduction | 45 | ||
| Why assess surgical risk? | 45 | ||
| How can we assess surgical risk? | 45 | ||
| Estimation of surgical risk | 46 | ||
| Clinical assessment | 46 | ||
| Risk prediction models and scoring systems | 46 | ||
| POSSUM | 47 | ||
| CR-POSSUM (colorectal) | 48 | ||
| O-POSSUM (oesophagogastric) | 48 | ||
| V-POSSUM (vascular) | 48 | ||
| ASA | 49 | ||
| Surgical Mortality Probability Model and Surgical Risk Scale | 49 | ||
| Surgical Risk Calculator | 50 | ||
| Surgical Outcome Risk Tool | 50 | ||
| Surgical Risk Preoperative Assessment System (SURPAS) | 50 | ||
| Other risk prediction models | 51 | ||
| Functional assessment | 51 | ||
| Cardiopulmonary exercise testing (CPEX) | 52 | ||
| Other objective measures of exercise capacity | 53 | ||
| Frailty | 53 | ||
| Sarcopenia and body composition analysis | 54 | ||
| Biomarkers | 54 | ||
| Communicating risk | 55 | ||
| Key references | 56 | ||
| Chapter 5: Perioperative and intensive care management of the surgical patient | 58 | ||
| Introduction | 58 | ||
| How big is the problem? | 58 | ||
| Why do patients die after surgery? | 59 | ||
| What is a high-risk surgical patient? | 59 | ||
| Variables associated with postoperative complications and death | 59 | ||
| The role of the splanchnic circulation | 60 | ||
| Strategies to improve outcomes | 60 | ||
| Oxygen delivery | 60 | ||
| Measurement and monitoring of cardiac output | 61 | ||
| Fluid resuscitation | 61 | ||
| Delirium as a postoperative complication | 61 | ||
| Conclusions | 61 | ||
| Key references | 63 | ||
| Chapter 6: Surgical nutrition | 64 | ||
| Introduction | 64 | ||
| Metabolic response to feeding, trauma and sepsis | 64 | ||
| Trauma | 65 | ||
| Protein metabolism | 65 | ||
| Carbohydrate metabolism | 66 | ||
| Fat metabolism | 67 | ||
| Mineral and micronutrient metabolism | 67 | ||
| Sepsis | 67 | ||
| Nutritional requirements | 67 | ||
| Proteins and amino acids | 67 | ||
| Energy requirements | 68 | ||
| Minerals and micronutrients | 68 | ||
| Identification of patients who are malnourished | 69 | ||
| Anthropometric measures | 69 | ||
| Height and weight | 69 | ||
| Body composition | 69 | ||
| Subcutaneous fat thickness | 69 | ||
| Bioelectrical impedance | 69 | ||
| Biochemical measures | 69 | ||
| Serum proteins | 69 | ||
| Nitrogen balance | 70 | ||
| Tests of function | 70 | ||
| Immune competence | 70 | ||
| Muscle function | 70 | ||
| Skeletal muscle | 70 | ||
| Respiratory muscle | 70 | ||
| How should nutritional status be assessed in clinical practice? | 70 | ||
| The Malnutrition Universal Screening Tool (MUST) | 70 | ||
| Significance of the resultant score and clinical management | 70 | ||
| Re-feeding syndrome | 71 | ||
| Nutritional support in surgical practice | 71 | ||
| Route of nutritional support | 71 | ||
| Enteral nutritional support | 71 | ||
| The importance of enteral nutrition | 71 | ||
| Routes of access for enteral nutritional support | 71 | ||
| Nasoenteric tubes | 71 | ||
| Gastrostomy tubes | 72 | ||
| Jejunostomy tubes | 72 | ||
| Nutrient solutions available for enteral nutrition | 72 | ||
| Polymeric diets | 72 | ||
| Elemental diets | 72 | ||
| Special formulations | 72 | ||
| Modular diets | 72 | ||
| Enteral nutrition delivery and complications | 72 | ||
| Parenteral nutritional support | 73 | ||
| Parenteral routes of access | 73 | ||
| Central venous access | 73 | ||
| Technical aspects of feeding lines | 73 | ||
| Catheter care | 73 | ||
| Peripheral venous access | 74 | ||
| Nutrients used in parenteral feeding solutions | 74 | ||
| Nitrogen sources | 74 | ||
| Energy sources | 74 | ||
| Other nutrients | 75 | ||
| Delivery and administration of PN | 75 | ||
| Complications of parenteral nutritional support | 75 | ||
| Monitoring patients receiving nutritional support | 75 | ||
| Nutritional support teams | 76 | ||
| Nutritional support in defined clinical situations | 76 | ||
| Nutritional support in the perioperative period | 76 | ||
| Parenteral nutrition | 76 | ||
| Nutritional support in patients with acute pancreatitis (see also Chapter 14) | 77 | ||
| Nutritional supplementation in inflammatory bowel disease | 77 | ||
| Nutritional support in enterocutaneous fistulas | 77 | ||
| Nutritional support in patients with burns | 77 | ||
| Nutritional supplementation with key nutrients: application to clinical practice | 77 | ||
| Combinations of these nutrients and their place in practice | 78 | ||
| Key references | 80 | ||
| Chapter 7: Abdominal hernias | 81 | ||
| Introduction | 81 | ||
| Aetiology | 81 | ||
| Classification of hernias | 82 | ||
| Mesh | 82 | ||
| Epigastric hernia | 84 | ||
| Aetiology | 84 | ||
| Clinical presentation | 84 | ||
| Management | 84 | ||
| Operative details | 84 | ||
| Complications | 85 | ||
| Umbilical and para-umbilical hernias | 85 | ||
| Congenital umbilical hernias | 85 | ||
| Para-umbilical hernias | 85 | ||
| Clinical presentation | 85 | ||
| Management | 85 | ||
| Operative details | 85 | ||
| Complications | 86 | ||
| Adult umbilical hernias | 86 | ||
| Spigelian, lumbar and other primary ventral hernias | 86 | ||
| Inguinal hernias | 86 | ||
| Anatomy | 86 | ||
| Definition | 87 | ||
| Inguinal hernia in infants and children (see also Chapter 18) | 87 | ||
| Clinical presentation | 87 | ||
| Management | 87 | ||
| Operative details | 88 | ||
| Complications | 88 | ||
| Adult inguinal hernias | 89 | ||
| Aetiology | 89 | ||
| Diagnosis | 89 | ||
| Management | 89 | ||
| Tension-free' open mesh repair | 89 | ||
| Laparoscopic repair | 91 | ||
| Intraperitoneal prosthetic repair | 91 | ||
| Transabdominal pre-peritoneal prosthetic (TAPP) repair | 91 | ||
| Totally extraperitoneal prosthetic (TEP) repair | 91 | ||
| Single incision laparoscopic surgery (SILS) and robotic surgery | 92 | ||
| Complications | 92 | ||
| Open suture, open mesh or laparoscopic repair? | 92 | ||
| Contralateral repair | 93 | ||
| Recurrent inguinal hernias | 93 | ||
| Open mesh repair of recurrent inguinal hernias | 93 | ||
| Laparoscopic repair of recurrent inguinal hernias | 93 | ||
| The asymptomatic hernia | 93 | ||
| Femoral hernia | 94 | ||
| Anatomy | 94 | ||
| Aetiology | 94 | ||
| Management | 94 | ||
| Operative details | 94 | ||
| The low approach (Lockwood) | 94 | ||
| Transinguinal approach (Lothiessen) | 94 | ||
| High approach (McEvedy) | 94 | ||
| Laparoscopic approach | 95 | ||
| Incisional hernia | 95 | ||
| Aetiology | 95 | ||
| Management | 95 | ||
| Mesh repair | 96 | ||
| Open sublay repair | 97 | ||
| Laparoscopic repair | 97 | ||
| Parastomal hernia | 99 | ||
| Emergency hernia surgery | 99 | ||
| Port-site hernia | 99 | ||
| Antibiotic prophylaxis in hernia surgery | 99 | ||
| Prophylactic' hernia surgery | 100 | ||
| Management of an infected mesh | 100 | ||
| Key references | 101 | ||
| Chapter 8: Neck surgery for the general surgeon | 102 | ||
| Introduction | 102 | ||
| Diagnostic approach to neck masses | 102 | ||
| Initial assessment (Table 8.1) | 102 | ||
| Imaging | 103 | ||
| Biopsy | 103 | ||
| Thyroid mass | 104 | ||
| Surgery for malignancy | 105 | ||
| Surgery for pressure symptoms | 107 | ||
| Surgery for hyperthyroidism | 107 | ||
| Postoperative management following thyroidectomy | 108 | ||
| Congenital masses | 108 | ||
| Parathyroid disease | 109 | ||
| Conclusion | 111 | ||
| Key references | 112 | ||
| Chapter 9: Human factors and patient safety in surgery | 114 | ||
| The scale of medical error | 114 | ||
| Adverse events in surgery | 114 | ||
| Human factors | 115 | ||
| Non-technical skills in surgery | 116 | ||
| Situation Awareness (SA) | 116 | ||
| Decision-making | 118 | ||
| Teamwork and communication | 118 | ||
| Leadership | 119 | ||
| Conclusion | 120 | ||
| Key references | 120 | ||
| Chapter 10: Principles of organ donation and general surgery in the transplant patient | 122 | ||
| Introduction | 122 | ||
| Principles of organ donation | 122 | ||
| Ethical and legal aspects of organ donation | 122 | ||
| Types of organ donation | 123 | ||
| Living donation | 123 | ||
| Living kidney donation | 124 | ||
| Living liver donation | 126 | ||
| Deceased organ donation | 126 | ||
| Donor identification and referral | 126 | ||
| Donation after brain death | 126 | ||
| Donation after circulatory death | 128 | ||
| Contraindications to deceased donation | 130 | ||
| General surgery in the transplant patient | 131 | ||
| Immunosuppression | 131 | ||
| Specific general surgical problems | 132 | ||
| Peptic ulceration | 132 | ||
| Colonic perforation | 132 | ||
| Cholelithiasis | 132 | ||
| Appendicitis | 132 | ||
| Key references | 133 | ||
| Chapter 11: Early assessment of the acute abdomen | 135 | ||
| Conditions associated with abdominal pain | 135 | ||
| Initial assessment: history, examination and simple tests | 136 | ||
| Initial investigations | 137 | ||
| Blood tests | 137 | ||
| Diagnostic imaging | 138 | ||
| Plain radiography | 138 | ||
| Contrast radiography | 138 | ||
| Ultrasonography | 139 | ||
| Computed tomography | 140 | ||
| Magnetic resonance imaging | 143 | ||
| Diagnostic laparoscopy | 143 | ||
| Special populations | 144 | ||
| Pathways/guidelines for assessment | 144 | ||
| Key references | 145 | ||
| Chapter 12: Perforations of the upper gastrointestinal tract | 146 | ||
| Introduction | 146 | ||
| Key principles of treatment | 146 | ||
| Anatomical consideration | 146 | ||
| Pathological considerations | 146 | ||
| Diagnosis | 147 | ||
| Advanced imaging | 147 | ||
| Perforated peptic ulceration | 148 | ||
| Cause | 148 | ||
| H. pylori | 148 | ||
| Non-steroidal anti-inflammatory drugs (NSAIDs) | 148 | ||
| Indications for surgery | 148 | ||
| Open or laparoscopic surgery? | 150 | ||
| New options | 151 | ||
| Giant duodenal ulcer | 151 | ||
| Perforated gastric ulcers | 151 | ||
| Antimicrobial therapy | 152 | ||
| Postoperative care | 152 | ||
| Oesophageal perforation | 152 | ||
| Causes | 153 | ||
| Iatrogenic | 153 | ||
| Spontaneous rupture (Boerhaave’s syndrome) | 153 | ||
| Caustic injury | 153 | ||
| Diagnosis of oesophageal perforation78 | 153 | ||
| Treatment | 153 | ||
| Drainage | 155 | ||
| Control of the perforation | 156 | ||
| Endoscopic therapy | 156 | ||
| Surgical repair | 157 | ||
| Resection and/or oesophageal exclusion | 157 | ||
| Nutrition | 158 | ||
| Perforation after endoscopic retrograde cholangiopancreatography | 158 | ||
| Intraperitoneal perforation | 158 | ||
| Duodenal wall injury | 158 | ||
| Retroperitoneal perforations | 158 | ||
| Chapter 13: Acute non-variceal upper gastrointestinal bleeding | 160 | ||
| Introduction | 160 | ||
| Aetiology | 160 | ||
| Initial assessment and triage | 160 | ||
| Scoring systems | 161 | ||
| Initial management | 162 | ||
| Massive haemorrhage | 162 | ||
| Use of blood and blood products | 162 | ||
| Management of patients on antiplatelet agents and anticoagulants | 163 | ||
| Early pharmacological treatment | 163 | ||
| Endoscopy | 164 | ||
| Endoscopic technique | 164 | ||
| Management of bleeding due to causes other than peptic ulceration | 164 | ||
| Gastritis/duodenitis | 164 | ||
| Mallory–Weiss syndrome | 164 | ||
| Oesophagitis | 165 | ||
| Neoplastic disease | 165 | ||
| Dieulafoy's lesion | 165 | ||
| Endoscopic management of bleeding peptic ulcers | 165 | ||
| Endoscopic stigmata of bleeding | 165 | ||
| Endoscopic treatment | 166 | ||
| Injection | 166 | ||
| Thermal methods | 167 | ||
| Mechanical methods | 167 | ||
| Hemospray® | 167 | ||
| Over-the-scope clip (OTSC)’ | 167 | ||
| Single versus combined methods | 167 | ||
| Limit of endoscopic therapy | 168 | ||
| Second-look endoscopy | 168 | ||
| Pharmacological management of bleeding peptic ulcers | 168 | ||
| Acid suppression | 168 | ||
| Surgical management of bleeding peptic ulcers | 169 | ||
| Choice of surgical procedure for bleeding peptic ulcers | 169 | ||
| Management of recurrent bleeding | 170 | ||
| The role of angiographic embolisation | 171 | ||
| Helicobacter pylori eradication | 171 | ||
| Use of NSAIDs | 172 | ||
| Summary | 172 | ||
| Key references | 173 | ||
| Chapter 14: Pancreatico-biliary emergencies | 174 | ||
| Introduction | 174 | ||
| Gallstones | 174 | ||
| Cholecystolithiasis and associated complications | 174 | ||
| Clinical presentation and diagnosis | 174 | ||
| Management of acute cholecystitis | 177 | ||
| Patient-specific factors for consideration in acute cholecystitis | 180 | ||
| Investigation for suspected choledocholithiasis in acute cholecystitis | 180 | ||
| Acalculous acute cholecystitis | 181 | ||
| Choledocholithiasis and associated complications | 181 | ||
| Management of choledocholithiasis | 182 | ||
| Acute bacterial cholangitis | 183 | ||
| Acute pancreatitis | 184 | ||
| Initial assessment, investigations and management | 184 | ||
| Early management of severe disease | 185 | ||
| Fluid management | 185 | ||
| Nutrition | 186 | ||
| Preventing secondary infectious complications | 187 | ||
| Management of mild biliary pancreatitis | 187 | ||
| When should a patient with severe acute pancreatitis be transferred? | 188 | ||
| Follow-up for non-biliary, non-ETOH-induced pancreatitis | 188 | ||
| Implementation and compliance with the evidence base | 188 | ||
| Technical considerations of cholecystectomy, laparoscopic bile duct exploration and ERCP | 188 | ||
| Key references | 191 | ||
| Chapter 15: Acute conditions of the small bowel and appendix | 193 | ||
| Introduction | 193 | ||
| Small-bowel obstruction | 193 | ||
| Mechanism | 193 | ||
| Presentation | 194 | ||
| Initial management | 194 | ||
| Investigations | 195 | ||
| Non-operative management | 195 | ||
| Surgical management | 196 | ||
| Operative principles | 196 | ||
| Laparoscopy | 197 | ||
| Reducing adhesion formation | 197 | ||
| Difficult closure | 197 | ||
| Special conditions | 197 | ||
| Radiation enteritis | 197 | ||
| Malignant obstruction | 198 | ||
| Abdominal wall hernia | 199 | ||
| Enterolith obstruction | 199 | ||
| Intussusception | 200 | ||
| Connective tissue disorders | 200 | ||
| Chronic intestinal pseudo-obstruction | 200 | ||
| Intestinal obstruction in the early postoperative period | 200 | ||
| Laparoscopy | 200 | ||
| Peritonitis | 201 | ||
| Crohn's disease | 201 | ||
| Presentation | 201 | ||
| Investigation | 201 | ||
| Surgery for acute Crohn's disease presenting de novo | 201 | ||
| Mesenteric ischaemia | 202 | ||
| Meckel's diverticulum | 203 | ||
| Haemorrhage | 203 | ||
| Appendicitis | 205 | ||
| Aetiology and pathology | 205 | ||
| Clinical features | 205 | ||
| Investigations | 206 | ||
| Differential diagnosis | 207 | ||
| Management | 207 | ||
| Surgical Treatment | 207 | ||
| Open appendicectomy | 207 | ||
| Laparoscopic appendicectomy | 208 | ||
| The normal appendix at open surgery | 209 | ||
| The normal appendix at laparoscopy | 209 | ||
| Non-surgical treatment | 209 | ||
| Treatment of atypical presentation of acute appendicitis | 210 | ||
| Appendix mass | 210 | ||
| Appendix abscess | 210 | ||
| Chronic appendicitis | 211 | ||
| Appendicitis in pregnancy | 211 | ||
| Postoperative complications and outcome | 211 | ||
| Hospital stay | 211 | ||
| Wound infection | 211 | ||
| Other septic complications | 212 | ||
| Prognosis | 212 | ||
| Appendiceal tumours | 212 | ||
| Neuroendocrine neoplasm | 212 | ||
| Mucinous tumours | 213 | ||
| Adenocarcinoma | 213 | ||
| Acknowledgement | 214 | ||
| Key references | 214 | ||
| Chapter 16: Colonic emergencies | 216 | ||
| Introduction | 216 | ||
| Colonic obstruction | 216 | ||
| Neoplastic obstruction | 216 | ||
| Intervention: colonic stents | 217 | ||
| Intervention: operative | 218 | ||
| Diverticular | 219 | ||
| Sigmoid volvulus | 219 | ||
| Caecal volvulus | 220 | ||
| Caecal bascule | 221 | ||
| Acute colonic pseudo-obstruction | 221 | ||
| Inflammation/infection | 222 | ||
| Toxic colitis/megacolon | 222 | ||
| Neutropenic enterocolitis | 225 | ||
| Perforation | 225 | ||
| Complicated colonic diverticulitis | 225 | ||
| Stercoral | 226 | ||
| Colonoscopic | 226 | ||
| Anastomotic leak/dehiscence | 227 | ||
| Haemorrhage | 228 | ||
| Ischaemia | 229 | ||
| Key references | 232 | ||
| Chapter 17: Anorectal emergencies | 234 | ||
| Introduction | 234 | ||
| Anorectal anatomy | 234 | ||
| Anorectal abscesses | 234 | ||
| Clinical features | 235 | ||
| Radiological imaging | 235 | ||
| Treatment | 236 | ||
| Technical tips | 237 | ||
| Fistula-in-ano | 237 | ||
| Management of secondary perianal sepsis | 238 | ||
| Malignant disease | 238 | ||
| Inflammatory bowel disease | 238 | ||
| Necrotising infection | 239 | ||
| Anorectal sepsis in neutropenic patients | 239 | ||
| Anorectal sepsis in HIV patients | 239 | ||
| Pilonidal abscess | 239 | ||
| Acute anal fissure | 239 | ||
| Haemorrhoids | 240 | ||
| Thrombosed haemorrhoids | 240 | ||
| Anorectal haemorrhage | 241 | ||
| Anorectal trauma | 241 | ||
| Anal sphincter injuries | 241 | ||
| Obstetric anal sphincter injuries | 241 | ||
| Non-obstetric trauma | 242 | ||
| Rectal injuries | 242 | ||
| Foreign bodies | 242 | ||
| Irreducible rectal prolapse | 242 | ||
| Key references | 243 | ||
| Chapter 18: Paediatric surgical emergencies | 245 | ||
| Introduction | 245 | ||
| Neonatal period | 245 | ||
| Prenatal diagnosis | 245 | ||
| Intestinal obstruction | 245 | ||
| Assessment | 245 | ||
| Specific forms of intestinal obstruction | 248 | ||
| Oesophageal atresia | 248 | ||
| Meconium ileus | 248 | ||
| Intestinal atresia/stenosis | 249 | ||
| Hirschsprung disease | 249 | ||
| Anorectal malformations | 249 | ||
| Malrotation | 250 | ||
| Inflammatory conditions | 251 | ||
| Assessment | 251 | ||
| Specific forms of abdominal inflammation | 251 | ||
| Meconium peritonitis | 251 | ||
| Necrotising enterocolitis | 251 | ||
| Isolated ileal perforation | 252 | ||
| Other neonatal conditions | 253 | ||
| Incarcerated inguinal hernia | 253 | ||
| Abdominal wall defects | 253 | ||
| Infancy | 253 | ||
| Hypertrophic pyloric stenosis | 253 | ||
| Intussusception | 254 | ||
| Children | 255 | ||
| Appendicitis | 255 | ||
| Fluid resuscitation of the child with a surgical emergency | 256 | ||
| Paediatric trauma | 256 | ||
| Chapter 19: Management of trauma for the general surgeon | 258 | ||
| Introduction | 258 | ||
| Evaluation of the injured patient | 259 | ||
| Primary and secondary survey, damage control surgery, transfer | 259 | ||
| Damage control surgery | 259 | ||
| Referral patterns | 260 | ||
| Regional injuries | 260 | ||
| Injury scoring scales | 260 | ||
| Blunt and penetrating abdominal trauma | 260 | ||
| Special investigations | 261 | ||
| Focused assessment with sonography in trauma (FAST) | 261 | ||
| Computed tomography (CT) | 262 | ||
| Diagnostic and therapeutic laparoscopy | 262 | ||
| Blunt trauma | 262 | ||
| Spleen | 262 | ||
| Liver | 263 | ||
| Kidneys | 263 | ||
| Abdominal stab and low-velocity gunshot wounds | 264 | ||
| Stab wounds | 264 | ||
| Gunshot wounds (GSW) | 264 | ||
| Small bowel, colon and rectum | 265 | ||
| Kidneys | 266 | ||
| Duodenum and pancreas | 267 | ||
| Abdominal vena cava | 268 | ||
| Complications | 268 | ||
| Pelvic fractures | 268 | ||
| A step-by-step guide to trauma laparotomy | 269 | ||
| Blunt and penetrating chest injuries | 270 | ||
| Rib fractures, pneumothorax, haemothorax and pulmonary contusions | 270 | ||
| Rib fracture | 270 | ||
| Pneumothorax and haemothorax | 270 | ||
| Pulmonary contusions | 271 | ||
| Intrathoracic complications | 271 | ||
| Cardiac injuries | 271 | ||
| Aortic injuries | 273 | ||
| Oesophageal injuries | 274 | ||
| Transmediastinal gunshot wounds | 274 | ||
| Emergency department thoracotomy | 274 | ||
| Emergency department thoracotomy technique99 | 275 | ||
| Retained knife blade | 275 | ||
| Thoraco-abdominal trauma | 276 | ||
| Diaphragmatic injuries | 276 | ||
| Neck trauma | 277 | ||
| Penetrating neck injuries | 277 | ||
| Vascular injuries | 278 | ||
| Oesophageal injuries | 279 | ||
| Pharyngeal injuries | 279 | ||
| Future developments | 279 | ||
| Resuscitative endovascular balloon occlusion of the aorta (REBOA) | 279 | ||
| Enhanced recovery after surgery (ERAS) | 279 | ||
| Key references | 280 | ||
| Chapter 20: Abdominal sepsis and abdominal compartment syndrome | 281 | ||
| Introduction | 281 | ||
| Definition of sepsis | 281 | ||
| Pathophysiology of sepsis | 282 | ||
| The slippery slope of sepsis | 283 | ||
| The Surviving Sepsis Campaign (SSC) | 283 | ||
| Systematic assessment | 283 | ||
| Lactate measurement | 285 | ||
| Antimicrobial therapy in abdominal sepsis | 285 | ||
| Imaging in abdominal sepsis | 285 | ||
| Early source control in abdominal sepsis | 286 | ||
| Aims of treatment in abdominal sepsis | 286 | ||
| Abdominal sepsis on the ICU | 287 | ||
| Assessment on the ICU | 288 | ||
| Re-operating in abdominal sepsis | 288 | ||
| Damage control laparotomy | 289 | ||
| Second-look (planned) re-laparotomy | 289 | ||
| Leaving the abdomen open (laparostomy) | 290 | ||
| The National Emergency Laparotomy Audit (NELA) | 291 | ||
| Abdominal compartment syndrome | 291 | ||
| Enterocutaneous fistulas (ECF) | 292 | ||
| Key references | 294 | ||
| Chapter 21: Complications of bariatric surgery presenting to the general surgeon and considerations for the general surgeon ... | 295 | ||
| Introduction | 295 | ||
| Causes of obesity | 295 | ||
| Mechanisms of weight loss surgery | 296 | ||
| Bariatric operations | 296 | ||
| Gastric band | 296 | ||
| Roux-en-Y gastric bypass | 297 | ||
| Mini-gastric bypass | 297 | ||
| Sleeve gastrectomy | 297 | ||
| Duodenal switch | 298 | ||
| Intragastric balloon | 298 | ||
| Older, more obsolete operations | 298 | ||
| Jejuno-ileal bypass (JIB) | 298 | ||
| Vertical banded gastroplasty (VBG) | 298 | ||
| Newer procedures | 299 | ||
| Endoscopic duodenojejunal sleeve | 299 | ||
| Gastric plication | 299 | ||
| Implantable neuroregulators (gastric ‘pacemakers’) | 299 | ||
| Complications of bariatric surgery | 299 | ||
| General complications | 299 | ||
| Specific complications | 300 | ||
| Clinical presentation | 301 | ||
| Gastric band patients | 301 | ||
| Vomiting and/or dysphagia | 301 | ||
| Band too tight | 301 | ||
| Acute band 'slippage' | 301 | ||
| Band erosion | 302 | ||
| Abdominal pain | 302 | ||
| Chest pain | 302 | ||
| Mega-oesophagus | 302 | ||
| Port problems | 303 | ||
| Migration | 303 | ||
| Leakage | 303 | ||
| Infection | 303 | ||
| Skin erosion | 303 | ||
| Sleeve gastrectomy patients | 303 | ||
| Staple-line leak or bleed | 303 | ||
| Splenic infarction | 303 | ||
| Omental necrosis | 303 | ||
| Sleeve stenosis | 303 | ||
| Gastric bypass/duodenal switch patients | 304 | ||
| Staple-line leak | 304 | ||
| Staple-line bleed | 304 | ||
| Small-bowel enterotomy | 304 | ||
| Early small-bowel obstruction | 304 | ||
| Late small-bowel obstruction | 304 | ||
| Gastro-gastric fistula | 305 | ||
| Dumping syndrome | 305 | ||
| Mini-gastric bypass patients | 305 | ||
| Gastric balloon patients | 305 | ||
| Gastric plication patients | 305 | ||
| Patients with older, now obsolete operations | 306 | ||
| Other postoperative problems | 306 | ||
| Gallstones | 306 | ||
| Nutritional deficiencies | 306 | ||
| Failure to lose weight | 306 | ||
| Considerations when operating on the obese patient | 306 | ||
| Preoperative measures | 306 | ||
| Anaesthesia | 306 | ||
| Surgery | 307 | ||
| Postoperative care | 307 | ||
| Patient optimisation | 307 | ||
| Intraoperative measures | 307 | ||
| Postoperative measures | 308 | ||
| Key references | 309 | ||
| Index | 311 |