Emergency Surgery for Low Resource Regions

Preface
Contents
Contributors
Part I: Principles of Surgery
	1: Role of Antibiotics in Surgery
		1.1	 Antibiotic Prophylaxis
		1.2	 Therapeutic Use of Antibiotics
		1.3	 Summary
	2: DVT Prophylaxis
		2.1	 Introduction
		2.2	 Non-Orthopedic Patients
		2.3	 Very Low Thrombosis Risk
		2.4	 Low Thrombosis Risk
		2.5	 Moderate or High Thrombosis Risk
		2.6	 Timing of Initiation
			2.6.1	 Duration
			2.6.2	 Dosing
			2.6.3	 Enoxaparin
			2.6.4	 Dalteparin
			2.6.5	 Tinzaparin
			2.6.6	 Unfractionated Heparin
		2.7	 Orthopedic Patients
		2.8	 Total Hip/Knee Arthroplasty and Hip Fracture Surgery
		2.9	 Timing of Initiation (for Hip/Knee Surgery)
			2.9.1	 Duration
			2.9.2	 Dosing
			2.9.3	 Enoxaparin
			2.9.4	 Unfractionated Heparin
			2.9.5	 Warfarin
			2.9.6	 Rivaroxaban
			2.9.7	 Apixaban
		2.10	 Lower Extremity Injuries Requiring Immobilization
		2.11	 Multiple Trauma
		2.12	 Pregnancy and VTE Prophylaxis
		2.13	 Periprocedural Management of Antithrombotic Therapy and Bridging Anticoagulation
		2.14	 Summary
	3: Nutrition in Surgical Patients
		3.1	 Components of Nutrition
		3.2	 Nutritional Assessment
		3.3	 Malnutrition Prior to Surgery
		3.4	 Post-operative Malnutrition
		3.5	 Pathophysiology
		3.6	 History and Examination Findings
		3.7	 Laboratory Tests
		3.8	 Routes of Administration of Nutrition
		3.9	 Components of Nutrition
		3.10	 Complications
		3.11	 Refeeding Syndrome
		3.12	 Monitoring
		3.13	 Summary
	4: Critically Ill Surgical Patients
		4.1	 Optimisation of High-Risk Patients
		4.2	 Goals of Optimisation
		4.3	 Clinical Application of Optimisation
		4.4	 Issues in Low Resource Regions
		4.5	 Overview of Sepsis
		4.6	 History of Sepsis Classification
		4.7	 Septic Shock
		4.8	 Treatment
		4.9	 Implications for Low Resource Regions
	5: Overview of Basic Surgical Techniques
		5.1	 Asepsis, Antisepsis, and Disinfection
		5.2	 Surgical Site Infection (SSI)
		5.3	 Surgical Wound Classification
		5.4	 Operative Factors
		5.5	 Wound Healing
		5.6	 Impaired Healing
		5.7	 Wound Management
		5.8	 Wound Closure
		5.9	 Control of Bleeding
		5.10	 Control of External Bleeding
		5.11	 Internal Bleeding
	6: Diagnostic Imaging in Surgery
		6.1	 Background
		6.2	 Diagnostic Work-up in the Emergency Department
		6.3	 Abdominal Plain X-ray
		6.4	 Abdominal Ultrasonography
		6.5	 Computed Tomography Scan
		6.6	 Emergency Imaging in Low Resource Regions
			6.6.1	 Perforated Viscus
			6.6.2	 Bowel Obstruction
			6.6.3	 Renal Stones
			6.6.4	 Ingested Foreign Body
			6.6.5	 Abdominal Aortic Aneurysm (AAA)
			6.6.6	 Acute Cholecystitis and Cholangitis
			6.6.7	 Acute Appendicitis
			6.6.8	 Acute Bowel Ischemia
			6.6.9	 Acute Diverticulitis
		6.7	 Conclusion
	7: Post-operative Care and Complications
		7.1	 Post-operative Care
			7.1.1	 General Approach
			7.1.2	 Analgesia
			7.1.3	 Fluids and Electrolytes
			7.1.4	 Nutrition
			7.1.5	 Prevention of Thromboembolism
			7.1.6	 Control of Potential Sources of Infection
		7.2	 Complications
			7.2.1	 Wound Complications
				7.2.1.1	 Seroma
				7.2.1.2	 Haematoma
			7.2.2	 Wound Infection
			7.2.3	 Wound Dehiscence
		7.3	 Gastrointestinal
			7.3.1	 Ileus
		7.4	 Post-operative Collections and Anastomotic Leaks
		7.5	 Intestinal Fistula
		7.6	 Respiratory
			7.6.1	 Atelectasis and Pneumonia
			7.6.2	 Thromboembolic
Part II: Gastrointestinal Surgery: The Acute Abdomen
	8: Approach to the Acute Abdomen
		8.1	 Overview
		8.2	 Clinical Assessment
		8.3	 Investigations—Laboratory
		8.4	 Investigations—Imaging
		8.5	 Management
		8.6	 Implications for Low Resource Regions
	9: Acute Appendicitis
		9.1	 Diagnosis
		9.2	 History
		9.3	 Examination
		9.4	 Appendicitis in Pregnancy
		9.5	 Appendicitis in Young Children
		9.6	 Appendicitis in the Elderly
		9.7	 Laboratory Investigations
		9.8	 Imaging
		9.9	 Treatment
		9.10	 Post-operative Complications
			9.10.1	 Wound Infection
			9.10.2	 Intra-abdominal Abscess
			9.10.3	 Neoplastic Pathology
			9.10.4	 Fistula
			9.10.5	 Appendix Mass
			9.10.6	 Appendix Abscess
		9.11	 Low Resource Alternatives
			9.11.1	 Diagnosis
			9.11.2	 Surgical Management
			9.11.3	 Late Presentation
		9.12	 Summary
	10: Gallstone Disease
		10.1	 History and Examination
		10.2	 Investigations
		10.3	 Differential Diagnosis
		10.4	 Treatment Options
			10.4.1	 Medication
			10.4.2	 Intervention Radiology
			10.4.3	 Intervention Endoscopy
			10.4.4	 Surgery
		10.5	 Complications
		10.6	 Bile Duct Injury and Leak
		10.7	 Wound Infection
		10.8	 Bleeding
		10.9	 Bowel Injury
		10.10	 Spilled Stones
		10.11	 Post Cholecystectomy Syndrome (PCS)
		10.12	 Summary
	11: Peptic Ulcer Disease
		11.1	 Introduction
		11.2	 Presentation
		11.3	 Management
		11.4	 Summary
	12: Acute Pancreatitis
		12.1	 Terminology
		12.2	 Epidemiology
		12.3	 Pathophysiology
		12.4	 Diagnosis
		12.5	 Initial Management
		12.6	 Role of Antibiotics
		12.7	 Nutrition
		12.8	 Clinical Management
		12.9	 Summary
	13: Acute Colonic Diverticulitis
		13.1	 Introduction
		13.2	 Diagnosis
			13.2.1	 History
			13.2.2	 Examination
			13.2.3	 Complications
		13.3	 Abscess Formation
		13.4	 Perforation and Generalised Peritonitis
		13.5	 Intestinal Obstruction
		13.6	 Fistula Formation
		13.7	 Investigations
			13.7.1	 Laboratory
			13.7.2	 Imaging
			13.7.3	 Differential Diagnosis
		13.8	 Management of Acute Diverticulitis
			13.8.1	 Early Diverticulitis
			13.8.2	 Complicated Diverticulitis
		13.9	 Peritonitis Secondary to Diverticulitis
		13.10	 Post Discharge Management
		13.11	 Recurrent Diverticulitis
		13.12	 Elective Surgery
		13.13	 Low Resource Implications
	14: Liver Abscess
		14.1	 Pyogenic Liver Abscess (PLA)
			14.1.1	 Presentation
			14.1.2	 Examination
			14.1.3	 Laboratory Studies
			14.1.4	 Imaging
			14.1.5	 Management
				14.1.5.1	 Antibiotics
				14.1.5.2	 Percutaneous Procedures
				14.1.5.3	 Surgical Treatment
				14.1.5.4	 Treatment of Underlying Pathology
		14.2	 Amoebic Liver Abscess (ALA)
			14.2.1	 Clinical Features
			14.2.2	 Investigations
			14.2.3	 Imaging
			14.2.4	 Management
			14.2.5	 Monitoring
		14.3	 Complications
		14.4	 Low Resource Alternatives
		14.5	 Conclusion
	15: Intra-Abdominal Abscess
		15.1	 Diagnosis
		15.2	 Management
		15.3	 Percutaneous Drainage
		15.4	 Surgical Access
		15.5	 Summary
	16: Mesenteric Ischaemia and Ischaemic Colitis
		16.1	 Mesenteric Ischaemia
			16.1.1	 Presentation
			16.1.2	 Pathophysiology
			16.1.3	 Investigations
			16.1.4	 Management
			16.1.5	 Surgical Exploration
			16.1.6	 Non-Occlusive Mesenteric Ischaemia
		16.2	 Mesenteric Venous Thrombosis
		16.3	 Low Resource Regions
		16.4	 Ischaemic Colitis
			16.4.1	 Presentation
			16.4.2	 Diagnosis
			16.4.3	 Imaging
			16.4.4	 Surgical Management
			16.4.5	 Low Resource Regions
Part III: Non-inflammatory Conditions of the Abdomen
	17: Upper Gastrointestinal Bleeding
		17.1	 Background
		17.2	 Pathology
		17.3	 Epidemiology
		17.4	 Diagnosis
		17.5	 Treatment
		17.6	 Initial Management
		17.7	 Resuscitation
		17.8	 In a Rural Health Centre
		17.9	 In a Secondary Level Hospital
		17.10	 In a Tertiary Level Hospital
		17.11	 Medical Treatment
		17.12	 Endoscopic Treatment
		17.13	 Radiological Haemostasis
		17.14	 Surgical Treatment
		17.15	 Conclusion
	18: Lower Gastrointestinal Bleeding
		18.1	 Aetiology
		18.2	 Diagnosis and Treatment
		18.3	 Low Resource Alternatives
	19: Small Bowel Obstruction
		19.1	 Introduction
		19.2	 Epidemiology
			19.2.1	 Risk Factors
		19.3	 Pathophysiology
		19.4	 Presentation
		19.5	 Investigations
		19.6	 Management
		19.7	 Hernia
		19.8	 Malignant Obstruction
	20: Large Bowel Obstruction
		20.1	 Introduction
		20.2	 Pathophysiology
		20.3	 Presentation
		20.4	 Management
	21: Intestinal Fistulae
		21.1	 Management
		21.2	 Sepsis
		21.3	 Nutrition
		21.4	 Assessment of Anatomy
		21.5	 Planning
		21.6	 Surgical Principles
		21.7	 Radiation Enteritis
		21.8	 Primary Fistulas
			21.8.1	 Crohn’s Disease
			21.8.2	 Diverticular Disease
			21.8.3	 Implications for Low Resource Regions
Part IV: Other Conditions
	22: Anorectal Emergencies
		22.1	 Introduction
		22.2	 Anal Fissure
		22.3	 Thrombosed Internal Haemorrhoid
		22.4	 Thrombosed External Haemorrhoid
		22.5	 Haemorrhoidal Bleeding
		22.6	 Anorectal Varices
		22.7	 Rectal Prolapse
		22.8	 Anorectal Abscesses
		22.9	 Obstructing Rectal Cancer
		22.10	 Summary
	23: Urological Emergencies
		23.1	 Acute Urinary Retention
		23.2	 Renal/Ureteric Colic
		23.3	 Priapism
		23.4	 Paraphimosis
		23.5	 Testicular Torsion
		23.6	 Fournier’s Gangrene
		23.7	 Urethral Trauma
	24: ENT Emergencies
		24.1	 Outer Ear
		24.2	 Middle Ear
		24.3	 Nasal Fracture
		24.4	 Epistaxis
		24.5	 Anterior Epistaxis
		24.6	 Posterior Epistaxis
		24.7	 Assessment
		24.8	 Medical Management
		24.9	 Facial Cellulitis
		24.10	 Peritonsillar Abscess(Quinsy)
		24.11	 Ludwig’s Angina
		24.12	 Conclusion
	25: Ophthalmologic Emergencies
		25.1	 Lid Lacerations
		25.2	 Corneal Lacerations
		25.3	 Globe Rupture
		25.4	 Hyphaema
		25.5	 Corneal Laceration/Globe Rupture (Suspected Intraocular Foreign Body)
		25.6	 Chemical Injuries
		25.7	 Acute Angle Closure Glaucoma
		25.8	 Retinal Tears
		25.9	 Retinal Detachment
		25.10	 Diabetic Maculoedema (DME) and Proliferative Diabetic Retinopathy (PDR)
		25.11	 Proliferative Diabetic Retinopathy (PDR)
	26: Principles of Burns Management
		26.1	 Introduction
		26.2	 Calculation of Burn Size
		26.3	 Burn Depth
		26.4	 Initial Resuscitation
		26.5	 Treatment
		26.6	 Conclusion
	27: Overview of Trauma
		27.1	 Prehospital Care
		27.2	 Emergency Department
		27.3	 Classification of Trauma Centres
		27.4	 Advanced Trauma Life Support (ATLS)
		27.5	 The Primary Survey
		27.6	 Airway
		27.7	 Breathing
		27.8	 Circulation
		27.9	 Disability
		27.10	 Exposure and Environment
		27.11	 Secondary Survey
		27.12	 Urgent Surgery
		27.13	 Imaging
		27.14	 Skill Set
		27.15	 Summary
	28: Paediatric Surgical Emergencies
		28.1	 Testicular Torsion
		28.2	 Peripubertal Torsion
		28.3	 Perinatal Torsion
		28.4	 Hernia’s
		28.5	 Inguinal Hernia
		28.6	 Intussusception
		28.7	 Appendicitis
		28.8	 Ingestion of Foreign Bodies
		28.9	 Urinary Retention
		28.10	 Neonatal Conditions
		28.11	 Pyloric Stenosis
		28.12	 Abdominal Access
Part V: Global Surgery
	29: Model for a Training Partnership in General Surgery
		29.1	 Establishing the Need
		29.2	 International Partner
		29.3	 Project Ownership
		29.4	 Model of Training
		29.5	 Memorandum of Understanding
		29.6	 Funding
		29.7	 Sustainability
		29.8	 Long-term Outcomes
		29.9	 Summary