Additional Information
Book Details
Abstract
Essential reading for residents and medical students, this popular handbook is a must-have resource for convenient, quick access to information on managing common surgical problems. Written by current surgery residents at the University of Cincinnati, the completely updated 7th Edition focuses on the surgical treatments, guidelines, procedures, and topics you need to know.
- New chapters cover Surgical Risk Assessment, Head and Neck Malignancy, Mediastinal Tumors, Dialysis Access, and Robotics.
- Rapid References section offers handy formulas and charts in one easy-access location.
- Thoroughly revised content throughout ensures that you stay up to date.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| THE MONT REIDSURGICAL HANDBOOK | i | ||
| THE MONT REIDSURGICAL HANDBOOK | iii | ||
| Copyright | iv | ||
| FOREWORD | v | ||
| PREFACE | vi | ||
| CONTENTS | xi | ||
| THE MONT REIDSURGICAL HANDBOOK | xv | ||
| I - Perioperative Care | 1 | ||
| 1 - Surgical History and Physical Examination | 3 | ||
| I. INTRODUCTION AND INITIAL CONTACT | 3 | ||
| II. HISTORY | 3 | ||
| A. CHIEF COMPLAINT | 3 | ||
| B. HISTORY OF PRESENT ILLNESS | 3 | ||
| C. REVIEW OF SYSTEMS | 4 | ||
| D. ALLERGIES | 4 | ||
| E. MEDICATION | 4 | ||
| F. PAST MEDICAL HISTORY | 5 | ||
| G. PAST SURGICAL HISTORY | 5 | ||
| H. FAMILY HISTORY | 5 | ||
| I. SOCIAL HISTORY | 5 | ||
| III. PHYSICAL EXAMINATION | 5 | ||
| A. VITAL SIGNS | 5 | ||
| B. GENERAL APPEARANCE | 7 | ||
| C. HEAD AND NECK | 8 | ||
| D. CHEST | 10 | ||
| E. CARDIOVASCULAR | 11 | ||
| F. ABDOMEN | 13 | ||
| G. GENITOURINARY | 16 | ||
| H. SKIN | 17 | ||
| I. MUSCULOSKELETAL | 18 | ||
| J. LYMPHATICS | 19 | ||
| K. NEUROLOGIC | 20 | ||
| 2 - Fluids and Electrolytes | 23 | ||
| I. BASIC PHYSIOLOGY | 23 | ||
| A. BODY FLUID COMPOSITION | 23 | ||
| B. SERUM OSMOLALITY AND TONICITY | 23 | ||
| C. FLUID AND ELECTROLYTE HOMEOSTASIS | 24 | ||
| II. ELECTROLYTE DISTURBANCES | 25 | ||
| A. SODIUM | 25 | ||
| B. POTASSIUM | 28 | ||
| C. CALCIUM | 29 | ||
| D. MAGNESIUM | 31 | ||
| E. PHOSPHORUS | 32 | ||
| III. PARENTERAL REPLACEMENT FLUID THERAPY | 33 | ||
| A. CRYSTALLOIDS | 33 | ||
| B. COLLOIDS | 34 | ||
| IV. ACID-BASE DISORDERS | 35 | ||
| A. PHYSIOLOGY | 35 | ||
| B. PRIMARY METABOLIC DISORDERS | 35 | ||
| C. PRIMARY RESPIRATORY DISORDERS | 37 | ||
| D. MIXED ACID-BASE DISORDERS | 38 | ||
| E. EVALUATION OF ACID-BASE DISORDERS (TABLE 2.3) | 38 | ||
| 3 - Nutrition | 40 | ||
| I. NUTRITION BASICS | 40 | ||
| II. DETERMINATION OF CALORIC NEEDS | 40 | ||
| III. NUTRITIONAL ASSESSMENT | 41 | ||
| IV. PREOPERATIVE NUTRITIONAL SUPPLEMENTATION | 45 | ||
| V. POSTOPERATIVE NUTRITIONAL SUPPLEMENTATION | 45 | ||
| VI. ENTERAL NUTRITION | 45 | ||
| VII. SHORT-TERM SUPPLEMENTATION | 45 | ||
| VIII. LONG-TERM SUPPLEMENTATION (>6 WEEKS) | 46 | ||
| IX. PRODUCTS | 46 | ||
| X. COMPLICATIONS OF ENTERAL FEEDING | 47 | ||
| XI. PARENTERAL NUTRITION | 48 | ||
| XII. BASIC COMPOSITION OF FORMULATIONS (TABLES 3.1 AND 3.2) | 48 | ||
| XIII. CENTRAL FORMULAS | 49 | ||
| XIV. PERIPHERAL PARENTERAL NUTRITION | 50 | ||
| XV. INFUSION | 50 | ||
| XVI. MONITORING | 50 | ||
| XVII. COMPLICATIONS | 50 | ||
| XVIII. IMMUNONUTRITION | 51 | ||
| XIX. NUTRIENTS/MACROMINERALS/MICRONUTRIENTS/VITAMINS | 52 | ||
| 4 - Wound Healing | 55 | ||
| I. PHASES OF WOUND HEALING | 55 | ||
| A. HEMOSTASIS (5–10 MINUTES POST INJURY) | 55 | ||
| C. PROLIFERATIVE (DAY 1–3 WEEKS POST INJURY) | 56 | ||
| II. FACTORS THAT AFFECT WOUND HEALING | 57 | ||
| A. OXYGENATION | 57 | ||
| B. INFECTION | 57 | ||
| C. NUTRITION | 57 | ||
| D. STEROIDS | 57 | ||
| E. SMOKING | 57 | ||
| F. AGE | 58 | ||
| G. FOREIGN BODIES | 58 | ||
| H. EDEMA | 58 | ||
| I. CHEMOTHERAPY | 58 | ||
| J. RADIATION | 58 | ||
| K. DIABETES MELLITUS | 58 | ||
| L. GENERAL HEALTH | 58 | ||
| III. WOUND PREPARATION | 58 | ||
| A. IRRIGATION | 58 | ||
| B. ANTIMICROBIALS | 58 | ||
| C. DÉBRIDEMENT | 59 | ||
| IV. TYPES OF WOUND CLOSURE | 59 | ||
| A. PRIMARY: CLOSURE OF WOUND BY DIRECT APPROXIMATION OF WOUND EDGES | 59 | ||
| B. SPONTANEOUS HEALING (SECONDARY INTENTION): SPONTANEOUS WOUND CONTRACTION AND EPITHELIALIZATION | 59 | ||
| C. TERTIARY HEALING | 60 | ||
| V. MANAGEMENT OF WOUND COMPLICATIONS | 60 | ||
| A. INFECTION | 60 | ||
| B. SEROMA | 60 | ||
| C. DEHISCENCE | 60 | ||
| VI. HYPERTROPHIC SCARS AND KELOIDS | 61 | ||
| A. HYPERTROPHIC SCARS | 61 | ||
| B. KELOIDS | 61 | ||
| 5 - Surgical Risk Assessment | 64 | ||
| I. RISKS AND BENEFITS OF SURGERY | 64 | ||
| II. SURGICAL RISK ASSESSMENT | 64 | ||
| III. PREOPERATIVE PREPARATION | 73 | ||
| IV. POSTOPERATIVE CARE | 76 | ||
| 6 - Suture Types, Needle Types, and Instruments | 81 | ||
| I. SUTURE MATERIAL | 81 | ||
| A. THE OPTIMAL SUTURE | 81 | ||
| B. SUTURE CHARACTERISTICS | 82 | ||
| C. ABSORBABLE SUTURE | 84 | ||
| D. NONABSORBABLE SUTURE | 85 | ||
| E. SUMMARY | 86 | ||
| II. NEEDLES | 87 | ||
| III. INSTRUMENTS | 89 | ||
| II - Anesthesia | 91 | ||
| 7 - Local Anesthesia | 93 | ||
| I. INJECTABLE AGENTS | 93 | ||
| A. MECHANISM OF ACTION | 93 | ||
| B. CLASSES | 93 | ||
| C. TOXICITY | 95 | ||
| D. USE OF EPINEPHRINE | 95 | ||
| II. TECHNIQUES | 96 | ||
| A. BEFORE INJECTING LOCAL ANESTHETIC IN TRAUMATIC INJURIES, BE SURE TO PERFORM AND DOCUMENT A DETAILED SENSORY EXAMINATION, WHICH MAY BE SUBSEQUENTLY MASKED BY YOUR BLOCK | 96 | ||
| B. OPTIMAL TIMING BETWEEN INJECTION AND INCISION | 96 | ||
| C. GENERAL TECHNIQUES TO DECREASE PAIN | 96 | ||
| D. FIELD BLOCKS | 96 | ||
| E. NERVE BLOCKS FOR THE FACE | 96 | ||
| F. NERVE BLOCKS FOR THE UPPER EXTREMITY | 99 | ||
| III. TOPICAL AGENTS | 100 | ||
| A. TOPICAL ANESTHESIA CAN AVOID THE PAIN AND ANXIETY OF NEEDLE INJECTION AND IS ESPECIALLY USEFUL IN THE PEDIATRIC POPULATION. IT CAN ALSO BE USED AS AN ADJUNCT TO DECREASE SUPERFICIAL SKIN PAIN BEFORE PERFORMING MORE TARGETED NERVE BLOCK WITH AN INJECTABLE LOCAL ANESTHETIC AGENT. | 100 | ||
| B. SYSTEMIC BLOOD LEVELS OF THESE COMPOUNDED TOPICAL ANESTHETICS DEPEND ON THE ABSORPTION, PATIENT SIZE, RATE OF ELIMINATION, AN... | 100 | ||
| C. COMMONLY USED PRODUCTS (10) | 100 | ||
| 8 - Conscious Sedation | 102 | ||
| I. INTRODUCTION | 102 | ||
| A. DEFINITION | 102 | ||
| B. APPLICATIONS (SELECTED) | 102 | ||
| II. PREPROCEDURAL EVALUATION | 102 | ||
| A. HISTORY | 102 | ||
| B. AIRWAY EXAMINATION | 103 | ||
| III. MONITORING | 104 | ||
| A. Best Achieved by Someone Other than Person Performing Procedure | 104 | ||
| B. PREPROCEDURE | 104 | ||
| C. CLINICAL ASSESSMENT | 104 | ||
| F. BLOOD PRESSURE | 105 | ||
| IV. AVAILABILITY OF EMERGENCY MEDICAL EQUIPMENT AND PERSONNEL | 105 | ||
| A. Immediate Access to Suction, Bag-Mask Ventilation, Intubation Materials, Defibrillator, and Emergency (Advanced Cardiac Life ... | 105 | ||
| B. Anesthesia or Other Trained Airway Staff in Close Proximity1397256787 | 105 | ||
| V. TRAINING IN AIRWAY MANAGEMENT | 105 | ||
| III - Surgical Critical Care | 123 | ||
| 10 - Surgical Infection | 125 | ||
| I. BACKGROUND AND SCOPE OF PROBLEM | 125 | ||
| II. MOST COMMON INFECTIONS AFFECTING SURGICAL PATIENTS | 127 | ||
| A. CENTRAL LINE–ASSOCIATED BLOODSTREAM INFECTION | 127 | ||
| B. SURGICAL SITE INFECTIONS | 128 | ||
| C. CATHETER-ASSOCIATED URINARY TRACT INFECTIONS | 131 | ||
| D. CLOSTRIDIUM DIFFICILE INFECTION | 133 | ||
| E. VENTILATOR-ASSOCIATED PNEUMONIA | 135 | ||
| F. PURULENT SKIN AND SOFT TISSUE INFECTIONS | 136 | ||
| G. NECROTIZING SOFT TISSUE INFECTION | 137 | ||
| H. INTRAABDOMINAL INFECTIONS | 138 | ||
| III. SEPSIS | 139 | ||
| 11 - Hemorrhage and Coagulation | 143 | ||
| I. GENERAL TOPICS | 143 | ||
| A. NORMAL BLOOD VOLUME AND COMPOSITION | 143 | ||
| B. CLASSES OF HEMORRHAGIC SHOCK (TABLE 11.1) | 143 | ||
| C. TYPING, SCREENING, AND CROSSMATCHING | 143 | ||
| D. GENERAL BLOOD PRODUCT ADMINISTRATION GUIDELINES | 144 | ||
| II. LABORATORY TESTS AND REFERENCE VALUES | 144 | ||
| A. COMPLETE BLOOD COUNT | 144 | ||
| B. PROTHROMBIN TIME | 144 | ||
| C. INTERNATIONAL NORMALIZED RATIO | 144 | ||
| D. ACTIVATED PARTIAL THROMBOPLASTIN TIME | 144 | ||
| E. ACTIVATED CLOTTING TIME | 144 | ||
| F. BLEEDING TIME | 145 | ||
| G. PLATELET FUNCTION TESTS | 145 | ||
| H. THROMBIN TIME | 145 | ||
| I. FIBRINOGEN | 145 | ||
| J. VISCOELASTIC TESTS | 145 | ||
| III. SPECIFIC BLOOD PRODUCTS | 146 | ||
| A. WHOLE BLOOD | 146 | ||
| B. PACKED RED BLOOD CELLS | 146 | ||
| C. FRESH FROZEN PLASMA | 147 | ||
| D. PLATELETS | 148 | ||
| E. CRYOPRECIPITATE | 148 | ||
| IV. MASSIVE TRANSFUSION AND DAMAGE CONTROL RESUSCITATION | 149 | ||
| A. DEFINITION OF MASSIVE TRANSFUSION VARIES, BUT MOST COMMONLY USED IS 10 OR MORE UNITS OF BLOOD PRODUCTS IN THE FIRST 24 HOURS | 149 | ||
| B. PREDICTORS OF NEED FOR MASSIVE TRANSFUSION | 149 | ||
| C. PRESENCE AND IMPLEMENTATION OF STANDARDIZED PROTOCOLS IMPROVE SURVIVAL IN PATIENTS REQUIRING MASSIVE TRANSFUSION | 149 | ||
| D. DAMAGE CONTROL RESUSCITATION IS A STRATEGY TO LIMIT ONGOING BLEEDING BY ADDRESSING HYPOTHERMIA, ACIDOSIS, AND COAGULOPATHY. | 149 | ||
| V. TRANSFUSION REACTIONS | 149 | ||
| A. IMMUNE MEDIATED | 149 | ||
| B. NONIMMUNOLOGIC REACTIONS | 151 | ||
| VI. SURGICAL COAGULOPATHY—GENERAL CONSIDERATIONS | 151 | ||
| A. COAGULATION CASCADE (FIG. 11.2) | 151 | ||
| B. MEDICAL HISTORY TO DETERMINE RISK FOR BLEEDING | 151 | ||
| VII. CONGENITAL BLEEDING DISORDERS | 153 | ||
| A. HEMOPHILIA A | 153 | ||
| B. HEMOPHILIA B (CHRISTMAS DISEASE) | 153 | ||
| C. VON WILLEBRAND DISEASE | 153 | ||
| VIII. ACQUIRED BLEEDING DISORDERS | 154 | ||
| A. VITAMIN K DEFICIENCY | 154 | ||
| B. HYPOTHERMIA | 154 | ||
| C. LIVER FAILURE | 154 | ||
| D. END-STAGE RENAL DISEASE | 154 | ||
| E. DISSEMINATED INTRAVASCULAR COAGULATION | 154 | ||
| F. ACQUIRED THROMBOCYTOPENIA | 154 | ||
| H. HYPERFIBRINOLYSIS | 155 | ||
| IX. MEDICATIONS | 155 | ||
| A. ANTIPLATELET AGENTS | 155 | ||
| B. HEPARINS | 156 | ||
| C. WARFARIN | 156 | ||
| D. DIRECT THROMBIN INHIBITORS | 156 | ||
| E. FACTOR XA INHIBITORS (FONDAPARINUX) | 157 | ||
| F. NEW ORAL ANTICOAGULANTS | 157 | ||
| G. ANTIFIBRINOLYTICS | 157 | ||
| 12 - Shock | 159 | ||
| I. PATHOPHYSIOLOGY | 159 | ||
| II. HEMODYNAMIC CONSIDERATIONS | 159 | ||
| A. IMPORTANT RELATIONSHIPS | 160 | ||
| B. PRELOAD | 160 | ||
| C. AFTERLOAD | 160 | ||
| III. ORGAN RESPONSE TO SHOCK | 161 | ||
| A. NEUROENDOCRINE RESPONSE | 161 | ||
| B. MICROVASCULAR DYSFUNCTION | 161 | ||
| C. INFLAMMATORY RESPONSE | 162 | ||
| D. PULMONARY | 162 | ||
| E. RENAL | 162 | ||
| IV. MULTIORGAN DYSFUNCTION SYNDROME | 162 | ||
| A. DEFINITION | 162 | ||
| B. CAUSES | 162 | ||
| C. PREVENTIVE MEASURES | 163 | ||
| V. SHOCK STATES | 163 | ||
| A. HYPOVOLEMIC SHOCK | 163 | ||
| B. SEPTIC SHOCK | 165 | ||
| C. NEUROGENIC SHOCK | 167 | ||
| D. CARDIOGENIC SHOCK | 168 | ||
| E. HYPOADRENAL SHOCK/ADRENAL INSUFFICIENCY | 169 | ||
| VI. VASOACTIVE AGENTS | 170 | ||
| 13 - Cardiopulmonary Monitoring | 171 | ||
| I. CARDIAC MONITORING | 171 | ||
| A. CARDIAC RHYTHMS | 171 | ||
| B. BLOOD PRESSURE MONITORING | 175 | ||
| C. HEMODYNAMIC MONITORING BASIC PRINCIPLES | 175 | ||
| D. SPECIFIC DEVICES FOR CARDIAC MONITORING | 176 | ||
| II. PULMONARY MONITORING | 182 | ||
| A. PULSE OXIMETRY | 182 | ||
| D. ARTERIAL OR VENOUS BLOOD GAS | 183 | ||
| III. IMPORTANT FORMULAS | 183 | ||
| A. CARDIAC OUTPUT | 183 | ||
| B. ARTERIAL CONTENT OF OXYGEN | 183 | ||
| C. OXYGEN DELIVERY | 184 | ||
| D. OXYGEN CONSUMPTION | 184 | ||
| 14 - Mechanical Ventilation | 185 | ||
| I. DETERMINING NEED FOR MECHANICAL VENTILATION | 185 | ||
| A. AIRWAY INSTABILITY | 185 | ||
| B. RESPIRATORY FAILURE | 185 | ||
| C. GUIDELINES | 185 | ||
| II. VENTILATION VERSUS OXYGENATION | 185 | ||
| A. VENTILATION | 185 | ||
| B. OXYGENATION | 186 | ||
| III. NONINVASIVE POSITIVE PRESSURE VENTILATION | 186 | ||
| A. POSITIVE PRESSURE VENTILATION | 186 | ||
| B. INITIAL SETTINGS | 186 | ||
| C. ADVANTAGES | 186 | ||
| D. RESERVED | 186 | ||
| IV. CONVENTIONAL MECHANICAL VENTILATION | 186 | ||
| A. MODES OF VENTILATION | 186 | ||
| B. VENTILATOR STRATEGIES | 187 | ||
| C. LIBERATION FROM MECHANICAL VENTILATION | 188 | ||
| D. FAILURE TO LIBERATE FROM MECHANICAL VENTILATION | 188 | ||
| V. EFFECTS ON CARDIAC PERFORMANCE | 189 | ||
| A. ENDOTRACHEAL INTUBATION AND MECHANICAL VENTILATION PLACE IMPORTANT PHYSIOLOGIC DEMANDS ON PATIENTS | 189 | ||
| B. THE SHIFT FROM NEGATIVE PRESSURE TO POSITIVE PRESSURE VENTILATION CAN COMPROMISE PRELOAD BY | 189 | ||
| C. POSITIVE PRESSURE VENTILATION | 189 | ||
| D. THE EFFECTS OF POSITIVE PRESSURE VENTILATION ON CARDIAC PERFORMANCE | 189 | ||
| VI. NEED FOR TRACHEOSTOMY | 189 | ||
| VII. VENTILATOR CAUTIONS | 190 | ||
| A. DEFINITION OF ACUTE RESPIRATORY DISTRESS SYNDROME | 190 | ||
| B. ACUTE LUNG INJURY/ACUTE RESPIRATORY DISTRESS SYNDROME TREATED WITH PROTECTIVE LUNG STRATEGY | 190 | ||
| C. VENTILATOR-ASSOCIATED PNEUMONIA | 190 | ||
| VIII. PEARLS | 190 | ||
| A. STANDARD INITIAL VENTILATOR SETTINGS | 190 | ||
| IV - Trauma Surgery | 193 | ||
| 15 - Primary and Secondary Survey | 195 | ||
| I. EPIDEMIOLOGY | 195 | ||
| A. MORTALITY | 195 | ||
| B. MECHANISMS OF INJURY | 195 | ||
| II. MANAGEMENT OF THE TRAUMA PATIENT | 195 | ||
| A. PRIMARY SURVEY | 195 | ||
| B. FURTHER EVALUATION AND TRANSFER | 198 | ||
| C. SECONDARY SURVEY | 198 | ||
| III. PEDIATRIC TRAUMA | 199 | ||
| A. MECHANISMS OF INJURY | 199 | ||
| B. PRIMARY SURVEY | 199 | ||
| IV. TRAUMA AND PREGNANCY | 200 | ||
| A. EPIDEMIOLOGY | 200 | ||
| B. ANATOMIC AND PHYSIOLOGIC CHANGES DURING PREGNANCY | 200 | ||
| C. MATERNAL EVALUATION | 200 | ||
| D. FETAL ASSESSMENT | 200 | ||
| V. PENETRATING NECK TRAUMA | 201 | ||
| A. ZONE I | 201 | ||
| B. ZONE II | 201 | ||
| C. ZONE III | 202 | ||
| D. NECK EXPLORATION | 202 | ||
| 16 - Abdominal Trauma | 203 | ||
| I. PATHOPHYSIOLOGY | 203 | ||
| II. DIAGNOSIS | 204 | ||
| III. TREATMENT | 206 | ||
| V. SPECIAL CIRCUMSTANCES | 217 | ||
| 17 - Thoracic Trauma | 220 | ||
| I. EPIDEMIOLOGY OF THORACIC TRAUMA | 220 | ||
| A. THORACIC TRAUMA | 220 | ||
| B. AFRICAN-AMERICAN MALES | 220 | ||
| C. MOTORCYCLE ACCIDENTS | 220 | ||
| II. PHYSICAL EXAMINATION OF THE CHEST | 220 | ||
| A. CHEST AUSCULTATION | 220 | ||
| B. POINT TENDERNESS | 220 | ||
| C. FLAIL CHEST | 220 | ||
| D. SUBCUTANEOUS EMPHYSEMA | 220 | ||
| E. DULLNESS VERSUS RESONANCE ON PERCUSSION | 221 | ||
| F. SEAT BELT SIGNS | 221 | ||
| III. ADJUNCTS TO THE PHYSICAL EXAMINATION | 221 | ||
| A. CHEST RADIOGRAPHS | 221 | ||
| IV. PATHOPHYSIOLOGY OF THORACIC TRAUMA | 221 | ||
| V. BLUNT CHEST TRAUMA | 222 | ||
| VI. PENETRATING CHEST TRAUMA | 225 | ||
| VII. RESUSCITATIVE THORACOTOMY | 228 | ||
| VIII. OTHER THORACIC PROCEDURES IN THE FACE OF TRAUMA | 231 | ||
| A. FOCUSED ASSESSMENT WITH SONOGRAPHY FOR TRAUMA EXAMINATION | 231 | ||
| B. PERICARDIOCENTESIS | 231 | ||
| C. SUBXIPHOID PERICARDIOTOMY | 231 | ||
| D. THORACOSCOPY | 231 | ||
| IX. POSTOPERATIVE CARE OF THE PATIENT WITH A CHEST INJURY | 231 | ||
| A. CHEST TUBE MANAGEMENT | 231 | ||
| X. COMPLICATIONS OF THORACIC TRAUMA | 232 | ||
| 18 - Extremity Trauma | 234 | ||
| I. EVALUATION OF THE INJURED LIMB | 234 | ||
| A. GENERAL POINTS | 234 | ||
| B. EVALUATION OF FRACTURES AND DISLOCATIONS | 234 | ||
| II. OPEN FRACTURES | 234 | ||
| A. DEFINITION | 234 | ||
| B. COMPLICATIONS OF OPEN FRACTURES | 235 | ||
| C. GUSTILO-ANDERSON CLASSIFICATION SYSTEM (TABLE 18.1) | 235 | ||
| D. EMERGENCY DEPARTMENT MANAGEMENT OF OPEN FRACTURES | 235 | ||
| III. COMPARTMENT SYNDROME | 237 | ||
| A. DEFINITION | 237 | ||
| B. CAUSES OF COMPARTMENT SYNDROME | 237 | ||
| C. SIGNS AND SYMPTOMS | 237 | ||
| D. DIAGNOSIS OF COMPARTMENT SYNDROME | 238 | ||
| E. SURGICAL TREATMENT OF ACUTE COMPARTMENT SYNDROME | 238 | ||
| IV. PELVIC FRACTURES | 239 | ||
| A. EVALUATION OF PELVIC RING FRACTURES | 239 | ||
| V. VASCULAR INJURY IN EXTREMITY TRAUMA | 241 | ||
| A. HISTORY AND PHYSICAL | 241 | ||
| B. MANAGEMENT OF EXTREMITY TRAUMA | 241 | ||
| C. COMPLICATIONS OF VASCULAR INJURIES | 242.e1 | ||
| VI. AMPUTATION IN TRAUMA | 242 | ||
| 19 - Burn Care | 243 | ||
| I. CAUSATIVE FACTORS | 243 | ||
| A. SCALDS | 243 | ||
| B. FLAME | 243 | ||
| C. FLASH | 243 | ||
| D. CONTACT | 243 | ||
| II. INDICATIONS FOR HOSPITAL ADMISSION | 243 | ||
| A. OUTPATIENT SETTING | 243 | ||
| B. BURN UNIT SETTING | 244 | ||
| III. INITIAL MANAGEMENT | 244 | ||
| A. HISTORY | 244 | ||
| B. AIRWAY/BREATHING | 244 | ||
| C. BURN EVALUATION | 246 | ||
| D. FLUID RESUSCITATION | 247 | ||
| E. INITIAL PROCEDURES | 248 | ||
| F. INITIAL TESTS | 249 | ||
| G. MEDICATIONS | 249 | ||
| IV. PATHOPHYSIOLOGIC CHANGES ASSOCIATED WITH BURN INJURIES | 250 | ||
| A. EDEMA | 250 | ||
| B. HEMODYNAMICS | 250 | ||
| V. BURN WOUND CARE | 250 | ||
| A. GOALS OF BURN WOUND CARE | 250 | ||
| B. TOPICAL AGENTS | 251 | ||
| C. LOCAL CARE | 251 | ||
| D. EARLY EXCISION AND GRAFTING | 251 | ||
| E. GRAFTING | 252 | ||
| VI. SUPPORTIVE CARE | 253 | ||
| A. NUTRITION | 253 | ||
| B. PHYSICAL AND OCCUPATIONAL THERAPY | 253 | ||
| C. ANALGESIA | 254 | ||
| VII. MANAGEMENT OF INFECTION IN THE BURN PATIENT | 254 | ||
| A. THE MOST COMMON INFECTION IN BURN PATIENTS IS PNEUMONIA | 254 | ||
| B. PATHOGENESIS OF WOUND SEPSIS IN AN UNTREATED BURN WOUND | 254 | ||
| C. CLINICAL SIGNS | 254 | ||
| D. DIAGNOSIS OF INVASIVE BURN WOUND SEPSIS | 254 | ||
| E. BACTERIOLOGY OF NOSOCOMIAL BURN INFECTION | 255 | ||
| F. PREVENTION OF BURN INFECTION | 255 | ||
| G. TREATMENT OF BURN INFECTION | 255 | ||
| H. NONBACTERIAL INFECTION | 255 | ||
| VIII. ELECTRICAL INJURIES | 256 | ||
| A. TISSUE DESTRUCTION | 256 | ||
| B. TREATMENT | 256 | ||
| C. FLUID RESUSCITATION | 256 | ||
| D. EARLY DEBRIDEMENT | 256 | ||
| E. IMMEDIATE EXTREMITY FASCIOTOMY | 256 | ||
| IX. CHEMICAL INJURIES | 256 | ||
| A. MANAGEMENT | 256 | ||
| X. OUTPATIENT AND CLINIC TREATMENT | 257 | ||
| A. SELECTION | 257 | ||
| B. TREATMENT | 257 | ||
| C. FOLLOW-UP CARE | 257 | ||
| D. WOUNDS | 257 | ||
| XI. COMPLICATIONS OF BURN INJURIES | 258 | ||
| A. GASTROINTESTINAL | 258 | ||
| B. OCULAR | 258 | ||
| C. CUTANEOUS | 258 | ||
| D. MISCELLANEOUS | 259 | ||
| 20 - Neurosurgical Emergencies | 260 | ||
| I. EVALUATION AND MANAGEMENT OF THE NEUROTRAUMA PATIENT | 260 | ||
| A. INITIAL ASSESSMENT | 260 | ||
| B. UNCONSCIOUS PATIENT | 261 | ||
| C. PHYSICAL EXAMINATION | 262 | ||
| D. RADIOLOGIC EVALUATION | 264 | ||
| II. CRANIAL TRAUMA | 266 | ||
| A. TRAUMATIC BRAIN INJURY | 266 | ||
| B. ELEVATED INTRACRANIAL PRESSURE | 267 | ||
| C. SPECIFIC TRAUMATIC CRANIAL INJURIES | 269 | ||
| D. PENETRATING TRAUMATIC BRAIN INJURY | 273 | ||
| E. TRAUMATIC BRAIN INJURY PROGNOSIS | 274 | ||
| III. SPINAL TRAUMA | 275 | ||
| A. GENERAL | 275 | ||
| B. ASSESSMENT | 275 | ||
| C. SPECIFIC SPINAL INJURIES | 280 | ||
| IV. PERIPHERAL NERVE TRAUMA | 286 | ||
| A. GENERAL | 286 | ||
| B. EVALUATION | 286 | ||
| C. TREATMENT | 288 | ||
| V. TRAUMATIC CEREBROVASCULAR INJURIES | 288 | ||
| B. BLUNT CEREBROVASCULAR INJURY | 288 | ||
| C. EVALUATION | 289 | ||
| D. TREATMENT | 290 | ||
| V - Gastrointestinal Surgery | 293 | ||
| 21 - Acute Abdomen | 295 | ||
| I. PHYSIOLOGY OF ABDOMINAL PAIN | 295 | ||
| A. VISCERAL PAIN | 295 | ||
| B. SOMATIC PAIN | 295 | ||
| C. REFERRED PAIN | 296 | ||
| II. HISTORY | 296 | ||
| A. PAIN | 296 | ||
| B. VOMITING | 297 | ||
| C. BOWEL FUNCTION | 298 | ||
| D. MEDICAL HISTORY | 298 | ||
| E. MEDICATION | 298 | ||
| III. PHYSICAL EXAMINATION | 298 | ||
| A. GENERAL APPEARANCE | 298 | ||
| B. VITAL SIGNS | 299 | ||
| C. ABDOMINAL EXAMINATION | 299 | ||
| D. EXAMINATION OF PELVIC CAVITY | 300 | ||
| IV. LABORATORY EXAMINATION | 301 | ||
| A. WHITE BLOOD CELL COUNT | 301 | ||
| B. HEMATOCRIT | 302 | ||
| C. PLATELET COUNT | 302 | ||
| D. ELECTROLYTES | 302 | ||
| E. ARTERIAL BLOOD GAS | 302 | ||
| F. LIVER FUNCTION TESTS | 302 | ||
| G. AMYLASE LEVEL INCREASE | 302 | ||
| H. URINE STUDIES | 302 | ||
| I. TROPONINS | 302 | ||
| V. RADIOGRAPHIC EVALUATION | 302 | ||
| A. UPRIGHT CHEST RADIOGRAPH | 302 | ||
| B. ABDOMINAL RADIOGRAPH | 303 | ||
| C. ULTRASONOGRAPHY | 303 | ||
| D. COMPUTED TOMOGRAPHY SCAN | 303 | ||
| VI. INITIAL TREATMENT AND PREOPERATIVE PREPARATION | 304 | ||
| A. ASSESSMENT | 304 | ||
| B. DIET | 304 | ||
| C. INTRAVENOUS FLUIDS | 304 | ||
| D. HEMODYNAMIC MONITORING | 304 | ||
| E. NASOGASTRIC TUBE | 304 | ||
| F. FOLEY CATHETER | 304 | ||
| G. TREATMENT | 304 | ||
| 22 - Abdominal Wall Hernias | 305 | ||
| I. HISTORICAL PERSPECTIVE | 305 | ||
| A. HENRY MARCY (1837–1924) | 305 | ||
| B. EDOARDO BASSINI (1844–1924) | 305 | ||
| C. SIR ASTLEY COOPER (1768–1841) | 305 | ||
| D. CHESTER MCVAY (1911–1987) | 305 | ||
| E. EDWARD EARLE SHOULDICE (1890–1965) | 305 | ||
| F. IRVING LICHTENSTEIN AND PARVIZ AMID | 305 | ||
| II. TERMINOLOGY | 306 | ||
| A. HERNIA | 306 | ||
| B. REDUCIBILITY | 306 | ||
| C. INCARCERATION | 306 | ||
| D. STRANGULATION | 306 | ||
| III. NATURAL HISTORY | 306 | ||
| A. INCIDENCE | 306 | ||
| IV. ANATOMIC CONSIDERATIONS | 306 | ||
| A. LAYERS OF THE ABDOMINAL WALL | 306 | ||
| B. INGUINAL CANAL | 307 | ||
| C. SPERMATIC CORD | 307 | ||
| D. PROCESSUS VAGINALIS | 307 | ||
| E. DEEP (INTERNAL) INGUINAL RING | 307 | ||
| F. SUPERFICIAL (EXTERNAL) INGUINAL RING | 307 | ||
| G. HESSELBACH TRIANGLE | 307 | ||
| H. INGUINAL (POUPART) LIGAMENT | 307 | ||
| I. ILIOPUBIC TRACT | 307 | ||
| J. LACUNAR (GIMBERNAT) LIGAMENT | 308 | ||
| K. PECTINEAL (COOPER) LIGAMENT | 308 | ||
| L. FEMORAL CANAL | 308 | ||
| M. INFERIOR LUMBAR (PETIT) TRIANGLE | 308 | ||
| N. SUPERIOR LUMBAR (GRYNFELTT) TRIANGLE | 308 | ||
| V. CLASSIFICATION OF HERNIAS | 308 | ||
| A. GROIN HERNIAS (FIG. 22.1) | 308 | ||
| B. VENTRAL HERNIAS | 308 | ||
| C. MISCELLANEOUS HERNIAS | 309 | ||
| VI. CAUSATIVE FACTORS | 311 | ||
| A. INDIRECT INGUINAL HERNIA | 311 | ||
| B. DIRECT INGUINAL HERNIA | 311 | ||
| C. FEMORAL HERNIA | 311 | ||
| D. CONTRIBUTING FACTORS | 311 | ||
| VII. DIAGNOSIS | 312 | ||
| A. HISTORY | 312 | ||
| B. EXAMINATION | 312 | ||
| C. SMALL BOWEL OBSTRUCTION | 312 | ||
| D. DIFFERENTIAL DIAGNOSIS OF GROIN MASS | 312 | ||
| E. REDUCTION OF INCARCERATED HERNIA | 312 | ||
| F. REDUCTION EN MASSE | 313 | ||
| VIII. PREOPERATIVE CONSIDERATIONS | 313 | ||
| A. PATIENT COMORBIDITIES AND RISK FACTORS | 313 | ||
| B. LAPAROSCOPIC VERSUS OPEN REPAIRS | 313 | ||
| IX. INGUINAL/FEMORAL HERNIA REPAIR | 314 | ||
| A. OPEN REPAIR | 314 | ||
| B. FEMORAL HERNIAS | 315 | ||
| C. LAPAROSCOPIC REPAIR | 315 | ||
| X. VENTRAL/UMBILICAL/INCISIONAL HERNIA REPAIR | 317 | ||
| A. OPEN REPAIR | 317 | ||
| B. LAPAROSCOPIC REPAIR | 318 | ||
| XI. POSTOPERATIVE COMPLICATIONS | 318 | ||
| A. RECURRENT HERNIA | 318 | ||
| B. INFECTION | 319 | ||
| C. BLEEDING | 319 | ||
| D. DYSEJACULATION | 319 | ||
| E. TESTICULAR ATROPHY | 319 | ||
| F. DIFFICULTY VOIDING | 319 | ||
| G. NEUROMA/NEURITIS | 319 | ||
| H. PAIN | 319 | ||
| I. URINARY RETENTION | 320 | ||
| 23 - Gastrointestinal Bleeding | 321 | ||
| I. HISTORY | 321 | ||
| A. CHARACTERIZATION OF BLEEDING | 321 | ||
| B. CAUSATIVE FACTORS | 321 | ||
| C. ADDITIONAL MEDICAL HISTORY | 321 | ||
| II. PHYSICAL EXAMINATION | 322 | ||
| A. GENERAL APPEARANCE | 322 | ||
| B. VITAL SIGNS | 322 | ||
| C. SKIN | 322 | ||
| D. HEAD AND NECK | 322 | ||
| E. ABDOMEN | 322 | ||
| F. DIGITAL RECTAL EXAMINATION | 322 | ||
| III. INITIAL MANAGEMENT | 322 | ||
| A. ASSESS THE MAGNITUDE OF HEMORRHAGE | 322 | ||
| B. STABILIZE HEMODYNAMIC STATUS | 323 | ||
| C. MONITOR FOR CONTINUED BLOOD LOSS | 323 | ||
| IV. LABORATORY EVALUATION | 323 | ||
| A. TYPE AND CROSSMATCH | 323 | ||
| B. HEMOGLOBIN/HEMATOCRIT/RED BLOOD CELLS CHARACTERISTICS | 323 | ||
| C. PLATELET COUNT | 323 | ||
| D. PROTHROMBIN AND PARTIAL THROMBOPLASTIN TIMES | 323 | ||
| E. THROMBOELASTOGRAPHY | 323 | ||
| F. RENAL PROFILE | 326 | ||
| V. INVESTIGATIVE AND DIAGNOSTIC PROCEDURES | 326 | ||
| A. NASOGASTRIC TUBE | 326 | ||
| B. ENDOSCOPY | 326 | ||
| C. ANGIOGRAPHY | 326 | ||
| E. COMPUTED TOMOGRAPHY | 327 | ||
| VI. NONSURGICAL TREATMENT | 327 | ||
| A. ENDOSCOPIC | 327 | ||
| B. ELECTROCAUTERY | 327 | ||
| C. VASOPRESSIN INFUSION | 327 | ||
| D. EMBOLIZATION | 327 | ||
| VII. DISEASE-SPECIFIC THERAPY | 327 | ||
| A. ACUTE HEMORRHAGIC GASTRITIS | 327 | ||
| B. PEPTIC ULCER DISEASE | 327 | ||
| C. ESOPHAGOGASTRIC VARICES | 328 | ||
| D. MALLORY-WEISS TEAR | 328 | ||
| E. DIEULAFOY LESION (EXULCERATIO SIMPLEX) | 329 | ||
| F. NEOPLASM | 329 | ||
| G. DIVERTICULOSIS | 329 | ||
| H. ARTERIOVENOUS MALFORMATIONS | 329 | ||
| I. MECKEL DIVERTICULUM | 330 | ||
| J. BENIGN ANORECTAL DISEASE | 330 | ||
| K. AORTOENTERIC FISTULA | 330 | ||
| 24 - Intestinal Obstruction | 331 | ||
| I. TERMINOLOGY | 331 | ||
| A. ILEUS | 331 | ||
| B. MECHANICAL OBSTRUCTION | 331 | ||
| C. SIMPLE OBSTRUCTION | 331 | ||
| D. CLOSED-LOOP OBSTRUCTION | 331 | ||
| E. STRANGULATION | 331 | ||
| II. CAUSATIVE FACTORS | 331 | ||
| A. SMALL BOWEL OBSTRUCTION | 331 | ||
| B. LARGE BOWEL OBSTRUCTION | 332 | ||
| D. ILEUS | 333 | ||
| III. PRESENTATION | 334 | ||
| A. HISTORY | 334 | ||
| B. PHYSICAL EXAMINATION | 335 | ||
| C. LABORATORY TESTS | 335 | ||
| IV. IMAGING | 336 | ||
| A. PLAIN FILMS | 336 | ||
| B. CONTRAST STUDIES | 337 | ||
| C. COMPUTED TOMOGRAPHY | 339 | ||
| V. MANAGEMENT | 339 | ||
| A. EXPECTANT/PREOPERATIVE MANAGEMENT (FIG. 24.2) | 339 | ||
| B. OPERATIVE MANAGEMENT | 341 | ||
| C. POSTOPERATIVE CARE | 343 | ||
| D. PARALYTIC ILEUS | 343 | ||
| VI. OUTCOMES | 343 | ||
| A. RECURRENCE | 343 | ||
| B. OPERATIVE MORTALITY | 343 | ||
| 25 - Peptic Ulcer Disease | 345 | ||
| I. OCCURRENCE | 345 | ||
| II. PRESENTATION AND EVALUATION | 345 | ||
| A. SYMPTOMS | 345 | ||
| B. PHYSICAL EXAMINATION | 346 | ||
| C. LABORATORY STUDIES | 346 | ||
| D. DEFINITIVE DIAGNOSIS | 346 | ||
| E. MODIFIED JOHNSON CLASSIFICATION | 346 | ||
| III. PATHOGENESIS | 346 | ||
| IV. HELICOBACTER PYLORI | 348 | ||
| V. TREATMENT OF UNCOMPLICATED DISEASE | 349 | ||
| A. PREVENTION | 349 | ||
| B. EMPIRIC MEDICAL THERAPY | 349 | ||
| C. CONCERN FOR GASTRIC CANCER | 349 | ||
| D. SURGICAL THERAPY | 349 | ||
| VI. TREATMENT OF COMPLICATED DISEASE | 349 | ||
| A. CONCERN FOR GASTRIC CANCER | 349 | ||
| B. BLEEDING PEPTIC ULCER | 350 | ||
| C. PERFORATED PEPTIC ULCER | 350 | ||
| D. OBSTRUCTION | 350 | ||
| E. INTRACTABILITY—CURRENTLY RARE | 351 | ||
| VII. DETAILS OF SURGICAL OPTIONS | 351 | ||
| A. HIGHLY SELECTIVE VAGOTOMY (OR PROXIMAL GASTRIC OR PARIETAL CELL) | 351 | ||
| B. OMENTAL (GRAHAM) PATCH | 351 | ||
| C. VAGOTOMY AND DRAINAGE | 351 | ||
| D. VAGOTOMY AND ANTRECTOMY | 351 | ||
| E. DISTAL GASTRECTOMY | 352 | ||
| F. POSTOPERATIVE COMPLICATIONS | 352 | ||
| 26 - Inflammatory Bowel Disease | 355 | ||
| I. INFLAMMATORY BOWEL DISEASE | 355 | ||
| A. ULCERATIVE COLITIS | 355 | ||
| B. CROHN DISEASE | 355 | ||
| C. INDETERMINATE COLITIS | 355 | ||
| D. ETIOLOGY | 355 | ||
| II. EXTRAINTESTINAL MANIFESTATIONS | 355 | ||
| A. CUTANEOUS | 355 | ||
| B. OCULAR | 356 | ||
| C. MUSCULOSKELETAL | 356 | ||
| D. HEPATOBILIARY | 356 | ||
| III. ULCERATIVE COLITIS | 356 | ||
| A. PATHOPHYSIOLOGY AND DISTRIBUTION | 356 | ||
| B. EPIDEMIOLOGY | 357 | ||
| C. CLINICAL MANIFESTATIONS | 357 | ||
| D. DIAGNOSIS | 357 | ||
| E. COMPLICATIONS | 358 | ||
| F. MEDICAL MANAGEMENT | 359 | ||
| G. SURGICAL MANAGEMENT | 361 | ||
| H. PROGNOSIS | 362 | ||
| IV. CROHN DISEASE | 363 | ||
| A. EPIDEMIOLOGY | 363 | ||
| B. PATHOPHYSIOLOGY AND DISTRIBUTION | 363 | ||
| C. CLINICAL MANIFESTATIONS | 363 | ||
| D. DIAGNOSIS | 364 | ||
| E. COMPLICATIONS | 365 | ||
| F. MEDICAL MANAGEMENT (SEE SECTION III.G) | 365 | ||
| G. SURGICAL MANAGEMENT | 366 | ||
| H. PROGNOSIS | 368 | ||
| V. INDETERMINATE COLITIS | 369 | ||
| A. TYPICALLY PRESENT WITH SYMPTOMS SIMILAR TO ULCERATIVE COLITIS | 369 | ||
| 27 - Benign Esophageal Disease | 371 | ||
| I. ANATOMY | 371 | ||
| A. GENERAL DESCRIPTION | 371 | ||
| B. BLOOD SUPPLY AND NERVES | 371 | ||
| C. HISTOLOGY | 372 | ||
| II. PHYSIOLOGY | 373 | ||
| A. SWALLOWING MECHANISM | 373 | ||
| B. SPHINCTERS | 373 | ||
| III. MOTILITY DISORDERS | 374 | ||
| A. ACHALASIA | 374 | ||
| B. DIFFUSE ESOPHAGEAL SPASM | 374 | ||
| C. NUTCRACKER ESOPHAGUS | 375 | ||
| D. HYPERTENSIVE LES | 375 | ||
| E. SCLERODERMA | 375 | ||
| IV. DIVERTICULA | 375 | ||
| A. DEFINITION | 375 | ||
| B. PHARYNGOESOPHAGEAL (ZENKER DIVERTICULUM) | 376 | ||
| C. MIDESOPHAGEAL | 376 | ||
| D. EPIPHRENIC | 376 | ||
| V. GASTROESOPHAGEAL REFLUX | 377 | ||
| A. ANATOMY | 377 | ||
| B. PATHOPHYSIOLOGY | 377 | ||
| C. DIAGNOSIS | 377 | ||
| D. TREATMENT | 378 | ||
| E. HIATAL HERNIA | 379 | ||
| F. BARRETT ESOPHAGUS | 380 | ||
| VI. BENIGN TUMORS OF THE ESOPHAGUS | 380 | ||
| A. LEIOMYOMA | 380 | ||
| B. OTHER BENIGN LESIONS | 380 | ||
| VII. ESOPHAGEAL RUPTURE AND PERFORATION | 381 | ||
| A. CAUSATIVE FACTORS | 381 | ||
| B. CLINICAL PRESENTATION | 381 | ||
| C. DIAGNOSIS | 381 | ||
| D. TREATMENT | 381 | ||
| VIII. CAUSTIC INJURY | 383 | ||
| A. BACKGROUND | 383 | ||
| B. CLINICAL PRESENTATION | 383 | ||
| C. DIAGNOSIS | 383 | ||
| D. TREATMENT | 383 | ||
| 28 - Benign Colorectal Disease | 386 | ||
| I. ANATOMY | 386 | ||
| A. RECTUM | 386 | ||
| B. ANAL CANAL | 386 | ||
| C. LEVATOR ANI MUSCLE | 386 | ||
| D. BLOOD SUPPLY AND LYMPHATIC DRAINAGE | 386 | ||
| II. HEMORRHOIDS | 387 | ||
| A. SIGNS AND SYMPTOMS | 388 | ||
| B. DIAGNOSIS | 388 | ||
| C. MEDICAL TREATMENT | 388 | ||
| D. OFFICE TREATMENT | 388 | ||
| E. SURGICAL HEMORRHOIDECTOMY | 389 | ||
| III. ANAL FISSURE | 390 | ||
| A. OVERVIEW | 390 | ||
| B. SIGNS AND SYMPTOMS | 390 | ||
| C. TREATMENT | 390 | ||
| IV. ANORECTAL ABSCESS | 391 | ||
| A. CLASSIFICATION (BASED ON LOCATION) | 391 | ||
| B. SIGNS AND SYMPTOMS | 392 | ||
| C. TREATMENT | 392 | ||
| V. FISTULA IN ANO | 393 | ||
| A. GENERAL | 393 | ||
| B. CLASSIFICATION | 393 | ||
| C. GOODSALL RULE | 393 | ||
| D. SIGNS AND SYMPTOMS | 394 | ||
| E. TREATMENT | 394 | ||
| VI. PILONIDAL DISEASE | 394 | ||
| A. GENERAL | 394 | ||
| B. TREATMENT | 395 | ||
| VII. ANAL AND PERIANAL INFECTIONS | 396 | ||
| A. CONDYLOMATA ACUMINATA | 396 | ||
| B. ANORECTAL HERPES | 396 | ||
| C. GONOCOCCAL PROCTITIS | 396 | ||
| VIII. PRURITUS ANI | 397 | ||
| A. ETIOLOGY | 397 | ||
| B. DIAGNOSIS | 397 | ||
| C. TREATMENT | 397 | ||
| IX. ANAL NEOPLASM | 398 | ||
| A. TUMORS OF THE ANAL CANAL | 398 | ||
| X. RECTAL PROLAPSE | 399 | ||
| A. CLASSIFICATION | 399 | ||
| B. CLINICAL FEATURES | 399 | ||
| C. EVALUATION | 400 | ||
| D. TREATMENT OPTIONS | 401 | ||
| XI. ANOSCOPY | 401 | ||
| A. GENERAL | 401 | ||
| B. TECHNIQUE | 401 | ||
| XII. RIGID SIGMOIDOSCOPY | 402 | ||
| A. GENERAL | 402 | ||
| B. TECHNIQUE | 402 | ||
| 29 - Appendix | 403 | ||
| I. OVERVIEW | 403 | ||
| A. ANATOMY | 403 | ||
| B. FUNCTION | 403 | ||
| II. EPIDEMIOLOGY | 403 | ||
| A. GENERAL | 403 | ||
| B. MORBIDITY AND MORTALITY | 403 | ||
| III. PATHOPHYSIOLOGY | 404 | ||
| A. GENERAL | 404 | ||
| B. COMPLICATIONS | 404 | ||
| IV. PRESENTATION | 404 | ||
| A. HISTORY | 404 | ||
| B. PHYSICAL EXAMINATION | 404 | ||
| C. LABORATORY AND RADIOLOGIC FINDINGS | 405 | ||
| V. DIFFERENTIAL DIAGNOSIS | 405 | ||
| VI. COMPLICATIONS | 406 | ||
| A. PERFORATION | 406 | ||
| B. PERITONITIS | 406 | ||
| C. ABSCESS | 406 | ||
| VII. TREATMENT | 406 | ||
| A. GENERAL | 406 | ||
| B. TECHNIQUE | 407 | ||
| C. LAPAROSCOPY | 408 | ||
| D. FUTURE RESEARCH | 409 | ||
| VIII. SPECIAL CIRCUMSTANCES | 409 | ||
| A. OLDER ADULTS | 409 | ||
| B. INFANTS | 409 | ||
| C. PREGNANCY | 409 | ||
| IX. APPENDICEAL TUMORS | 410 | ||
| A. CARCINOID | 410 | ||
| B. ADENOCARCINOMA | 410 | ||
| C. PSEUDOMYXOMA | 411 | ||
| 30 - Benign Pancreatic Disease | 412 | ||
| I. ANATOMY | 412 | ||
| A. EMBRYOLOGY | 412 | ||
| B. HISTOLOGY | 412 | ||
| C. GROSS ANATOMY | 413 | ||
| D. VASCULAR/LYMPHATIC ANATOMY | 413 | ||
| E. DUCT SYSTEM | 415 | ||
| II. ACUTE PANCREATITIS | 416 | ||
| A. BASICS | 416 | ||
| B. PATHOGENESIS | 416 | ||
| C. ETIOLOGY/RISK FACTORS | 417 | ||
| D. DIAGNOSIS | 419 | ||
| E. TREATMENT | 421 | ||
| F. PROGNOSIS | 422 | ||
| G. COMPLICATIONS | 423 | ||
| III. CHRONIC PANCREATITIS | 427 | ||
| A. BASICS | 427 | ||
| B. ETIOLOGY | 428 | ||
| C. DIAGNOSIS | 429 | ||
| D. TREATMENT | 429 | ||
| E. COMPLICATIONS | 432 | ||
| 31 - Surgical Diseases of the Spleen | 434 | ||
| I. ANATOMY | 434 | ||
| A. AVERAGE ADULT SPLEEN | 434 | ||
| B. ENCAPSULATED | 434 | ||
| C. SPLENOMEGALY DEFINITION | 434 | ||
| D. BLOOD SUPPLY | 434 | ||
| E. STRUCTURAL SUPPORT | 434 | ||
| F. MICROANATOMY | 434 | ||
| G. ACCESSORY SPLEENS | 435 | ||
| II. FUNCTION | 435 | ||
| A. HEMATOLOGIC | 435 | ||
| B. IMMUNOLOGIC | 435 | ||
| III. GENERAL INDICATIONS FOR SPLENECTOMY | 435 | ||
| A. TRAUMA | 435 | ||
| B. RED BLOOD CELL DISORDERS | 435 | ||
| C. MYELOPROLIFERATIVE DISORDERS | 436 | ||
| D. WHITE BLOOD CELLS DISORDERS | 436 | ||
| E. PLATELET DISORDERS | 437 | ||
| F. OTHER SPLENIC DISORDERS | 438 | ||
| IV. SURGICAL TECHNIQUES | 439 | ||
| A. OPEN SPLENECTOMY | 439 | ||
| B. LAPAROSCOPIC SPLENECTOMY | 439 | ||
| C. HAND-ASSISTED TECHNIQUE | 439 | ||
| V. POSTSPLENECTOMY CONSIDERATIONS | 439 | ||
| A. OVERWHELMING POSTSPLENECTOMY INFECTION | 439 | ||
| B. POSTSPLENECTOMY HEMATOLOGIC CHANGES | 440 | ||
| C. HEMORRHAGE | 440 | ||
| D. INFECTION | 440 | ||
| E. PORTAL VEIN THROMBOSIS | 440 | ||
| F. PANCREATITIS, PSEUDOCYST, FISTULA | 441 | ||
| 32 - Bariatric Surgery | 442 | ||
| I. EPIDEMIOLOGY OF MORBID OBESITY | 442 | ||
| A. DEFINITIONS | 442 | ||
| B. CAUSES OF OBESITY | 442 | ||
| C. EPIDEMIOLOGY | 442 | ||
| II. COMORBIDITY ASSOCIATED WITH MORBID OBESITY | 443 | ||
| A. NEOPLASIA | 443 | ||
| B. CARDIOVASCULAR DISEASE | 443 | ||
| C. PULMONARY DISEASE | 443 | ||
| D. ENDOCRINE DISEASE | 443 | ||
| E. GASTROINTESTINAL DISEASE | 443 | ||
| F. OTHER COMORBIDITIES ASSOCIATED WITH MORBID OBESITY | 443 | ||
| III. MEDICAL THERAPY FOR MORBID OBESITY | 444 | ||
| IV. TYPES OF PROCEDURES | 444 | ||
| A. MALABSORPTIVE OPERATIONS | 444 | ||
| B. RESTRICTIVE OPERATIONS | 444 | ||
| C. COMBINED OPERATIONS ARE RESTRICTIVE AND MALABSORPTIVE | 444 | ||
| V. PREOPERATIVE WORK-UP | 444 | ||
| A. PATIENT SELECTION CRITERIA | 444 | ||
| B. PREOPERATIVE ASSESSMENT—MULTIDISCIPLINARY APPROACH | 445 | ||
| C. CONTRAINDICATIONS | 445 | ||
| VI. SURGICAL PROCEDURES FOR THE BARIATRIC PATIENT | 445 | ||
| A. LAPAROSCOPIC SLEEVE GASTRECTOMY | 445 | ||
| B. LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS | 446 | ||
| C. LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING | 447 | ||
| D. JEJUNOILEAL BYPASS | 448 | ||
| E. VERTICAL BANDED GASTROPLASTY | 448 | ||
| F. BILIOPANCREATIC DIVERSION | 448 | ||
| VII. RESULTS OF BARIATRIC SURGERY | 448 | ||
| A. SURGICAL THERAPY | 448 | ||
| B. RISK REDUCTION | 448 | ||
| E. WEIGHT LOSS | 449 | ||
| VI - Surgical Oncology | 451 | ||
| 33 - Tumor Biology, Syndromes, and Genetic Mutations | 453 | ||
| I. SELF-SUFFICIENCY IN GROWTH SIGNALS | 453 | ||
| A. GROWTH FACTORS | 453 | ||
| B. ALTERATION OF GROWTH SIGNALING PATHWAYS | 453 | ||
| C. SOS/RAS/RAF/MITOGEN-ACTIVATED PROTEIN KINASE PATHWAY | 453 | ||
| D. TUMOR GROWTH IS DEPENDENT ON MANY FACTORS | 453 | ||
| II. INSENSITIVITY TO GROWTH-INHIBITORY SIGNALS | 453 | ||
| A. RETINOBLASTOMA PROTEIN | 453 | ||
| III. EVASION OF PROGRAMMED CELL DEATH | 454 | ||
| A. P53 TUMOR-SUPPRESSOR PROTEIN | 454 | ||
| B. EXTRINSIC APOPTOSIS INDUCTION | 454 | ||
| IV. LIMITLESS REPLICATIVE POTENTIAL | 454 | ||
| V. SUSTAINED ANGIOGENESIS | 454 | ||
| VI. TISSUE INVASION AND METASTASIS | 455 | ||
| A. TETHERING MOLECULES ARE ALTERED | 455 | ||
| B. PROTEASES DEGRADE EXTRACELLULAR MATRICES | 455 | ||
| VII. GENETIC INSTABILITY | 455 | ||
| A. THE PREVIOUS SIX (I–VI) CHARACTERISTICS MUST BE OBTAINED THROUGH GENETIC ALTERATION | 455 | ||
| B. MALFUNCTION OF THE “CARETAKER” SYSTEM | 455 | ||
| VIII. FAMILIAL CANCER SYNDROMES | 456 | ||
| A. FAMILIAL ADENOMATOUS POLYPOSIS | 456 | ||
| B. HEREDITARY BREAST-OVARIAN CANCER SYNDROMES | 456 | ||
| D. LI-FRAUMENI SYNDROME | 456 | ||
| E. MULTIPLE ENDOCRINE NEOPLASIA | 456 | ||
| F. VON HIPPEL-LINDAU DISEASE | 457 | ||
| G. COWDEN SYNDROME | 457 | ||
| H. HEREDITARY DIFFUSE GASTRIC CANCER | 457 | ||
| I. PEUTZ-JEGHERS SYNDROME | 457 | ||
| IX. PHARMACOTHERAPY | 457 | ||
| A. TUMOR GROWTH AND KINETICS | 457 | ||
| B. DRUG MECHANISMS AND THERAPEUTICS | 457 | ||
| X. CHEMOTHERAPEUTIC AGENTS: MECHANISMS, USES, AND IMPORTANT TOXICITIES | 459 | ||
| A. ALKYLATING AGENTS | 459 | ||
| B. ANTIMETABOLITES | 459 | ||
| C. ANTITUMOR ANTIBIOTICS | 459 | ||
| D. MITOTIC INHIBITORS | 460 | ||
| E. HORMONAL AGENTS | 460 | ||
| F. IMMUNOTHERAPY | 460 | ||
| G. MISCELLANEOUS | 461 | ||
| RECOMMENDED READINGS | 461 | ||
| 34 - Head and Neck Malignancy | 462 | ||
| I. EPIDEMIOLOGY | 462 | ||
| II. WORK-UP OF A NECK MASS | 462 | ||
| III. NECK DISSECTION | 463 | ||
| IV. TREATMENT OF CANCER BY SITE | 465 | ||
| A. CARCINOMA OF THE ORAL CAVITY AND LIP | 465 | ||
| B. OROPHARYNGEAL CARCINOMA | 465 | ||
| C. LARYNGEAL CANCER | 465 | ||
| D. HYPOPHARYNGEAL | 466 | ||
| E. NASOPHARYNGEAL CARCINOMA | 467 | ||
| F. SALIVARY GLAND TUMORS | 467 | ||
| V. NECK DISSECTION INDICATIONS FOR SALIVARY GLAND MALIGNANCY | 469 | ||
| A. RARER SITES OF CARCINOMA | 469 | ||
| 35 - Esophageal Malignancy | 470 | ||
| I. ESOPHAGEAL ANATOMY | 470 | ||
| II. EPIDEMIOLOGY | 470 | ||
| III. HISTOLOGY AND RISK FACTORS | 470 | ||
| IV. DIAGNOSIS AND STAGING | 471 | ||
| V. TNM STAGING SYSTEM | 472 | ||
| VI. TREATMENT PLANNING | 473 | ||
| A. IMPLICATIONS FOR THERAPY | 474 | ||
| VII. ESOPHAGECTOMY | 474 | ||
| VIII. ESOPHAGECTOMY APPROACHES | 474 | ||
| IX. ENDOSCOPIC THERAPIES | 475 | ||
| X. CHEMOTHERAPY AND RADIOTHERAPY | 476 | ||
| XI. PALLIATIVE CARE | 477 | ||
| A. DYSPHAGIA AND OBSTRUCTION | 477 | ||
| B. ESOPHAGEAL-AIRWAY FISTULA | 477 | ||
| 36 - Gastric Malignancy | 478 | ||
| I. ADENOCARCINOMA OF THE STOMACH | 478 | ||
| A. EPIDEMIOLOGY | 478 | ||
| B. RISK FACTORS | 478 | ||
| C. PATHOLOGIC CLASSIFICATIONS | 479 | ||
| D. CLINICAL MANIFESTATIONS | 480 | ||
| E. SCREENING | 480 | ||
| F. DIAGNOSIS/STAGING | 480 | ||
| I. SURGICAL TREATMENT | 481 | ||
| J. NEOADJUVANT/ADJUVANT THERAPY | 483 | ||
| K. PROGNOSIS (5-YEAR SURVIVAL) | 483 | ||
| II. GASTRIC LYMPHOMA | 483 | ||
| A. GENERAL CONSIDERATIONS | 483 | ||
| B. CLINICAL PRESENTATION | 484 | ||
| C. PATHOLOGY | 484 | ||
| D. DIAGNOSIS | 484 | ||
| E. TREATMENT | 484 | ||
| III. GASTROINTESTINAL STROMAL TUMORS | 484 | ||
| A. GENERAL CONSIDERATIONS | 484 | ||
| B. OTHER CHARACTERISTICS | 484 | ||
| C. DIAGNOSIS | 485 | ||
| D. PATHOLOGIC LESIONS | 485 | ||
| E. TREATMENT | 485 | ||
| 37 - Small Bowel Malignancy | 486 | ||
| I. EPIDEMIOLOGY | 486 | ||
| A. INCIDENCE | 486 | ||
| B. TUMOR CHARACTERISTICS | 486 | ||
| C. GENETIC PREDISPOSITION AND PATHOGENESIS | 487 | ||
| II. DIAGNOSIS | 488 | ||
| III. STAGING | 490 | ||
| A. ADENOCARCINOMA | 490 | ||
| B. LYMPHOMA | 490 | ||
| C. SARCOMA AND CARCINOID TUMORS | 490 | ||
| IV. MANAGEMENT | 490 | ||
| A. SURGERY | 490 | ||
| B. CHEMOTHERAPY | 490 | ||
| 38 - Malignant Colorectal and Perianal Disease | 492 | ||
| I. COLORECTAL CANCER: EPIDEMIOLOGY | 492 | ||
| A. EACH YEAR IN THE UNITED STATES, 135,000 CASES OF COLORECTAL CANCER WILL BE DIAGNOSED | 492 | ||
| B. ALMOST 50,000 PEOPLE DIE OF COLORECTAL CANCER ANNUALLY IN THE UNITED STATES. | 492 | ||
| II. RISK FACTORS | 492 | ||
| III. SIGNS AND SYMPTOMS | 492 | ||
| IV. SCREENING GUIDELINES FOR COLORECTAL CANCER | 493 | ||
| A. AVERAGE-RISK PATIENT, STARTING AT AGE 50–75 YEARS—ANY OF THE FOLLOWING SCREENING MODALITIES ARE ACCEPTED | 493 | ||
| C. FAMILIAL ADENOMATOUS POLYPOSIS | 493 | ||
| D. HEREDITARY NONPOLYPOSIS COLORECTAL CANCER | 493 | ||
| E. FAMILY HISTORY | 493 | ||
| V. POLYPS | 494 | ||
| VI. PATHOGENESIS | 494 | ||
| A. LOSS OF HETEROZYGOSITY PATHWAY—80% OF CASES | 494 | ||
| B. REPLICATION ERROR REPAIR PATHWAY—20% OF CASES | 495 | ||
| C. ADENOMATOUS POLYPOSIS SYNDROMES | 495 | ||
| D. NONADENOMATOUS POLYPOSIS SYNDROMES | 495 | ||
| E. NONPOLYPOSIS SYNDROMES | 495 | ||
| VII. PREOPERATIVE EVALUATION | 496 | ||
| A. COMPLETE HISTORY | 496 | ||
| B. COLONOSCOPY | 496 | ||
| C. RECTAL CANCER | 496 | ||
| D. CARCINOEMBRYONIC ANTIGEN | 496 | ||
| VIII. TREATMENT OF COLON CANCER | 498 | ||
| A. GENERAL PRINCIPLES | 498 | ||
| B. SURGICAL THERAPY FOR RESECTABLE MASSES | 498 | ||
| C. CHEMOTHERAPEUTIC REGIMENS | 498 | ||
| D. STAGE-SPECIFIC THERAPY | 498 | ||
| IX. RECTAL CANCER | 500 | ||
| A. STAGE-SPECIFIC THERAPY | 500 | ||
| B. OPERATIVE APPROACH | 500 | ||
| C. CHEMOTHERAPEUTIC REGIMENS | 501 | ||
| X. POSTOPERATIVE FOLLOW-UP | 501 | ||
| A. DIAGNOSIS AND TREATMENT | 501 | ||
| B. TREATMENT OF LOCAL RECURRENT DISEASE | 502 | ||
| XI. ANAL CANCER | 502 | ||
| XII. TUMORS OF THE ANAL CANAL | 503 | ||
| XIII. SIGNS AND SYMPTOMS | 503 | ||
| XIV. SCREENING | 503 | ||
| XV. ANATOMY AND CHARACTERIZATION | 503 | ||
| A. ANAL TUMORS ARE CLASSIFIED INTO TWO GROUPS | 503 | ||
| B. ANATOMY | 503 | ||
| XVI. TUMORS OF THE ANAL CANAL | 503 | ||
| A. ANAL INTRAEPITHELIAL NEOPLASIA | 503 | ||
| C. DIAGNOSIS | 505 | ||
| D. STAGING | 505 | ||
| E. TREATMENT | 505 | ||
| F. ADENOCARCINOMA OF THE ANAL CANAL | 505 | ||
| XVII. TUMORS OF THE ANAL MARGIN | 505 | ||
| A. SQUAMOUS CELL CARCINOMA | 505 | ||
| B. DIAGNOSIS AND STAGING | 505 | ||
| C. TREATMENT | 505 | ||
| XVIII. MALIGNANT MELANOMA OF THE ANAL MARGIN/CANAL | 506 | ||
| A. DIAGNOSIS AND STAGING | 506 | ||
| B. TREATMENT | 506 | ||
| 39 - Malignant Pancreas Disease | 507 | ||
| I. PANCREATIC ADENOCARCINOMA | 507 | ||
| A. EPIDEMIOLOGY | 507 | ||
| B. CAUSATIVE FACTORS | 507 | ||
| C. PATHOLOGY | 508 | ||
| D. PRESENTATION | 508 | ||
| E. DIAGNOSTIC EVALUATION/STAGING | 509 | ||
| F. SURGICAL THERAPY/RESECTABILITY | 511 | ||
| G. NEOADJUVANT THERAPY | 512 | ||
| H. ADJUVANT THERAPY | 512 | ||
| I. SURVEILLANCE | 512 | ||
| J. SURVIVAL | 512 | ||
| II. PREMALIGNANT CYSTIC NEOPLASMS OF THE PANCREAS | 513 | ||
| A. MUCINOUS CYSTIC NEOPLASMS (MCNS) | 513 | ||
| B. INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS | 513 | ||
| 40 - Diseases of the Breast | 515 | ||
| I. ANATOMY AND PHYSIOLOGY | 515 | ||
| A. ANATOMY BASICS | 515 | ||
| B. LYMPHATIC DRAINAGE | 515 | ||
| C. NERVES | 516 | ||
| D. BLOOD SUPPLY | 516 | ||
| E. PHYSIOLOGY | 516 | ||
| II. HISTORY | 516 | ||
| A. AGE | 516 | ||
| B. MASS | 517 | ||
| C. NIPPLE DISCHARGE (TABLE 40.1) | 517 | ||
| D. BREAST PAIN (MASTODYNIA) | 517 | ||
| E. GYNECOLOGIC HISTORY | 517 | ||
| F. MEDICAL HISTORY | 518 | ||
| G. SURGICAL HISTORY | 518 | ||
| H. FAMILY HISTORY | 518 | ||
| I. CONSTITUTIONAL SYMPTOMS | 518 | ||
| III. PHYSICAL EXAMINATION | 518 | ||
| A. INSPECTION | 518 | ||
| B. PALPATION | 518 | ||
| C. SCREENING | 518 | ||
| IV. RADIOGRAPHIC STUDIES | 519 | ||
| A. MAMMOGRAPHY | 519 | ||
| B. MAMMOGRAPHIC FINDINGS SUGGESTIVE OF MALIGNANCY | 519 | ||
| C. ULTRASONOGRAPHY | 519 | ||
| D. MAGNETIC RESONANCE IMAGING | 519 | ||
| E. DIGITAL BREAST TOMOSYNTHESIS | 520 | ||
| V. EVALUATION OF BREAST MASS | 520 | ||
| A. NIPPLE DISCHARGE | 520 | ||
| B. PALPABLE LESIONS | 520 | ||
| C. FINE-NEEDLE ASPIRATION BIOPSY | 520 | ||
| D. CORE NEEDLE BIOPSY (PERCUTANEOUS) | 521 | ||
| E. EXCISIONAL BIOPSY | 521 | ||
| VI. BENIGN BREAST DISEASE | 521 | ||
| A. GALACTORRHEA | 521 | ||
| B. FIBROCYSTIC CHANGES | 521 | ||
| C. FIBROADENOMA | 522 | ||
| D. PHYLLODES TUMOR AND CYSTOSARCOMA PHYLLODES | 522 | ||
| E. INTRADUCTAL PAPILLOMA | 523 | ||
| F. FAT NECROSIS | 523 | ||
| G. PLASMA CELL MASTITIS AND PERIDUCTAL MASTITIS | 523 | ||
| H. GALACTOCELE | 523 | ||
| I. MASTITIS AND BREAST ABSCESS | 524 | ||
| J. MONDOR DISEASE | 524 | ||
| K. GYNECOMASTIA | 524 | ||
| L. POLAND SYNDROME | 525 | ||
| VII. BREAST CANCER | 525 | ||
| A. EPIDEMIOLOGY | 525 | ||
| B. RISK FACTORS | 525 | ||
| C. CLINICAL PRESENTATION | 526 | ||
| D. TNM CLASSIFICATION | 526 | ||
| E. STAGING | 527 | ||
| F. PATHOLOGIC LESIONS | 527 | ||
| G. SURGICAL TREATMENT OPTIONS | 530 | ||
| H. SURGICAL TREATMENT BY STAGE | 531 | ||
| I. RADIOTHERAPY TO CHEST AND BREAST | 532 | ||
| J. CHEMOTHERAPY AND HORMONAL THERAPY | 533 | ||
| K. BREAST CANCER AND PREGNANCY | 534 | ||
| L. MALE BREAST CANCER | 536 | ||
| 41 - Malignant Skin Lesions | 538 | ||
| I. BASAL CELL CARCINOMA | 538 | ||
| A. GENERAL | 538 | ||
| B. DIAGNOSIS | 538 | ||
| C. TREATMENT | 538 | ||
| II. SQUAMOUS CELL CARCINOMA | 539 | ||
| VII - Hepatobiliary Surgery | 545 | ||
| 42 - Benign Gallbladder and Biliary Tree | 547 | ||
| I. ANATOMY | 547 | ||
| A. GALLBLADDER | 547 | ||
| B. BILE DUCTS | 547 | ||
| C. ANOMALIES | 548 | ||
| II. CHOLELITHIASIS | 548 | ||
| A. INCIDENCE | 548 | ||
| B. CAUSATIVE FACTORS | 548 | ||
| C. TYPES OF GALLSTONES | 549 | ||
| D. TREATMENT OF ASYMPTOMATIC CHOLELITHIASIS | 549 | ||
| III. SYMPTOMATIC CHOLELITHIASIS | 549 | ||
| A. BILIARY COLIC | 549 | ||
| B. ACUTE CALCULOUS CHOLECYSTITIS | 550 | ||
| IV. CHOLEDOCHOLITHIASIS | 552 | ||
| A. CAUSATIVE FACTORS AND NATURAL HISTORY | 552 | ||
| B. TREATMENT | 552 | ||
| V. CHOLANGITIS | 554 | ||
| A. CAUSATIVE FACTORS AND PATHOPHYSIOLOGY | 554 | ||
| B. CLINICAL FEATURES AND DIAGNOSIS | 554 | ||
| C. TREATMENT | 554 | ||
| VI. ACALCULOUS CHOLECYSTITIS | 555 | ||
| A. EPIDEMIOLOGY AND PATHOGENESIS | 555 | ||
| B. NATURAL HISTORY | 555 | ||
| C. CLINICAL MANIFESTATION AND DIAGNOSIS | 555 | ||
| D. TREATMENT | 555 | ||
| VII. OTHER DISORDERS OF THE GALLBLADDER | 556 | ||
| A. GALLSTONE DISEASE IN PREGNANCY | 556 | ||
| B. BILIARY DYSKINESIA | 556 | ||
| C. BILIARY SLUDGE | 556 | ||
| D. MIRIZZI SYNDROME | 556 | ||
| E. GALLSTONE ILEUS | 556 | ||
| F. EMPHYSEMATOUS CHOLECYSTITIS | 557 | ||
| G. CALCIFIED “PORCELAIN” GALLBLADDER | 557 | ||
| VIII. MEDICAL TREATMENTS | 557 | ||
| A. ORAL DISSOLUTION THERAPY | 557 | ||
| B. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY | 558 | ||
| IX. LAPAROSCOPIC CHOLECYSTECTOMY | 558 | ||
| A. SETUP | 558 | ||
| B. TECHNIQUE (FIGS. 42.1 AND 42.2) | 558 | ||
| C. POSTOPERATIVE CARE | 559 | ||
| D. COMPLICATIONS | 559 | ||
| 43 - Malignant Gallbladder and Biliary Tree | 562 | ||
| I. GALLBLADDER CANCER | 562 | ||
| A. GENERAL CONSIDERATIONS | 562 | ||
| B. PRESENTATION | 562 | ||
| C. TREATMENT | 562 | ||
| II. BILE DUCT CANCER (CHOLANGIOCARCINOMA) | 563 | ||
| A. GENERAL CONSIDERATIONS | 563 | ||
| B. INTRAHEPATIC CHOLANGIOCARCINOMA | 563 | ||
| C. EXTRAHEPATIC CHOLANGIOCARCINOMA | 564 | ||
| 44 - Benign Liver Disease, Cirrhosis, and Portal Hypertension | 565 | ||
| I. PATHOPHYSIOLOGY | 565 | ||
| II. MORPHOLOGY | 565 | ||
| III. ETIOLOGY | 565 | ||
| IV. DIAGNOSIS | 567 | ||
| V. CLASSIFICATION | 568 | ||
| VI. CONSEQUENCES OF CIRRHOSIS | 569 | ||
| VII. HEPATIC SYNDROMES | 575 | ||
| 45 - Liver Tumors | 576 | ||
| VIII - Transplant Surgery | 583 | ||
| 46 - Renal Transplantation | 585 | ||
| I. GENERAL CONSIDERATIONS | 585 | ||
| A. HISTORY AND EPIDEMIOLOGY | 585 | ||
| B. IMMUNOLOGY OF RENAL TRANSPLANTATION | 585 | ||
| C. IMMUNOSUPPRESSION | 585 | ||
| II. EVALUATION OF CANDIDATES FOR TRANSPLANTATION | 586 | ||
| A. INDICATIONS | 586 | ||
| C. RELATIVE CONTRAINDICATIONS | 586 | ||
| D. PATIENT EVALUATION | 586 | ||
| E. INDICATION FOR PRETRANSPLANT NATIVE NEPHRECTOMY | 587 | ||
| III. KIDNEY DONATION | 587 | ||
| A. LIVING DONOR KIDNEY TRANSPLANTATION | 587 | ||
| B. CLASSICALLY DEFINED DONOR CATEGORIES | 587 | ||
| IV. SPECIFIC OPERATIVE CONSIDERATIONS | 588 | ||
| A. LIVING DONOR NEPHRECTOMY | 588 | ||
| B. TRANSPLANT PROCEDURE | 588 | ||
| V. POSTOPERATIVE CONSIDERATIONS | 588 | ||
| A. POSTOPERATIVE CARE | 588 | ||
| B. ASSESSMENT OF GRAFT FUNCTION | 589 | ||
| C. COMPLICATIONS | 589 | ||
| VI. OUTCOMES | 590 | ||
| A. SURVIVAL BENEFIT OF RENAL TRANSPLANTATION | 590 | ||
| B. SURVIVAL | 590 | ||
| 47 - Liver Transplantation | 593 | ||
| I. GENERAL CONSIDERATIONS | 593 | ||
| A. HISTORY | 593 | ||
| B. INDICATIONS AND LISTING PROCESS FOR TRANSPLANTATION | 593 | ||
| C. SPECIFIC INDICATIONS | 593 | ||
| D. CONTRAINDICATIONS | 594 | ||
| E. ORGAN SELECTION | 594 | ||
| II. SPECIFIC OPERATIVE CONSIDERATIONS | 595 | ||
| A. TRADITIONAL OPERATIVE TECHNIQUE | 595 | ||
| B. PIGGYBACK TECHNIQUE | 596 | ||
| C. LIVING DONOR HEPATECTOMY | 596 | ||
| III. POSTOPERATIVE CONSIDERATIONS | 596 | ||
| A. POSTOPERATIVE CARE | 596 | ||
| B. IMMUNOSUPPRESSION (PROTOCOLS VARY BY INSTITUTION) | 596 | ||
| C. ASSESSMENT OF GRAFT FUNCTION | 597 | ||
| D. COMPLICATIONS | 597 | ||
| 48 - Pancreas Transplantation | 600 | ||
| I. GENERAL CONSIDERATIONS | 600 | ||
| A. HISTORY AND EPIDEMIOLOGY | 600 | ||
| B. INDICATIONS FOR PANCREAS TRANSPLANTATION | 600 | ||
| C. TYPES OF PANCREAS TRANSPLANTS | 600 | ||
| D. ORGAN SELECTION | 601 | ||
| II. SPECIFIC OPERATIVE CONSIDERATIONS | 601 | ||
| A. TRANSPLANT ANATOMY | 601 | ||
| B. MANAGEMENT OF EXOCRINE SECRETIONS | 601 | ||
| III. POSTOPERATIVE CONSIDERATIONS | 601 | ||
| A. POSTOPERATIVE CARE | 601 | ||
| B. COMPLICATIONS | 602 | ||
| C. OUTCOMES | 602 | ||
| IV. ISLET CELL TRANSPLANTATION | 603 | ||
| A. BACKGROUND | 603 | ||
| B. INDICATIONS | 603 | ||
| C. TECHNIQUE | 603 | ||
| D. OUTCOMES | 603 | ||
| V. PANCREAS VERSUS ISLET CELL TRANSPLANTATION | 604 | ||
| IX - Endocrine Surgery | 605 | ||
| 49 - Thyroid | 607 | ||
| I. EMBRYOLOGY | 607 | ||
| A. THYROID DEVELOPMENT | 607 | ||
| B. DEVELOPMENTAL ANOMALIES | 607 | ||
| II. ANATOMY | 607 | ||
| A. OVERVIEW | 607 | ||
| B. ARTERIAL SUPPLY | 607 | ||
| C. VENOUS DRAINAGE | 608 | ||
| D. NERVES | 608 | ||
| E. LYMPHATICS | 608 | ||
| F. HISTOLOGY | 608 | ||
| III. PHYSIOLOGY | 608 | ||
| A. IODINE METABOLISM | 608 | ||
| B. THYROID HORMONE SYNTHESIS | 608 | ||
| C. THYROID HORMONE FUNCTION | 608 | ||
| D. THYROID HORMONE REGULATION | 609 | ||
| E. CALCITONIN | 609 | ||
| IV. WORK-UP OF THYROID DISEASE | 609 | ||
| A. CLINICAL PRESENTATION | 609 | ||
| B. LABORATORY DATA | 609 | ||
| C. IMAGING | 610 | ||
| D. BIOPSY | 610 | ||
| V. HYPERTHYROIDISM | 610 | ||
| A. DIFFUSE TOXIC GOITER—GRAVES DISEASE | 610 | ||
| B. TOXIC ADENOMA—PLUMMER DISEASE | 611 | ||
| C. TOXIC MULTINODULAR GOITER | 611 | ||
| D. THYROID STORM | 611 | ||
| VI. HYPOTHYROIDISM | 611 | ||
| A. CHRONIC LYMPHOCYTIC THYROIDITIS—HASHIMOTO THYROIDITIS | 611 | ||
| VII. THYROIDITIS AND NONTOXIC GOITERS | 612 | ||
| A. ACUTE SUPPURATIVE THYROIDITIS | 612 | ||
| B. SUBACUTE THYROIDITIS | 612 | ||
| C. RIEDELS THYROIDITIS (INVASIVE FIBROUS THYROIDITIS) | 612 | ||
| D. NONTOXIC GOITER | 613 | ||
| VIII. THYROID NODULES | 613 | ||
| A. CLINICAL PRESENTATION | 613 | ||
| B. CLINICAL EVALUATION | 613 | ||
| C. MANAGEMENT BASED ON FINE-NEEDLE ASPIRATION RESULTS | 613 | ||
| D. CYSTIC NODULES | 613 | ||
| E. INCIDENTALOMA | 614 | ||
| IX. THYROID NEOPLASMS | 614 | ||
| A. EPIDEMIOLOGY | 614 | ||
| B. PAPILLARY THYROID CARCINOMA | 614 | ||
| C. FOLLICULAR THYROID CARCINOMA | 615 | ||
| D. HÜRTHLE CELL CARCINOMA | 615 | ||
| E. MEDULLARY THYROID CANCER | 615 | ||
| F. ANAPLASTIC THYROID CANCER | 616 | ||
| G. THYROID LYMPHOMA | 616 | ||
| H. ADJUVANT THERAPY | 616 | ||
| 50 - Parathyroid | 618 | ||
| I. PARATHYROID EMBRYOLOGY AND ANATOMY | 618 | ||
| A. EMBRYOLOGY | 618 | ||
| B. ANATOMY | 618 | ||
| C. PHYSIOLOGY | 618 | ||
| II. PRIMARY HYPERPARATHYROIDISM | 619 | ||
| A. GENERAL | 619 | ||
| B. CAUSATIVE FACTORS | 619 | ||
| C. PRESENTATION | 619 | ||
| D. DIAGNOSIS | 619 | ||
| E. MANAGEMENT | 620 | ||
| III. SECONDARY HYPERPARATHYROIDISM | 621 | ||
| A. CAUSATIVE FACTORS | 621 | ||
| B. SYMPTOMS | 621 | ||
| C. TREATMENT | 621 | ||
| IV. TERTIARY HYPERPARATHYROIDISM | 621 | ||
| A. CAUSATIVE FACTOR | 621 | ||
| B. SYMPTOMS | 622 | ||
| C. TREATMENT | 622 | ||
| V. PARATHYROID CARCINOMA | 622 | ||
| 51 - Adrenal Gland | 623 | ||
| I. EMBRYOLOGY AND ANATOMY | 623 | ||
| A. GENERAL | 623 | ||
| B. ARTERIAL SUPPLY | 623 | ||
| C. VENOUS DRAINAGE | 623 | ||
| D. CORTEX | 623 | ||
| E. MEDULLA | 623 | ||
| II. ZONA GLOMERULOSA—MINERALOCORTICOIDS | 624 | ||
| X - Vascular Surgery | 641 | ||
| 53 - Thromboembolic Disease | 643 | ||
| I. INTRODUCTION | 643 | ||
| A. EPIDEMIOLOGY | 643 | ||
| B. CAUSATIVE FACTORS | 643 | ||
| D. CLINICAL PRESENTATION | 644 | ||
| E. DIFFERENTIAL DIAGNOSES | 644 | ||
| F. DIAGNOSIS | 644 | ||
| G. SEQUELAE | 644 | ||
| II. METHODS OF PROPHYLAXIS AND TREATMENT OF DEEP VENOUS THROMBOSES AND PULMONARY EMBOLI | 645 | ||
| A. DEEP VEIN THROMBOSIS PROPHYLAXIS | 645 | ||
| B. TREATMENT OF DEEP VEIN THROMBOSIS AND PULMONARY EMBOLI | 645 | ||
| C. PROPHYLACTIC INFERIOR VENA CAVA FILTER PLACEMENT | 647 | ||
| III. AN APPROACH TO PROPHYLAXIS | 647 | ||
| A. DETERMINE THE PATIENT’S RISK FACTORS | 647 | ||
| B. PROPHYLAXIS OF CHOICE | 647 | ||
| IV. APPROACH TO THE PATIENT WITH PULMONARY EMBOLUS | 648 | ||
| A. PHYSIOLOGY | 648 | ||
| D. SURGICAL TREATMENT OPTIONS | 648 | ||
| 54 - Aneurysms | 650 | ||
| I. EPIDEMIOLOGY | 650 | ||
| A. GENERAL | 650 | ||
| B. CASE REPORT | 650 | ||
| C. RISK FACTORS | 650 | ||
| D. CAUSATIVE FACTORS | 651 | ||
| II. PATHOLOGY | 651 | ||
| A. LOCATION | 651 | ||
| B. CHARACTERISTICS | 651 | ||
| C. ASSOCIATED MANIFESTATIONS OF DIFFUSE ATHEROSCLEROSIS | 651 | ||
| III. NATURAL HISTORY | 651 | ||
| A. GENERAL CONSIDERATIONS | 651 | ||
| B. STATISTICS | 652 | ||
| IV. CLINICAL PRESENTATION | 652 | ||
| A. SYMPTOMS | 652 | ||
| B. PHYSICAL EXAMINATION | 652 | ||
| V. DIAGNOSTIC STUDIES | 652 | ||
| A. PLAIN FILMS | 652 | ||
| B. B-MODE ULTRASOUND | 652 | ||
| C. COMPUTED TOMOGRAPHY SCAN | 653 | ||
| D. MAGNETIC RESONANCE IMAGING | 653 | ||
| E. AORTOGRAPHY | 653 | ||
| VI. ELECTIVE MANAGEMENT OF ABDOMINAL AORTIC ANEURYSM | 653 | ||
| A. OPERATIVE INDICATIONS | 653 | ||
| B. PREOPERATIVE WORK-UP | 653 | ||
| C. PREOPERATIVE PREPARATION | 654 | ||
| VII. OPEN ABDOMINAL AORTIC ANEURYSM REPAIR | 654 | ||
| A. APPROACH | 654 | ||
| B. OPERATIVE STEPS | 654 | ||
| C. INTRAOPERATIVE PROBLEMS | 655 | ||
| D. PROSTHETIC GRAFT | 655 | ||
| E. POSTOPERATIVE COURSE | 655 | ||
| VIII. COMPLICATIONS | 656 | ||
| A. LOWER EXTREMITY ISCHEMIA | 656 | ||
| B. CARDIAC EVENTS | 656 | ||
| C. RENAL INSUFFICIENCY | 656 | ||
| D. STROKE | 656 | ||
| E. COLONIC ISCHEMIA | 656 | ||
| F. SPINAL CORD ISCHEMIA | 656 | ||
| G. SEXUAL DYSFUNCTION | 656 | ||
| H. LATE COMPLICATIONS | 657 | ||
| IX. ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR | 657 | ||
| A. INDICATIONS | 657 | ||
| B. PROCEDURE | 657 | ||
| C. LONG-TERM CARE | 658 | ||
| D. COMPLICATIONS | 658 | ||
| E. OUTCOMES | 659 | ||
| X. OPERATIVE MORTALITY | 659 | ||
| A. OPEN REPAIR | 659 | ||
| B. ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR | 659 | ||
| XI. RUPTURED ABDOMINAL AORTIC ANEURYSM | 659 | ||
| A. SYMPTOMS | 659 | ||
| B. PRINCIPLES OF MANAGEMENT | 659 | ||
| XII. ABDOMINAL AORTIC ANEURYSM SCREENING (TABLE 54.3) | 660 | ||
| A. ULTRASOUND | 660 | ||
| 55 - Peripheral Vascular Disease | 661 | ||
| I. DEFINITIONS | 661 | ||
| II. PERIPHERAL ARTERIAL DISEASE | 661 | ||
| A. EPIDEMIOLOGY | 661 | ||
| B. RISK FACTORS | 661 | ||
| C. NATURAL HISTORY | 661 | ||
| D. PATHOPHYSIOLOGY | 662 | ||
| E. SYMPTOMS | 662 | ||
| F. PHYSICAL EXAMINATION FINDINGS | 663 | ||
| G. LAB WORK | 663 | ||
| H. DIAGNOSTIC STUDIES | 663 | ||
| III. MANAGEMENT OF ATHEROSCLEROTIC PERIPHERAL ARTERIAL DISEASE | 666 | ||
| A. MEDICAL MANAGEMENT | 666 | ||
| B. REVASCULARIZATION THERAPY | 666 | ||
| C. CRITICAL LIMB ISCHEMIA | 669 | ||
| D. ACUTE LIMB ISCHEMIA | 669 | ||
| IV. RENAL ARTERY DISEASE | 670 | ||
| A. EPIDEMIOLOGY | 670 | ||
| B. NATURAL HISTORY | 670 | ||
| C. CLINICAL CONSEQUENCE | 670 | ||
| D. PATHOPHYSIOLOGY | 671 | ||
| E. DIAGNOSIS | 672 | ||
| F. RENAL ARTERY ANEURYSMS | 673 | ||
| V. LOWER EXTREMITY ANEURYSM DISEASE | 674 | ||
| A. EPIDEMIOLOGY | 674 | ||
| B. NATURAL HISTORY | 674 | ||
| C. FEMORAL ARTERY ANEURYSMS | 674 | ||
| D. POPLITEAL ARTERY ANEURYSMS | 675 | ||
| E. FEMORAL ARTERY PSEUDOANEURYSM | 676 | ||
| F. MYCOTIC ANEURYSMS | 676 | ||
| VI. CHRONIC VENOUS INSUFFICIENCY | 677 | ||
| A. OVERVIEW | 677 | ||
| B. DIAGNOSIS | 677 | ||
| C. MANAGEMENT | 678 | ||
| 56 - Carotid Disease | 680 | ||
| I. BACKGROUND: STROKE | 680 | ||
| II. DIAGNOSIS | 681 | ||
| A. HISTORY | 681 | ||
| B. PHYSICAL EXAMINATION | 682 | ||
| C. IMAGING | 682 | ||
| III. DIFFERENTIAL DIAGNOSIS OF STROKE/TRANSIENT ISCHEMIC ATTACKS | 684 | ||
| A. ATHEROSCLEROTIC DISEASE | 684 | ||
| B. FIBROMUSCULAR DYSPLASIA | 685 | ||
| C. COILS AND KINKS BECAUSE OF ANATOMIC VARIATION | 685 | ||
| D. CAROTID ANEURYSMS | 685 | ||
| E. CAROTID DISSECTION | 685 | ||
| F. RADIATION ARTERITIS | 685 | ||
| G. TAKAYASU ARTERITIS | 685 | ||
| H. GIANT CELL ARTERITIS | 686 | ||
| IV. MANAGEMENT | 686 | ||
| A. MEDICAL | 686 | ||
| B. SURGICAL—CAROTID ENDARTERECTOMY | 686 | ||
| C. ENDOVASCULAR—CAROTID ARTERY STENTING | 687 | ||
| V. POSTOPERATIVE COMPLICATIONS | 687 | ||
| A. CARDIOVASCULAR | 688 | ||
| B. NEUROLOGIC | 688 | ||
| VI. POSTOPERATIVE CARE | 688 | ||
| 57 - Mesenteric Ischemia | 689 | ||
| I. ANATOMY AND PHYSIOLOGY | 689 | ||
| A. VASCULAR SUPPLY | 689 | ||
| B. COLLATERAL VESSELS | 689 | ||
| C. PHYSIOLOGY | 689 | ||
| II. EPIDEMIOLOGY | 690 | ||
| III. ACUTE MESENTERIC ISCHEMIA | 690 | ||
| A. RISK FACTORS | 690 | ||
| B. CLINICAL PRESENTATION | 690 | ||
| C. CAUSATIVE FACTORS | 690 | ||
| D. DIAGNOSIS | 691 | ||
| E. MANAGEMENT | 691 | ||
| IV. CHRONIC MESENTERIC ISCHEMIA | 693 | ||
| A. CAUSATIVE FACTORS | 693 | ||
| B. DIAGNOSIS | 693 | ||
| C. TREATMENT | 693 | ||
| D. PROGNOSIS | 693 | ||
| V. MESENTERIC VENOUS THROMBOSIS | 694 | ||
| A. CAUSATIVE FACTORS—VENOUS THROMBOSIS PREDOMINANTLY A RESULT OF STAGNATION OF BLOOD FLOW, HYPERCOAGULABILITY, AND VASCULAR INJU... | 694 | ||
| B. CLINICAL PRESENTATION | 694 | ||
| C. DIAGNOSIS | 694 | ||
| D. TREATMENT | 694 | ||
| E. PROGNOSIS | 695 | ||
| VI. MEDIAN ARCUATE LIGAMENT SYNDROME (CELIAC ARTERY COMPRESSION SYNDROME) | 695 | ||
| A. CAUSATIVE FACTORS | 695 | ||
| B. PRESENTATION | 695 | ||
| C. DIAGNOSIS | 695 | ||
| D. TREATMENT | 695 | ||
| 58 - Dialysis Access | 696 | ||
| I. INTRODUCTION | 696 | ||
| II. GENERAL OVERVIEW OF DIALYSIS ACCESS TYPES | 696 | ||
| A. SHORT-TERM/EMERGENT ACCESS | 696 | ||
| B. LONG-TERM ACCESS | 696 | ||
| III. DIALYSIS CATHETERS | 696 | ||
| A. NONTUNNELED (NONCUFFED CATHETERS) | 696 | ||
| B. TUNNELED CATHETERS (CUFFED) | 697 | ||
| IV. ARTERIOVENOUS FISTULAS AND GRAFTS | 697 | ||
| A. ARTERIOVENOUS FISTULA | 697 | ||
| B. ARTERIOVENOUS GRAFT | 697 | ||
| V. ARTERIOVENOUS FISTULA MATURATION | 698 | ||
| VI. COMPLICATIONS OF ARTERIOVENOUS FISTULAS AND GRAFTS | 699 | ||
| VII. PERITONEAL DIALYSIS | 700 | ||
| 59 - The Diabetic Patient | 702 | ||
| I. DEFINITIONS | 702 | ||
| A. DIABETES | 702 | ||
| B. METABOLIC SYNDROME | 702 | ||
| II. MEDICAL THERAPIES | 703 | ||
| A. ORAL ANTIHYPERGLYCEMICS | 703 | ||
| B. INSULIN | 703 | ||
| D. ADJUSTING MEDICATIONS FOR SURGERY | 705 | ||
| E. HYPOGLYCEMIA (BLOOD GLUCOSE LEVEL LESS THAN 70 MG/DL) | 705 | ||
| F. DIABETIC KETOACIDOSIS | 706 | ||
| G. NONKETOTIC HYPEROSMOLAR HYPERGLYCEMIA | 707 | ||
| III. GLYCEMIC CONTROL IN THE CRITICALLY ILL PATIENT | 707 | ||
| A. HYPERGLYCEMIC RESPONSE TO SURGERY AND ANESTHESIA | 707 | ||
| B. IATROGENIC HYPERGLYCEMIA | 707 | ||
| C. GLYCEMIC CONTROL | 707 | ||
| D. SPECIAL POPULATIONS | 707 | ||
| IV. COMPLICATIONS OF DIABETES | 708 | ||
| A. TISSUE HYPOXIA CAUSED BY MICROVASCULAR DISEASE | 708 | ||
| V. DIABETIC FOOT ULCERS | 709 | ||
| XI - Cardiothoracic Surgery | 713 | ||
| 60 - Benign Tumors of the Lung | 715 | ||
| I. OVERVIEW | 715 | ||
| II. HISTORY | 715 | ||
| III. PHYSICAL EXAMINATION | 715 | ||
| IV. INITIAL EVALUATION | 715 | ||
| V. IMAGING | 716 | ||
| VI. BIOPSY OPTIONS | 716 | ||
| VII. EPITHELIAL TUMORS | 717 | ||
| A. POLYPS | 717 | ||
| B. PAPILLOMA | 717 | ||
| C. MUCOUS GLAND ADENOMA | 717 | ||
| VIII. MESENCHYMAL TUMORS | 718 | ||
| A. VESSEL ORIGIN | 718 | ||
| IX. MISCELLANEOUS TUMORS | 719 | ||
| A. FIBROMA | 719 | ||
| B. HAMARTOMA | 719 | ||
| C. TERATOMA | 720 | ||
| X. OTHER TUMORS | 720 | ||
| A. LIPOMA | 720 | ||
| B. CHONDROMA | 720 | ||
| XI. INFLAMMATORY PSEUDOTUMORS | 721 | ||
| A. PLASMA CELL GRANULOMA | 721 | ||
| B. PULMONARY HYALINIZING GRANULOMA | 721 | ||
| XII. OTHER BENIGN TUMORS | 721 | ||
| A. MUCINOUS CYSTADENOMA | 721 | ||
| B. NODULAR AMYLOID | 722 | ||
| 61 - Malignant Tumors of the Lung | 723 | ||
| I. EPIDEMIOLOGY | 723 | ||
| A. GENERAL | 723 | ||
| B. MORTALITY | 723 | ||
| II. ETIOLOGY | 723 | ||
| A. CIGARETTE SMOKING | 723 | ||
| B. EXPOSURE | 723 | ||
| III. SCREENING | 724 | ||
| A. GENERAL | 724 | ||
| B. SCREENING MODALITIES | 724 | ||
| IV. SOLITARY PULMONARY NODULE | 725 | ||
| A. GENERAL | 725 | ||
| B. DIFFERENTIAL DIAGNOSIS | 725 | ||
| C. RADIOGRAPHIC CHARACTERISTICS OF BENIGN NODULE | 725 | ||
| D. MANAGEMENT OF SOLITARY PULMONARY NODULE | 725 | ||
| V. CLINICAL FEATURES | 725 | ||
| A. RESPIRATORY | 725 | ||
| B. ASSOCIATED SYNDROMES | 726 | ||
| C. EVIDENCE OF METASTATIC OR LOCALLY ADVANCED DISEASE | 726 | ||
| D. METHOD OF SPREAD | 726 | ||
| VI. PATHOLOGY | 726 | ||
| A. HISTOLOGIC CLASSIFICATION | 726 | ||
| B. LOCATION OF PRIMARY TUMORS | 727 | ||
| VII. ADENOCARCINOMA—40% | 727 | ||
| XII - Surgical Subspecialties | 769 | ||
| 65 - General Pediatric Surgery | 771 | ||
| I. FLUIDS AND NUTRITION | 771 | ||
| A. MAINTENANCE FLUIDS | 771 | ||
| B. RESUSCITATION FLUIDS | 771 | ||
| C. FLUID BALANCE | 771 | ||
| D. ACID-BASE ANOMALIES | 771 | ||
| E. TOTAL PARENTERAL NUTRITION | 772 | ||
| II. LESIONS OF THE HEAD AND NECK | 772 | ||
| A. THRYOGLOSSAL DUCT CYST | 772 | ||
| B. BRANCHIAL CLEFT ANOMALIES | 773 | ||
| III. THORACIC DISORDERS | 773 | ||
| A. PULMONARY SEQUESTRATION | 773 | ||
| B. CONGENITAL CYSTIC ADENOMATOID MALFORMATION | 774 | ||
| C. CONGENITAL DIAPHRAGMATIC HERNIA | 774 | ||
| IV. ESOPHAGEAL ANOMALIES | 776 | ||
| A. TRACHEOESOPHAGEAL FISTULA | 776 | ||
| B. ISOLATED ESOPHAGEAL ATRESIA—TYPE A (6%) | 777 | ||
| C. SURVIVAL | 778 | ||
| V. GASTROINTESTINAL TRACT | 778 | ||
| A. HYPERTROPHIC PYLORIC STENOSIS | 778 | ||
| B. INTESTINAL OBSTRUCTION IN THE NEONATE | 779 | ||
| D. NECROTIZING ENTEROCOLITIS | 782 | ||
| E. MECKEL DIVERTICULUM | 783 | ||
| F. APPENDICITIS | 783 | ||
| G. GASTROESOPHAGEAL REFLUX | 784 | ||
| VI. ABDOMINAL WALL DEFECTS | 785 | ||
| A. OMPHALOCELE | 785 | ||
| B. GASTROSCHISIS | 785 | ||
| C. UMBILICAL HERNIA | 786 | ||
| D. INGUINAL HERNIA | 786 | ||
| E. SHORT BOWEL SYNDROME | 787 | ||
| VII. ANORECTAL MALFORMATIONS | 787 | ||
| VIII. NEOPLASMS | 788 | ||
| A. NEUROBLASTOMA | 788 | ||
| B. WILMS TUMOR | 788 | ||
| 66 - Neurosurgery | 790 | ||
| I. CRANIAL URGENCIES AND EMERGENCIES | 790 | ||
| A. SPONTANEOUS SUBARACHNOID HEMORRHAGE | 790 | ||
| C. MALIGNANT STROKE (FIG. 66.3) | 798 | ||
| D. HYDROCEPHALUS | 799 | ||
| II. SPINAL URGENCIES AND EMERGENCIES | 801 | ||
| A. DEGENERATIVE SPINAL DISEASE | 801 | ||
| III. CNS TUMORS | 804 | ||
| A. BRAIN TUMORS (FIG. 66.5) | 804 | ||
| B. SPINAL TUMORS (FIG. 66.7) | 809 | ||
| IV. CNS INFECTIOUS URGENCIES AND EMERGENCIES (FIG. 66.8) | 811 | ||
| A. EPIDURAL ABSCESS | 811 | ||
| B. SUBDURAL EMPYEMA | 813 | ||
| C. PARENCHYMAL ABSCESS | 814 | ||
| V. OTHER NEUROSURGICAL URGENCIES/EMERGENCIES | 814 | ||
| A. SEIZURES AND STATUS EPILEPTICUS | 814 | ||
| B. BACLOFEN TOXICITY AND WITHDRAWAL | 816 | ||
| VI. HERNIATION SYNDROMES AND BRAIN DEATH | 817 | ||
| A. HERNIATION SYNDROMES CAN RESULT FROM A VARIETY OF BOTH TRAUMATIC AND NONTRAUMATIC CRANIAL PATHOLOGIES; THERE ARE FOUR COMMON ... | 817 | ||
| B. BRAIN DEATH | 818 | ||
| 67 - Orthopedic Surgery | 821 | ||
| I. ASSESSMENT OF THE ORTHOPEDIC PATIENT | 821 | ||
| A. BASIC ADVANCED TRAUMA LIFE SUPPORT PRINCIPLES | 821 | ||
| II. ORTHOPEDIC EMERGENCIES | 821 | ||
| A. HEMODYNAMICALLY UNSTABLE PELVIC FRACTURES | 821 | ||
| B. OPEN FRACTURES | 823 | ||
| C. COMPARTMENT SYNDROME | 826 | ||
| D. VASCULAR INJURY ASSOCIATED WITH EXTREMITY TRAUMA | 827 | ||
| E. TRAUMATIC ARTHROTOMIES | 828 | ||
| F. GUNSHOT WOUNDS | 830 | ||
| G. BITE INJURIES | 831 | ||
| 68 - Plastic Surgery: Breast Reconstruction | 834 | ||
| I. INTRODUCTION | 834 | ||
| II. RELEVANT ANATOMY FOR RECONSTRUCTION | 834 | ||
| A. VASCULAR SUPPLY (FIG. 68.1) | 834 | ||
| B. INNERVATION | 834 | ||
| III. PREOPERATIVE EVALUATION | 834 | ||
| A. GOALS OF RECONSTRUCTION | 834 | ||
| B. TIMING | 835 | ||
| C. CURRENT TECHNIQUES | 836 | ||
| D. TECHNIQUE SELECTION CRITERIA | 836 | ||
| IV. TECHNIQUES | 836 | ||
| A. PROSTHETIC RECONSTRUCTION USING IMPLANTS AND EXPANDERS | 836 | ||
| B. AUTOLOGOUS TISSUE TRANSFER | 837 | ||
| C. NIPPLE AREOLAR COMPLEX RECONSTRUCTION (FIG. 68.4) | 840 | ||
| V. ONCOPLASTIC SURGERY | 841 | ||
| A. DEFINITION | 841 | ||
| B. CONSIDERATIONS | 841 | ||
| C. TECHNIQUES | 841 | ||
| VI. POSTRECONSTRUCTION FOLLOW-UP | 842 | ||
| XIII - Future of Surgery | 845 | ||
| 69 - Robotics and Newer Surgical Technologies | 847 | ||
| I. SINGLE-INCISION LAPAROSCOPIC SURGERY | 847 | ||
| II. ROBOTIC SURGERY | 847 | ||
| III. NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY | 849 | ||
| IV. ENDOLUMINAL AND ENDOVASCULAR SURGERY | 850 | ||
| XIV - Procedures | 853 | ||
| 70 - Procedures | 855 | ||
| I. INDICATIONS FOR AN ARTIFICIAL AIRWAY | 855 | ||
| A. ABSOLUTE | 855 | ||
| B. RELATIVE | 855 | ||
| II. NONSURGICAL TECHNIQUES | 855 | ||
| A. INITIAL/TEMPORIZING MANEUVERS | 855 | ||
| B. OROTRACHEAL INTUBATION | 856 | ||
| C. NASOTRACHEAL INTUBATION | 858 | ||
| D. COMPLICATIONS | 859 | ||
| III. SURGICAL AIRWAY OPTIONS AND METHODS | 859 | ||
| A. CRICOTHYROIDOTOMY | 859 | ||
| B. TRACHEOSTOMY | 860 | ||
| C. PERCUTANEOUS TRACHEOSTOMY | 861 | ||
| D. COMPLICATIONS | 861 | ||
| IV. ALTERNATE AIRWAY METHODS | 862 | ||
| A. COMBITUBE | 862 | ||
| B. FIBEROPTIC BRONCHOSCOPY | 862 | ||
| C. LARYNGEAL MASK AIRWAY | 862 | ||
| V. ARTERIAL CATHETERIZATION | 862 | ||
| A. INDICATIONS | 862 | ||
| B. TECHNIQUES | 862 | ||
| C. COMPLICATIONS | 864 | ||
| VI. BLADDER CATHETERIZATION | 864 | ||
| A. INDICATIONS FOR INDWELLING URETHRAL CATHETER | 864 | ||
| B. COMPLICATIONS OF INDWELLING URINARY CATHETER | 865 | ||
| C. CONTRAINDICATIONS OF BLADDER CATHETERIZATION | 865 | ||
| D. TECHNIQUES | 865 | ||
| E. ALTERNATIVES | 873 | ||
| VII. CENTRAL VENOUS LINES | 873 | ||
| A. INDICATIONS | 873 | ||
| C. TECHNIQUES | 873 | ||
| D. COMPLICATIONS | 876 | ||
| VIII. ENTERAL ACCESS | 877 | ||
| A. NASOGASTRIC TUBES | 877 | ||
| B. OROGASTRIC TUBES | 878 | ||
| C. FEEDING TUBES | 879 | ||
| X. PULMONARY ARTERY (SWAN-GANZ) CATHETERIZATION | 881 | ||
| A. INDICATIONS | 881 | ||
| B. DESIGN | 882 | ||
| C. MEASUREMENT | 882 | ||
| D. PITFALLS | 884 | ||
| XI. ABSCESS DRAINAGE | 885 | ||
| A. TECHNIQUE | 885 | ||
| XII. THORACENTESIS | 885 | ||
| A. INDICATIONS | 885 | ||
| B. TECHNIQUE | 886 | ||
| C. POSITIONING | 886 | ||
| D. PROCEDURE | 886 | ||
| E. INTERPRETATION OF RESULTS (TABLE 70.3) | 887 | ||
| F. COMPLICATIONS | 888 | ||
| XV - Rapid References | 889 | ||
| 71 - Rapid References | 891 | ||
| Index | 895 | ||
| A | 895 | ||
| B | 903 | ||
| C | 908 | ||
| D | 918 | ||
| E | 920 | ||
| F | 923 | ||
| G | 925 | ||
| H | 928 | ||
| I | 933 | ||
| J | 935 | ||
| K | 936 | ||
| L | 936 | ||
| M | 939 | ||
| N | 943 | ||
| O | 947 | ||
| P | 948 | ||
| Q | 956 | ||
| R | 956 | ||
| S | 958 | ||
| T | 964 | ||
| U | 969 | ||
| V | 970 | ||
| W | 971 | ||
| X | 972 | ||
| Y | 972 | ||
| Z | 972 |