دسترسی نامحدود
برای کاربرانی که ثبت نام کرده اند
دانلود کتاب Essential Surgery: Problems, Diagnosis and Management
دانلود کتاب جراحی ضروری: مشکلات، تشخیص و مدیریت
مشخصات کتاب
Essential Surgery: Problems, Diagnosis and Management
دسته بندی: جراحی ، ارتوپدی ویرایش: 5 نویسندگان: Clive R. G. Quick, Joanna B. Reed, Simon J. F. Harper, Kourosh Saeb-Parsy سری: ISBN (شابک) : 9780702046742, 9780702054839 ناشر: Elsevier سال نشر: 2013 تعداد صفحات: 673 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 78 مگابایت
قیمت کتاب (تومان) : 78,000
در صورت تبدیل فایل کتاب Essential Surgery: Problems, Diagnosis and Management به فرمت های PDF، EPUB، AZW3، MOBI و یا DJVU می توانید به پشتیبان اطلاع دهید تا فایل مورد نظر را تبدیل نمایند.
توجه داشته باشید کتاب جراحی ضروری: مشکلات، تشخیص و مدیریت نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
توضیحاتی در مورد کتاب جراحی ضروری: مشکلات، تشخیص و مدیریت
نسخه پاک شده با صفحه بندی و نشانک های اصلاح شده.
توضیحاتی درمورد کتاب به خارجی
Cleaned version with corrected pagination and bookmarks.
فهرست مطالب
Essential Surgery Copyright page Foreword Preface Changes for this edition Operative surgery Acknowledgements Part I: Principles of Surgical Care Chapter 1: Mechanisms of surgical disease and surgery in practice A short history of surgery Approaches to surgical problems What do surgeons do? What sort of patients come to surgeons? The diagnostic process Formulating a diagnosis Principal mechanisms of surgical disease Congenital conditions Acquired conditions Trauma Inflammation Infection Neoplasia Vascular disorders Degenerative disorders Metabolic disorders Endocrine disorders and hormonal therapy Other abnormalities of tissue growth Iatrogenic disorders Drugs, toxins and diet Psychogenic disorders Disorders of function Medical ethics and confidentiality Confidentiality Do not resuscitate (DNR) orders Guidelines for when a DNR may be issued: Communication With patients Palliative care Breaking bad news Communicating with colleagues Communication via the clinical record Evidence-based medicine and guidelines History Cherry-picking the evidence versus systematic review Longitudinal or cohort studies Ranking the quality of evidence (Box 1.5) Other classifications of quality of evidence Quality and limitations of clinical trials Resources Guidelines Keeping up to date: continuing medical education Consent to treatment When is consent necessary? The unconscious patient Practical aspects of consent for treatment Obtaining consent (Box 1.6) Consent in children Jehovah’s Witnesses Clinical governance and clinical audit Management attitude to quality of care Education and training of clinical staff Clinical audit Clinical effectiveness Research and development Clinical performance Risk management Information management Surgical (clinical) audit Medical research versus medical audit Carrying out an audit (Box 1.7) Peer group review of medical audit data Examples of how clinical audit can improve the quality of care: Confidential enquiry into perioperative deaths (CEPOD) Educational lessons from CEPOD Research in surgery How are potentially improved methods evaluated? Design of research and experiments Clinical trials Drug trials Trial design and conduct Patient safety Dealing with an adverse event Introduction General hazards Theatre safety Surgical mishaps Injuries and hazards of moving and positioning patients Peripheral nerve injuries Eye injuries Direct pressure effects Burns Hypothermia Infection risks Hazards during immediate postoperative recovery Radiation hazards Section I: Disease Processes Chapter 2: Managing physiological change in the surgical patient Systemic responses Factors responsible for systemic responses (Box 2.1) Management of the deteriorating patient Stressors in the surgical patient Direct and indirect tissue trauma Fall in intravascular volume Reduced cardiac output and peripheral perfusion Systemic inflammatory responses and sepsis (see Ch. 3) Pain Stress Excess heat loss Blood coagulation changes Starvation and stress-induced catabolism Metabolic responses to pathophysiological stress Effects on carbohydrate metabolism Effects on body proteins and nitrogen metabolism Effects on lipid stores and metabolism Fluid, electrolyte and acid–base management Introduction Normal fluid and electrolyte homeostasis Maintenance of water and sodium Maintenance of potassium Limits of compensatory mechanisms Physiological changes in response to surgery and trauma Effects of a fall in renal perfusion Other factors in water conservation Postoperative situation Abdominal compartment syndrome Problems of fluid and electrolyte depletion Loss of whole blood or plasma Gastrointestinal fluid loss Intra-abdominal accumulation of inflammatory fluid Systemic sepsis (SIRS and multiple organ dysfunction syndrome) Abnormal insensible fluid loss Preventing acute renal failure Common fluid and electrolyte problems Intermediate elective operations and uncomplicated emergency operations Introduction to management Major operations Enhanced recovery programmes Abnormalities of individual electrolytes Abnormalities of plasma sodium concentration Hyponatraemia Hypernatraemia Abnormalities of plasma potassium concentration Hypokalaemia Hyperkalaemia Acid–base disturbances (see Fig. 2.4 and Table 2.4) Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis Nutritional management in the surgical patient Essential principles Recognising the patient at risk Effects of starvation Simple starvation Trauma, surgery or sepsis Supplementary nutrition Methods of giving supplementary nutrition Sip feeds Tube feeds Total parenteral nutrition (TPN) Indications for TPN Methods of giving TPN Refeeding syndrome Chapter 3: Immunity, inflammation and infection Immune responses Introduction Innate immunity Adaptive immunity Inflammation Acute inflammation Introduction Resolution Abscess formation (Fig. 3.3) The chronic state Antibiotics and abscesses Organisation and repair Wound healing Healing by primary intention Healing by secondary intention Factors impairing wound healing Chronic inflammation Chronic abscesses Chronic ulcers Specific granulomatous infections and inflammations Infection General principles Methods of control of nosocomial infection Environment Staff Patients Procedures Universal blood and body fluid precautions Hepatitis B vaccination Needle-stick and other penetrating injuries Viral infection following sharps injury Use of microbiological tests in managing surgical infections Principles of treatment of surgical infection Removal of infected foci Antibiotic therapy (see Table 3.1) Empirical antibiotic therapy Specific antibiotic therapy Nutritional support Bacteria of particular surgical importance Staphylococci Pathophysiology Antibiotic sensitivities MRSA Streptococci Pathophysiology Streptococci of particular surgical significance Strep. pyogenes (group A Strep. and other beta-haemolytic streptococci) Viridans streptococci Strep. pneumoniae (pneumococcus) Strep. milleri (anginosus group) Anaerobic streptococci Antibiotic sensitivities Enterococci Pathophysiology Antibiotic sensitivities Enterobacteriaceae Pathophysiology Antibiotic sensitivities ‘Non-surgical’ Enterobacteriaceae Pseudomonas Pathophysiology Antibiotic sensitivities Acinetobacter Anaerobes Antibiotic sensitivities Bacteroides Pathophysiology Clostridia Gas gangrene Treatment of gas gangrene Tetanus Pseudomembranous colitis Viruses of particular surgical importance Human immunodeficiency virus (HIV) Classification of HIV infections Surgical involvement in HIV cases Viral hepatitis Hepatitis A Hepatitis B Diagnosis of hepatitis B Treatment of hepatitis B Hepatitis C Hepatitis D Hepatitis E Sepsis (see also http://www.survivesepsis.org/) Multiple organ dysfunction and the systemic inflammatory response syndrome Pathophysiology of SIRS and MODS Mediators of SIRS and MODS Sepsis Clinical conditions leading to sirs and mods Infection Endogenous sources of infection Prevention of sepsis and MODS Surgical aspects Other preventive factors in at-risk patients Chapter 4: Shock and resuscitation The pathophysiology of shock Early recognition of shock Types of shock Hypovolaemic shock (preload insufficiency) Distributive shock Septic shock Pump failure (cardiogenic shock) Anaphylactic shock Clinical features of shock Specific treatments for shock Hypovolaemic shock Cardiogenic shock Septic shock Disseminated intravascular coagulation Anaphylactic shock Resuscitation of the ‘collapsed’ non-trauma patient Principles of managing shock by resuscitation A scheme for managing the acutely ill or shocked patient Recognition of the acutely unwell patient Sequence for action in the patient at risk A. Initial assessment History Vital signs Examination—the initial survey General impression including skin Head and neck Chest Heart Abdomen including rectal and/or vaginal examination if necessary Limbs Neurology B. Broad diagnosis C. Immediate care Oxygen Fluid management Drugs D. Monitoring and reassessment Monitoring Reassessment E. Investigation to narrow the diagnosis F. Definitive treatment Section II: Diagnostic Techniques Chapter 5: Imaging and interventional techniques in surgery Introduction Plain radiology Personal radiation protection General Principles of Radiology Electronic recording techniques Plain radiology Chest X-ray Plain abdominal radiology Free intraperitoneal gas Bone X-rays Contrast radiology Contrast materials Examples of contrast radiology Bowel contrast radiology Preparation for bowel contrast studies Upper gastrointestinal tract Large bowel Small bowel Complications of barium contrast studies Biliary radiology Magnetic resonance cholangio-pancreatography (MRCP) (Fig. 5.6 e and f) Percutaneous transhepatic cholangiography (PTC) Endoscopic retrograde cholangio-pancreatography (ERCP) Operative cholangiography and choledochoscopy T-tube cholangiography Vascular Radiology (Angiography) General principles and hazards of arteriography and venography Arteriography Endovascular techniques Percutaneous transluminal angioplasty (PTA) or balloon angioplasty Techniques of percutaneous angioplasty Local arterial thrombolytic therapy Therapeutic embolisation Minimal access graft placement Venous techniques Venography Placement of vena caval filters Minimally invasive treatment of varicose veins Urography General principles of urography Special precautions with intravenous urography CT urography Percutaneous therapeutic techniques Medical Ultrasound General principles of medical ultrasound Special transducers Applications of ultrasound in general surgery Doppler-shifted ultrasound Main applications of hand-held Doppler ultrasound Duplex Doppler ultrasound scanning Applications of duplex Doppler Cross-Sectional Imaging Computerised tomography (CT scanning) General principles of CT scanning Applications of CT scanning Magnetic resonance imaging (MRI) Principles of magnetic resonance imaging Disadvantages of MRI Applications of magnetic resonance imaging General surgical diagnosis Blood flow Positron emission tomography (PET) Interventional Radiology Tissue sampling Fine-needle aspiration cytology (FNA) and core biopsy Drainage of abscesses and fluid collections Dilatation of gastrointestinal strictures Radionuclide Scanning Principles of radionuclide scanning Applications of radionuclide scanning Lung scanning Bone scanning Renal scans Scanning for gastrointestinal bleeding Leucocyte scanning for inflammation and infection Thyroid scans Cardiovascular imaging Liver and spleen scans Hepatobiliary imaging (HIDA scanning) Flexible Endoscopy Principles of flexible endoscopy Fibreoptic illumination Image transmission Structure of flexible endoscopes Applications of flexible endoscopy Diagnostic upper gastrointestinal endoscopy Therapeutic upper gastrointestinal endoscopy Treatment of upper gastrointestinal haemorrhage Treatment of oesophageal strictures Diagnostic and therapeutic duodenoscopy Enteroscopy Large bowel endoscopy (colonoscopy) Urological endoscopy Diagnostic and therapeutic laparoscopy Chapter 6: Screening for adult disease Principles of screening Introduction Assessing the potential benefits of screening Premature introduction of screening Criteria for assessing a screening programme Evolution of screening programmes Criteria for an effective screening programme The disease The diagnostic test Diagnosis and treatment Limitations of screening Bias Participation rates Other aspects of screening Cost effectiveness Research benefits Consent Screening for cancer Early detection of cancer Cervical cancer Ovarian cancer Breast cancer Effectiveness of mammographic screening The Cochrane view of breast screening Why breast screening is claimed to improve survival Other benefits from breast screening Colorectal cancer Prostate cancer Lung cancer Screening for cardiovascular disease Hypertension Abdominal aortic aneurysm Introduction Appropriateness of screening for AAA Trials of AAA screening The Danish study The Huntingdon study The UK MASS study The consequences of screening for AAA in an area Part II: Perioperative care Chapter 7: Preoperative assessment Introduction Principles of preoperative assessment Essentials of preoperative assessment Explanations to the patient and informed consent Planning the recovery period Marking the operation site Immediate preoperative starvation and fluid restriction Liaison with anaesthetist Operating theatre arrangements Planning the order of an operating list Preparation for major operation History Presenting complaint Results of outpatient investigations Systems enquiry Past medical history Family history Social history Drug history Examination Summary Chapter 8: Medical problems Introduction Cardiac and cerebrovascular disease 1. ischaemic heart disease Clinical problems a. Stable angina and myocardial infarction more than three months previously b. Acute coronary syndrome (ACS) 2. chronic heart failure (CHF) Clinical problems a. CHF before operation b. Decompensated heart failure developing during or after operation Preoperative assessment of cardiac failure 3. cardiac arrhythmias Clinical problems a. Atrial fibrillation (Fig. 8.2) b. Bradycardia c. Other arrhythmias 4. hypertension Clinical problems a. Mild-to-moderate essential hypertension b. Treated hypertension c. Severe or poorly controlled hypertension Preoperative assessment of hypertensive patients 5. cerebrovascular disease 6. valvular heart disease Aortic stenosis Infective endocarditis and indications for antibiotic prophylaxis Respiratory diseases Clinical problems a. Chronic obstructive pulmonary disease (COPD) b. Cigarette smoking c. Current respiratory infections d. Asthma e. Previous pulmonary embolism or deep venous thrombosis Preoperative investigation of respiratory disease Perioperative management of respiratory disease and high-risk patients Gastrointestinal disorders Malnutrition Nutritional assessment Indications for nutritional support Dental problems Peptic ulcer disease Gastro-oesophageal reflux disease (GORD) Inflammatory bowel disease Hepatic disorders Clinical problems a. History of jaundice b. Presence of obstructive jaundice c. The patient with known hepatitis d. The patient with known cirrhosis Preoperative assessment and management Renal disorders Clinical problems a. Mild/moderate chronic renal failure (CKD stage 1–3, eGFR > 30 ml/min) b. Severe chronic renal failure (CKD stage 4–5, eGFR < 30 ml/min) Preoperative assessment Diabetes mellitus Clinical problems a. Insulin-dependent diabetes b. Diabetics controlled on oral hypoglycaemic drugs c. Diabetics controlled by diet alone d. Poorly controlled diabetes on emergency admission Thyroid disease Thyrotoxicosis (Fig. 8.6)Case History Fig. 8.6 Thyrotoxic eye signs This woman of 36 presented with a typical history of primary thyrotoxicosis (Graves’ disease), with weight loss, irritability and menstrual irregularity. In addition her eyesight had become blurred. She had florid exophthalmos with protruding eyeballs (proptosis) and lid lag. She was barely able to close her eyelids and would soon be at risk of corneal drying Hypothyroidism Disorders of adrenal function Adrenal insufficiency Perioperative ‘steroid cover’ Cushing’s syndrome Musculoskeletal and neurological disorders Rheumatoid arthritis Preoperative assessment of a patient with rheumatoid arthritis Haematological disorders Anaemias Haemoglobinopathies Polycythaemia Leukaemia, leucopenia and thrombocytopenia Bleeding disorders Clinical problems of bleeding disorders a. Inherited clotting disorders b. Anticoagulant therapy c. Liver disease d. Aspirin and clopidogrel therapy e. Malabsorption of fat-soluble vitamins Psychiatric disorders Mental illness and learning disability Alcoholism and drug addiction Problems of drug withdrawal Dementia Obesity Chronic drug therapy Chapter 9: Blood transfusion Principles of blood transfusion Laboratory aspects of blood transfusion Blood grouping and compatibility testing Storage and useful life of blood Blood transfusion in clinical practice Blood transfusion and elective surgery Volume and rate of transfusion Volume and rate in haemorrhage Volume and rate in anaemia Reducing the need for bank blood transfusion Non-transfusion methods Preoperative Intraoperative Autologous transfusion Preoperative autologous donation (PAD) Acute normovolaemic haemodilution (ANH) Intraoperative cell salvage (IOCS) Postoperative cell salvage (POCS) Hazards and complications of blood transfusion Febrile non-haemolytic transfusion reactions (FNHTR) Haemolytic reactions Allergic reactions Infection Infections transmitted by donor blood or blood product transfusion Hepatitis viruses Human immunodeficiency virus (HIV) Cytomegalovirus Protozoal infection—malaria Variant Creutzfeldt–Jakob disease (vCJD) Contamination of blood or giving sets with microorganisms Immunosuppressive effects of blood transfusion Fluid overload Transfusion-related acute lung injury (TRALI) Delayed transfusion reactions Post-transfusion purpura (PTP) Transfusion-associated graft versus host disease (Ta-GvHD) Chapter 10: Principles and techniques of operative surgery including neurosurgery and orthopaedics Introduction Principles of asepsis Introduction The operating environment Minimising infection from operating theatre personnel Minimising infection from the patient’s skin Reducing infection from internal viscera Sterilisation of instruments and other supplies Surgical technique Prevention of cross-infection (nosocomial infection) Prophylactic antibiotics Operations involving bowel and biliary system Operations involving implantation of prostheses Operations where ischaemic or necrotic muscle may remain Basic surgical techniques Anaesthesia General principles Choice of anaesthetic technique Incision technique Choice of incision Dissection and handling of deeper tissues Principles of haemostasis Clipping, ligation and under-running Diathermy Tourniquet and exsanguination Pressure Suturing and surgical repair Types of suture material and needles Absorbable versus non-absorbable materials Natural versus synthetic materials Monofilament versus polyfilament sutures Wire sutures Gauge of suture material Types of suture needle Methods of skin suturing Clips and staples Postoperative wound management Types of wound dressing Removal of dressings and sutures Management of drains in the postoperative period Soft tissue surgery Methods of obtaining tissue for diagnosis Open or endoscopic biopsy Biopsy guided by ultrasound or CT scanning Cytology ‘Minor’ operative procedures Local anaesthesia for skin lesions Biopsy techniques Excision biopsy Incision biopsy Destruction of lesions by diathermy, electrocautery, cryocautery or curettage Removal of cysts Marsupialisation Surgery involving infected tissues Management of abscesses Management of infected surgical wounds Management of dirty or contaminated wounds Principles of plastic surgery Tissue transfer techniques Skin grafts Vascularised flaps Free flaps Laparoscopic surgery Introduction to minimal access surgery Laparoscopy Advantages of laparoscopic surgery Surgical advantages Postoperative advantages Risks and complications Technique of laparoscopy Robotic-assisted surgery Applications of laparoscopy Diagnostic laparoscopy Therapeutic laparoscopy Laparoscopic appendicectomy Laparoscopic inguinal hernia repair Laparoscopic fundoplication Laparoscopic management of duodenal ulcer perforation Laparoscopic placement of enterocutaneous jejunostomy tube Laparoscopic splenectomy Laparoscopic adrenalectomy Laparoscopically assisted colectomy Laparoscopic surgery for obesity Principles of neurosurgery Introduction Perioperative considerations Intraoperative considerations Postoperative considerations Surgical management of hydrocephalus Treatment of communicating hydrocephalus Treatment of non-communicating hydrocephalus Basic principles of craniotomy Presentation of brain tumours Orthopaedic surgery The normal locomotor system Axial and appendicular skeleton Structure of bone and articular cartilage Bone Articular cartilage Limb compartments Orthopaedic disorders Arthritis Osteoarthritis Post-traumatic osteoarthritis Inflammatory arthropathies Crystal arthropathies Infection Osteomyelitis Septic arthritis Tumours Paediatric orthopaedics and growth disorders Elective orthopaedics Investigation in orthopaedics Plain radiology Ultrasound Magnetic resonance imaging (MRI) Computed tomography (CT) Arthroscopy Joint replacement surgery Chapter 11: Diagnosis and management of common postoperative problems Introduction Postoperative pain Methods of management Analgesia for minor and intermediate surgery Analgesia for major surgery and trauma Excessive postoperative pain Pyrexia (see Fig. 11.3) Tachycardia Cough, shortness of breath and tachypnoea Collapse or rapid general deterioration Nausea and vomiting Drugs as a cause Causes in the immediate postoperative period Bowel obstruction causing nausea and vomiting Systemic disorders causing nausea and vomiting Haematemesis Other disorders of bowel function Diarrhoea Constipation Poor urine output Retention of urine Pathophysiology Management of postoperative urinary retention Conservative measures Catheterisation Blocked catheter Diminished urine production Changes in mental state Other causes Jaundice General causes Causes related to biliary or liver surgery Chapter 12: Complications of surgery Introduction Complications of anaesthesia General complications of operations Inadvertent trauma in the operating department Haemorrhage Perioperative haemorrhage Early postoperative haemorrhage Management of early postoperative haemorrhage Later postoperative haemorrhage Surgical injury Unavoidable tissue damage Inadvertent tissue damage Infection related to the operation site Minor wound infections Wound cellulitis and abscess Gas gangrene Late infective complications Impaired healing Factors retarding wound healing Wound dehiscence (‘burst abdomen’) Incisional hernia Complications of any surgical condition Respiratory complications Effects of anaesthesia and surgery on respiratory function Atelectasis Pathophysiology and clinical features Prevention and treatment of atelectasis Pneumonias Aspiration pneumonitis Aspiration pneumonia Acute respiratory distress syndrome (ARDS) Pathophysiology of ARDS Clinical features of ARDS Treatment of ARDS Venous thromboembolism (VTE) Pathophysiology Deep vein thrombosis (DVT) Diagnostic tests for DVT Pulmonary embolism Diagnosis of pulmonary embolism (PE) Management of venous thromboembolism Prevention of venous thromboembolism Fluid and electrolyte disturbances Antibiotic-associated colitis Pathophysiology and clinical features Acute renal failure (insufficiency) Pathophysiology Prevention and management of acute renal failure Pressure sores Pathophysiology Prevention and management of pressure sores Complications of operations involving bowel Delayed return of bowel function Temporary interruption of peristalsis Adynamic bowel disorders Acute gastric dilatation ‘Pseudo-obstruction’ Mechanical bowel obstruction Early postoperative mechanical obstruction Late postoperative mechanical obstruction Anastomotic failure Intra-abdominal abscesses Abscess associated with bowel anastomosis Other intra-abdominal abscesses Peritonitis Bowel fistula Acute bowel ischaemia Chapter 13: Principles of cancer management Introduction Neoplasia Benign neoplasms Malignant neoplasms Carcinogenesis Multiple primary lesions and recurrences Growth and spread of malignant tumours Treatment of malignant tumours Basic principles of cancer management Teamworking in cancer management Treatment options Surgery for cancer General principles of cancer surgery (Box 13.3) Radiotherapy General principles of radiotherapy Major applications of radiotherapy Primary curative radiotherapy Adjuvant radiotherapy Palliative radiotherapy Complications of radiotherapy Long-term side-effects of radiotherapy Chemotherapy General principles of chemotherapy Major applications of chemotherapy Primary curative treatment Adjuvant chemotherapy General palliative treatment Side-effects of chemotherapy Hormonal manipulation Targeted therapies Lymphoma Breast cancer Imatinib The future Palliative care Principles of palliative care Approach to common symptoms requiring palliation other than pain Cancer pain Assessment of pain Principles of cancer pain management Opioid analgesia Establishing treatment Chapter 14: Principles of transplantation surgery Introduction Transplant immunology Major histocompatibility complex Tissue typing and transplant sharing schemes Immunosuppression Graft rejection Hyperacute rejection Acute rejection Chronic rejection Practical problems of transplantation Sources of organs for transplantation ‘Brain death’ Living donation Organ preservation and transport Specific organ transplants Kidney transplants Liver transplants Pancreas transplants Heart and lung transplants Small bowel transplants Part III: Principles of Accident Surgery Chapter 15: Major trauma Introduction Pre-hospital assessment and intervention Introduction Assessment at the scene of a road traffic collision Preventing secondary injuries and damage Pre-hospital care Airway and breathing Spine Circulation Wounds Fractured limbs Transport to hospital Preliminary hospital management of multiple and serious injuries Organisation of the accident department Initial care in the accident department Assessment of the seriously injured patient Recording of events X-rays and other investigations Abdominal injuries Introduction Diagnosis of abdominal injuries Clinical observation Investigative techniques Focused abdominal sonography for trauma (FAST) CT scanning for abdominal injuries Penetrating abdominal wounds Stab wounds and other sharp abdominal wounds Bullet and other missile injuries Closed (blunt) abdominal injuries Injuries to specific solid organs Spleen (Fig. 15.7)Case History Fig. 15.7 Ruptured spleen (a) This 67-year-old woman sustained fractures of the left lower ribs in a fall. Discharged from hospital the next day but re-presented 6 weeks later with abdominal swelling, tenderness and anaemia. This ultrasound scan shows a large subcapsular splenic haematoma (arrowed), which had developed slowly, and intrasplenic haemorrhage H. She rapidly recovered after splenectomy. (b) This operative specimen comes from a 15-year-old girl who fell off her pony, which then trod on the left chest. She was admitted with bruising over the lower ribs and tachycardia. At laparotomy, her spleen was found to be split completely in half, necessitating removal Liver Other organs Bowel injuries Lower urinary tract injuries Damage control laparotomy Chest injuries General principles Thoracostomy (open and tube) Vascular trauma Bleeding Ischaemia Patterns of vascular injury False aneurysm Arteriovenous fistula Diagnosis of vascular injury Clinical signs Investigation Management of vascular injury Compartment syndrome Damage control in vascular injury Vessel ligation Shunting Primary amputation Interventional radiology in vascular injury Orthopaedic trauma Introduction Fractures Introduction Fracture healing Principles of fracture management Initial management of fractures Definitive management of fractures (see Table 15.4) Open (compound) fractures Pathological fractures Complications of fractures (see Box 15.8) Specific fractures Common upper limb fractures Common lower limb fractures Pelvis and spinal fractures Pelvic fractures Spinal fractures (Fig. 15.10)Case History Fig. 15.10 Cervical spine fractures (a) This 17-year-old boy was admitted semiconscious after crashing his motorcycle and landing head-first in a ditch. On examination he was tetraplegic and unable to move his upper or lower limbs but could shrug his shoulders. This lateral cervical spine X-ray shows a burst fracture of the body of C6 (arrowed) with fragments in the spinal canal; there is also some posterior subluxation of C5. (b) Left lateral cervical spine X-ray from another unconscious young patient showing a fracture (arrowed) of the body of C2 and severe anterior subluxation of C1. Common ligamentous injuries Dislocations Damage control orthopaedics Paediatric trauma Chapter 16: Head and maxillofacial injuries Head injuries Introduction Pathophysiology of traumatic brain injury Primary brain injury Concussion Diffuse axonal injury Focal brain injuries Secondary brain injury Cerebral hypoxia Intracranial bleeding Extradural (epidural) haemorrhage Subdural haematoma Chronic subdural haematoma Intracerebral haemorrhage Infection Skull fractures The importance of skull fractures Types of skull fracture Linear fractures Depressed fractures Open (compound) fractures Fractures of the skull base Management of head injuries Pre-hospital management Clinical assessment History Examination 1. Level of consciousness 2. Pupil size and reactivity 3. Limb movements and responses Imaging for suspected head injuries Practical management of head injuries Head injury observations Indications for prompt neurosurgical referral after head injury Management of moderate and severe head injuries Initial management Continuing care Rehabilitation Maxillofacial injuries General principles Examination for facial fractures Radiology Mandibular fractures Fractures of the middle third of the face Fractures of the nasal bones Fractures of the orbit and zygoma Depressed fractures of the zygoma Blow-out fractures of the orbit Injuries to the teeth Common ENT emergencies Chapter 17: Soft tissue injuries and burns Soft tissue injuries Minor soft tissue injuries Intermediate soft tissue injuries Foreign bodies Flap lacerations Facial lacerations Scalp lacerations Major soft tissue injuries Injury to a vital part of the body Eye Neck Lacerations to the limbs and hands Extensive facial lacerations Vascular injuries involving blood loss or ischaemia Compartment syndrome Animal-associated soft tissue injuries Snakebite Arthropod bites and stings Animal bites Types of infection Pasteurellosis Streptococcal and staphylococcal infections Human bites Gunshot, missile and stab wounds Traumatic amputation of digits or limbs Principles of digit and limb replantation surgery Contamination with soil and road dirt Crush injuries Presentation Management Peripheral nerve injuries Anatomy Types of injury Nerve regeneration Clinical types of nerve injury Compression Traction Laceration Missile injury Repair of nerve injury Direct repair Cable grafting Results of nerve repair Burns Introduction Epidemiology Pathophysiology of burns Systemic effects (Box 17.2) Electrocution burns Chemical burns Non-accidental injury (NAI) Assessment of the burnt patient History Calculating the burnt area Principles of management of burns First aid Analgesia Dressings Where should burns be managed? Outpatient management of minor burns Managing burns of specific depth Management of extensive burns Resuscitation and fluid management Local management of the burns Inhalational injuries Follow-up and late treatment OF BURNS Part IV: Symtoms, Diagnosis and Management Section I: Abdomen, General Principles Chapter 18: Non-acute abdominal pain and other abdominal symptoms and signs Introduction Pain Character, timing and site of the pain The site of origin, distribution and radiation of the pain Diseases causing non-acute abdominal pain—typical patterns Non-acute abdominal pain in children Approach to investigation of non-acute abdominal pain Dysphagia AND ODYNOPHAGIA Clinical presentation Approach to investigation of dysphagia Weight loss, anorexia and associated symptoms Approach to investigation of weight loss, anorexia and associated symptoms Anal and perianal symptoms Anal bleeding Anal pain and discomfort Perianal itching and irritation ‘Something coming down’ Perianal discharge Approach to investigation of anal and perianal symptoms Change in bowel habit, rectal bleeding and related symptoms Frequency of defaecation and stool consistency Constipation Diarrhoea Erratic bowel habit Changes in the nature of the stool Presence of frank blood, altered blood or mucus in the stool Frank rectal bleeding Occult faecal blood loss Rectal passage of mucus or pus Tenesmus Approach to investigation of change in bowel habit Iron deficiency anaemia Approach to investigation of anaemia Obstructive jaundice The normal enterohepatic circulation (Fig. 18.8) Pathophysiology of obstructive jaundice History and examination of patients with obstructive jaundice History-taking Examination Approach to investigation of jaundice Urine tests Blood tests Imaging Hepatobiliary ultrasonography CT scanning Endoscopic and magnetic resonance cholangio-pancreatography Laparoscopy and liver biopsy Principles of management of obstructive jaundice Potentially curable obstructions Obstruction due to incurable tumour Terminal disease Special risks of surgery in the jaundiced patient Abdominal mass or distension Clinical assessment of an abdominal mass History General examination Examination of an abdominal mass Examination of masses in specific regions of the abdomen (see Fig. 18.1) Mass in the right hypochondrium (right upper quadrant or RUQ) Epigastric mass Mass in the left hypochondrium (left upper quadrant or LUQ) Mass in the loin or flank Mass in the left iliac fossa Suprapubic mass Mass in the right iliac fossa Central abdominal mass Rectal mass and findings on pelvic examination Interpretation of a finding of ascites Malignant ascites Lymphatic obstruction Tuberculosis Non-surgical causes Diffuse abdominal distension Approach to investigation of an abdominal mass or distension Laboratory tests Radiology Endoscopy Other methods of tissue diagnosis Examination under anaesthesia, laparoscopy and exploratory laparotomy Chapter 19: The acute abdomen and acute gastrointestinal haemorrhage Introduction Basic principles of managing the acute abdomen Disorders and diseases causing the acute abdomen Intestinal obstruction Pathophysiology of intestinal obstruction Symptoms of intestinal obstruction Vomiting Pain Constipation Effects of the competence of the ileocaecal valve Incomplete obstruction Physical signs of intestinal obstruction General examination Groin examination Abdominal examination Radiological investigation of suspected bowel obstruction The adynamic bowel Pseudo-obstruction of the colon Principles of management of intestinal obstruction Bowel strangulation Pathophysiology of bowel strangulation Symptoms and signs of bowel strangulation Principles of management of suspected bowel strangulation Peritonitis Pathophysiology and clinical features of peritonitis Intra-abdominal haemorrhage Principles of management of peritonitis Intra-abdominal abscess Pathophysiology and clinical features of intra-abdominal abscess Principles of management of an intra-abdominal abscess Perforation of an abdominal viscus Pathophysiology and clinical features of perforation Principles of management of perforation Acute bowel ischaemia Pathophysiology and clinical features of intestinal ischaemia Principles of management of intestinal ischaemia Major gastrointestinal haemorrhage Pathophysiology and clinical features Management of upper gastrointestinal haemorrhage Initial management and resuscitation Clinical history, examination and investigation Stratification of risk Endoscopic management of acute upper gastrointestinal haemorrhage Surgical management More distal gastrointestinal haemorrhage Section II: Upper Gastrointestinal and Hepatobiliary Chapter 20: Gallstone diseases and related disorders Introduction Structure and function of the biliary system Pathophysiology of the biliary system Gallstone composition The role of inflammation and infection The role of chronic obstruction Other pathological mechanisms Epidemiology of gallstones Investigation of gall bladder pathology Blood tests for haematological and liver abnormalities Imaging in investigating gall bladder pathology Investigating the biliary duct system The non-jaundiced patient The jaundiced patient Clinical presentations of gallstone disease Chronic symptoms suggestive of gall bladder disease Biliary colic Clinical features Management Acute cholecystitis Pathophysiology and clinical features Management Acute cholecystectomy Empyema of the gall bladder Cholecysto-duodenal fistula and gallstone ileus Carcinoma of the gall bladder Bile duct stones Pathophysiology Clinical presentations of stones in the biliary tract Obstructive jaundice Asymptomatic duct stones Acute pancreatitis Ascending cholangitis Management of gallstone disease Non-surgical treatment of gallstones Surgical management of gallstones Indications for surgery and preparation of the patient Cholecystectomy—open versus laparoscopic surgery Laparoscopic management of gall bladder disease Operative technique Results of laparoscopic cholecystectomy Operations on the common bile duct Exploration of the common bile duct Endoscopic management of bile duct stones Complications of biliary surgery The retained stone Biliary peritonitis Bile duct damage Haemorrhage Hazards of pre-existing jaundice Ascending cholangitis and other infections Chapter 21: Peptic ulceration and related disorders Introduction Pathophysiology and epidemiology of peptic disorders Pathophysiology of peptic ulceration Outcomes of breaches of the mucosal barrier Epidemiology and aetiology of peptic ulcer disease The size of the problem Sites of peptic ulceration (see Fig. 21.2) Stomach and duodenum Oesophagus Aetiological factors in peptic disease H. pylori infection Acid–pepsin production Mucosal resistance Other mucosal irritants Investigation and clinical features of peptic disorders Investigation of suspected peptic ulcer disease Endoscopy Contrast radiology Presenting features of peptic ulcer disease Non-acute presentations of peptic ulcer disease Peptic disorders of the oesophagus Peptic disorders of the stomach Gastritis Stress ulcers Chronic gastric ulceration Peptic disorders of the duodenum Duodenitis Chronic duodenal ulceration Management of chronic peptic ulcer disease Control of predisposing or aggravating causes Elimination of proven H. pylori infection Diminishing of irritant effects of acid–pepsin Administration of mucosal protective agents Reduction of acid secretion H2-receptor blockade and proton pump antagonists Vagotomy Surgical removal of intractable ulcers and gastrin-secreting tissue Complications and side-effects of partial gastrectomy Correction of secondary anatomical problems Emergency presentations of peptic ulcer disease Haemorrhage from a peptic ulcer Perforation of a peptic ulcer Clinical presentation of perforated peptic ulcer Diagnosis of perforated peptic ulcer Surgical management of peptic perforation Conservative management of perforated duodenal ulcer Pyloric stenosisCase History Fig. 21.10 Gastric outlet obstruction Barium meal examination in a woman of 78 who presented with a 2-week history of vomiting. She was grossly dehydrated with a hypochloraemic alkalosis. She was resuscitated and a nasogastric tube passed. This film shows huge gastric dilatation and no flow of barium beyond the pylorus. She also has incidental gallstones (GS). The obstruction proved to be due to chronic duodenal ulceration, but a diagnosis of carcinoma of the gastric antrum must be considered in such a patient Clinical features of pyloric stenosis Biochemical abnormalities in pyloric stenosis Management of pyloric stenosis Chapter 22: Disorders of the oesophagus Introduction Carcinoma of the oesophagus Pathology and clinical features Epidemiology and aetiology Investigation of suspected oesophageal carcinoma Staging the cancer Management of carcinoma of the oesophagus Surgery Inoperable lesions Hiatus hernia and reflux oesophagitis Pathophysiology Clinical features of reflux oesophagitis Management of hiatus hernia and reflux oesophagitis Reducing reflux Prokinetic agents Reducing acid–pepsin production Management of strictures Surgery for hiatus hernia and reflux oesophagitis Achalasia Pathophysiology and clinical presentation Investigation of suspected achalasia Management of achalasia Pharyngeal pouch Oesophageal web Gastro-oesophageal varices Pathophysiology Elective management Management of bleeding gastro-oesophageal varices Diagnosis and resuscitation Treatment Chapter 23: Tumours of the stomach and small intestine Introduction Carcinoma of stomach Pathology of gastric carcinoma Epidemiology of gastric carcinoma Aetiology of gastric carcinoma and premalignant conditions Atrophic gastritis Helicobacter pylori infection Dietary factors Clinical features of gastric carcinoma Spread of gastric cancer Direct spread and metastasis Investigation of suspected gastric carcinoma Initial diagnosis Staging Management of gastric carcinoma Radical surgery Chemotherapy and radiotherapy Palliative procedures Gastric polyps Gastrointestinal stromal tumours (GIST) Small bowel gastrointestinal stromal tumours Gastric and small bowel lymphomas Pathology and clinical features of lymphomas Management of lymphomas Carcinoid tumours Pathology of carcinoid tumours Clinical presentation of carcinoid tumours Management of carcinoid tumours Other tumours of the small intestine Chapter 24: Tumours of the pancreas and hepatobiliary system; the spleen Introduction Carcinoma of the pancreas Pathology Clinical features of ductal pancreatic carcinoma Pain and other abdominal symptoms and signs Obstructive jaundice Approach to investigation of suspected pancreatic carcinoma (Box 24.2) CT and ultrasound imaging Endoscopic ultrasound (EUS) and needle aspiration cytology Magnetic resonance cholangio-pancreatography (MRCP) Endoscopic retrograde cholangio-pancreatography (ERCP) and therapeutic intervention Lesions in the body and tail of the pancreas Cystic neoplasms of the pancreas Management of pancreatic carcinoma Surgical resection and adjuvant therapy Palliation of pancreatic cancer Endocrine tumours of the pancreas Insulinomas (Fig. 24.4) Glucagonomas Gastrinomas Multiple endocrine neoplasia syndromes (MEN) Biliary and periampullary tumours Management of extrahepatic cholangiocarcinoma and periampullary carcinoma Carcinoma of the gall bladder Primary sclerosing cholangitis Liver tumours and abscesses Liver abscesses Hepatocellular carcinoma Clinical features and management of hepatocellular carcinoma Secondary liver tumours The spleen Elective splenectomy Chapter 25: Pancreatitis Introduction Acute Pancreatitis Aetiology and epidemiology of acute pancreatitis Pathophysiology of acute pancreatitis Clinical features of acute pancreatitis (see Box 25.3) Investigation of suspected pancreatitis Plasma amylase Imaging Endoscopy Clinical classification Mild acute pancreatitis Severe acute pancreatitis Management of acute pancreatitis Mild attacks Severe attacks Endoscopy and surgery in severe acute pancreatitis Complications of acute pancreatitis Mortality Pancreatic necrosis and infection Fluid collections around the pancreas Pancreatic pseudocyst Pancreatic abscess Complications of severe acute pancreatitis Late complications of acute pancreatitis Recurrent and Chronic Pancreatitis Recurrent acute pancreatitis Chronic pancreatitis Section III: Coloproctology Chapter 26: Appendicitis Introduction Anatomy of the appendix Pathophysiology of appendicitis Clinical features of appendicitis Classic appendicitis Other presentations of acute appendicitis Making the diagnosis of appendicitis Special points in the history and examination Differential diagnosis The equivocal diagnosis Problems in the diagnosis of appendicitis The very young The elderly Pregnancy The ‘grumbling’ appendix Appendicectomy Antibiotic prophylaxis Technique of appendicectomy Open appendicectomy Laparoscopic appendicectomy The ‘lily-white’ appendix The appendix mass Chapter 27: Colorectal polyps and carcinoma Introduction Colorectal Polyps Adenomatous polyps and adenomas Classification of colonic adenomas Distribution of colorectal adenomas Symptoms and signs of colorectal polyps Diagnosis and management of colorectal polyps Adenocarcinoma of Colon and Rectum Epidemiology of colorectal carcinoma Inherited conditions causing bowel cancer Polyposis syndromes Hereditary non-polyposis colorectal cancer (HNPCC) Pathophysiology of colorectal carcinoma Presentation of large bowel carcinoma Blood loss and anaemia Change of bowel habit and large bowel obstruction Rectal bleeding Tenesmus Perforation Clinical signs in suspected colorectal carcinoma Investigation of suspected colorectal carcinoma Blood tests Imaging for staging Management of colorectal carcinoma Staging of colorectal carcinoma Operations for colorectal cancer The role of adjuvant radiotherapy and chemotherapy Management of advanced disease and recurrence Complications of large bowel surgery Stomas Indications and general principles Permanent stomas Temporary stomas Emergency procedures Defunctioning stomas Bowel rest Types of stoma Loop stoma Split or ‘spectacle’ stoma End stoma Hartmann’s procedure: end colostomy and rectal stump Irrigation technique for managing a colostomy Complications of colostomy and ileostomy Chapter 28: Chronic inflammatory disorders of the bowel Introduction Epidemiology and aetiology of inflammatory bowel disease Ulcerative Colitis Pathophysiology of ulcerative colitis Clinical features of ulcerative colitis Clinical examination and investigation of suspected ulcerative colitis Proctitis Contrast radiology Endoscopy Fulminant ulcerative colitis Management of ulcerative colitis Aminosalicylate preparations Corticosteroids Other supportive measures Surgery for ulcerative colitis Crohn’s Disease Pathophysiology and clinical consequences of crohn’s disease Effects of mucosal inflammation Effects of transmural inflammation Perianal inflammation Systemic features Symptoms and signs in crohn’s disease Approach to investigation of suspected crohn’s disease Management of Crohn’s disease Anti-inflammatory agents Immunomodulators Other supportive treatments The role of surgery in Crohn’s disease Other Chronic Inflammations of the Colon Amoebic colitis Clinical features of amoebic colitis Diagnosis of amoebiasis Treatment of amoebiasis Microscopic colitis Chapter 29: Disorders of large bowel motility, structure and perfusion Introduction Modern diet and disease Epidemiological observations Mechanisms of disease caused by modern diet Dietary fibre content Irritable bowel syndrome Clinical features of irritable bowel syndrome Pathophysiology and aetiology of irritable bowel syndrome Management of irritable bowel syndrome Constipation Clinical features of constipation Pathophysiology of chronic constipation Management of constipation Sigmoid volvulus (Fig. 29.1) Pathophysiology of sigmoid volvulus Clinical features of sigmoid volvulus Management of sigmoid volvulus Diverticular disease Pathophysiology of diverticular disease Complications of diverticular disease Clinical presentations of diverticular disease and their management Chronic grumbling diverticular pain (see Fig. 29.3b) Acute diverticulitis (i.e. spreading pericolic inflammation, see Fig. 29.3c) Hinchey classification of abscesses and perforation Pericolic abscess (see Fig. 29.3d) Diverticular perforation (Fig. 29.3e) Fistula formation into other abdominal or pelvic structures (Fig. 29.3g) Intestinal obstruction (Fig. 29.3h) Acute rectal haemorrhage (Fig. 29.3f) Colonic angiodysplasias Ischaemic colitis Chapter 30: Anal and perianal disorders Introduction Anatomy of the anal canal Haemorrhoids Pathogenesis of haemorrhoids Classification of haemorrhoids Symptoms and signs of haemorrhoids Acute presentations of haemorrhoids Conservative management and prevention of haemorrhoids Surgical treatments for haemorrhoids Injection of sclerosants or banding Haemorrhoidectomy Haemorrhoidal artery ligation operation (HALO) Thrombosed external haemorrhoids Anal fissure Management of anal fissure Anorectal abscesses Pathophysiology and clinical features Treatment of anorectal abscesses Anal fistula Pilonidal sinus and abscess Pilonidal abscess Treatment of pilonidal sinus Rectal prolapse Management of rectal prolapse Faecal incontinence (Table 30.1) Anorectal incontinence Anal warts (condylomata ACCUMINATA) Squamous cell carcinoma of the anus Epidemiology Clinical features Other rare anal neoplasms Proctalgia fugax Pruritus ani Section IV: Thoracic Surgery Excluding Cardiac Chapter 31: Thoracic surgery Introduction Investigative techniques Imaging Lung function tests Bronchoscopy Pleural aspiration and percutaneous biopsy Video-mediastinoscopy Thoracoscopy Anterior mediastinotomy Thoracotomy Therapeutic procedures Tracheostomy Principles of tracheostomy Complications of tracheostomy Thoracotomy Posterolateral thoracotomy Lateral thoracotomy Anterior thoracotomy Median sternotomy Specific thoracic disorders Problems affecting the pleural space Introduction Pneumothorax Treatment of pneumothorax Aspiration Intercostal tube drainage Treatment of persistent or recurrent pneumothorax Excess pleural fluid Malignant effusions Empyema Haemothorax Lung abscess Cancer of the lung Staging of lung cancer and its implications Palliative treatment Surgical treatment of lung cancer Non-malignant indications for lung resection Malignant mesothelioma Presentation of malignant mesothelioma Investigation Treatment Benign asbestos diseases of the chest Disorders of the mediastinum Anterior mediastinum Retrosternal thyroid Thymus Parathyroid Lymph node enlargement Germ cell tumours Middle mediastinum Posterior mediastinum Section IV: Groin and Male Genitalia Chapter 32: Hernias and other groin problems Introduction Lumps in the groin Clinical examination Position for examination Consistency and reducibility Relationship to the inguinal ligament Direct and indirect inguinal hernias (Fig. 32.3) Inguinal and femoral hernias Inguinal hernia Anatomical considerations Mechanisms of inguinal hernia formation Spigelian hernia Natural history of inguinal hernia Hernial strangulation Management of inguinal hernias Inguinal herniorrhaphy and herniotomy Complications of hernia repair Recurrence Laparoscopic inguinal hernia repair (described in Ch. 10) Postoperative care and return to normal activities Trusses Femoral hernia Clinical features of femoral hernia Strangulated femoral hernia Management of femoral hernia Enlarged inguinal lymph nodes Clinical features of enlarged inguinal lymph nodes Saphena varix Femoral artery aneurysm Chronic groin pain Ventral hernias Epigastric hernias (see Fig. 32.16) Umbilical and paraumbilical hernias Chapter 33: Disorders of the male genitalia Disorders of the scrotal contents Introduction Clinical examination of scrotal lumps and swellings The origin of a scrotal lump Testicular and epididymal lumps Scrotal pain Acute pain (Box 33.1) Chronic pain Inflammation of the epididymis and testis Epididymitis Tuberculous epididymitis Orchitis Hydrocoele Primary hydrocoele Management Hydrocoele of the cord Fournier’s scrotal gangrene Epididymal cyst and spermatocoele Varicocoele Testicular tumours Pathology of testicular tumours Seminomas Teratomas Clinical features of testicular tumours Investigation and treatment of testicular tumours Tumour markers Surgical exploration Management of seminoma Management of teratomas and other non-seminomatous germ cell tumours Long-term surveillance Fertility Absent scrotal testis (cryptorchidism) Management of maldescent of the testis Torsion of the testis or epididymal appendage Testicular torsion (Figs. 33.8 and 33.9) Torsion of the epididymal appendage (hydatid of morgagni) Management of suspected testicular torsion Trauma to the testis Male sterilisation Disorders of the penis Foreskin problems in adults Phimosis Balano-posthitis (balanitis) Paraphimosis Circumcision Peyronie’s disease Carcinoma of the penis Priapism Section V: Urology Chapter 34: Symptoms, signs and investigation of urinary tract disorders Introduction Symptoms of urinary tract disease Symptoms caused by intrinsic disease of the urinary tract Urinary symptoms caused by non-urinary disease The common symptoms of urinary tract disease Abdominal pain Pain arising from the kidneys and upper tract Pain arising from the bladder and lower tract Pain simulating urinary tract disease Haematuria Causes of haematuria (see Fig. 34.2 for renal causes) Diagnostic features of haematuria Dysuria Disorders of micturition Lower Urinary Tract Symptoms (LUTS) Retention of urine Acute retention Chronic retention Urinary incontinence Loss of cortical control Disorders of sacral reflex control of detrusor and sphincter function Structural abnormalities of the bladder or sphincter Pneumaturia Haemospermia Approach to the diagnosis of urinary symptoms Special points in the history Physical examination General examination Abdominal examination Rectal examination Investigation of suspected urinary tract disease Are any blood tests likely to be helpful in diagnosis? What urine tests are indicated? Where is the lesion? Suspected upper tract lesions Ultrasound CT scanning Intravenous urography Special contrast investigations Radionuclide scanning Suspected lower tract lesions Radiography and ultrasound Cystourethroscopy Other investigations Chapter 35: Disorders of the prostate Introduction Anatomy Benign prostatic hyperplasia Pathophysiology of benign prostatic hyperplasia Clinical features of benign prostatic hyperplasia Complications of bladder outlet obstruction Management of benign prostatic hyperplasia Diagnosis Relief of chronic retention and obstructive effects on the kidney Cystoscopy Drug treatments Transurethral resection of prostate (TURP) and other transurethral treatments Retropubic prostatectomy Complications of TURP and open prostatectomy Long-term catheterisation or stenting Acute urinary retention and its management Diagnosis of acute retention Catheterisation Evaluating the underlying cause and any precipitating factors ‘Trial without catheter’ Indwelling catheters and their management Catheters in paraplegic patients Carcinoma of the prostate Pathophysiology of prostatic carcinoma Symptoms and signs of prostatic cancer Approach to investigation of suspected prostatic carcinoma (Figs 35.6 and 35.7) Management of prostatic carcinoma Early-stage disease (stages T1 or T2; N0, M0) Locally advanced disease (stages T3 or T4, N0, M0) Metastatic disease (stage N+ and/or M+) Hormonal therapy Prostatitis Acute prostatitis Chronic prostatitis Chapter 36: Tumours of the kidney and urinary tract Introduction Renal cell carcinoma Pathology of renal cell carcinoma Staging of renal cell carcinoma Clinical features of renal cell carcinoma Approach to investigation of suspected renal cell carcinoma Management of renal cell carcinoma Urothelial carcinoma (transitional cell carcinoma) Epidemiology and aetiology of urothelial carcinoma Pathology of urothelial carcinoma Clinical features of urothelial carcinoma Investigation of suspected urothelial carcinoma Staging of urothelial tumours of the bladder Management of urothelial carcinoma Bladder tumours Urothelial tumours of the upper tract Unusual urinary tract tumours Follow-up and control of recurrent disease Chapter 37: Stone disease of the urinary tract Introduction Pathophysiology of stone disease Chemical composition Mechanisms of stone formation Calcium-containing stones Stones caused by excessive urinary excretion of a stone constituent Other predisposing factors Clinical features of stone disease Obstruction of urinary flow Pelvicalyceal obstruction Passage of stones into the ureter Predisposition to infection Local irritation and tissue damage Investigation and management of suspected urinary tract stones Approach to investigation Methods of investigation Indications for stone removal (Box 37.3) Methods of stone removal Cystoscopic techniques Open surgical methods Percutaneous techniques of stone removal Non-invasive stone removal technique (Fig. 37.6c) Management of acute ureteric colic Investigation of ureteric colic Long-term management of urological stone disease Management of metabolic abnormalities Long-term follow-up of patients with urinary tract stones Chapter 38: Urinary tract infections Introduction Bacterial infections of the lower urinary tract Pathophysiology of lower urinary tract infections Clinical features of lower urinary tract infections Bacteriological diagnosis of lower urinary tract infections Management of bladder infections Recurrent bladder infections The elderly, debilitated and infirm Young and middle-aged women Patients with urinary tract abnormalities predisposing to infection Upper urinary tract infections Pathophysiology of upper urinary tract infections Clinical features of upper urinary tract infections Management of upper urinary tract infections Complications of acute pyelonephritis (see Figs 38.1 and 38.2)Case History Fig. 38.2 Perinephric abscess This woman of 55 presented with a 3-week history of left loin pain and 48 hours of rigors. The photograph shows a large abscess surrounding the left kidney, ‘pointing’ in the posterior loin. A plain abdominal film showed a staghorn calculus in the kidney and isotope studies showed no function in that kidney. The abscess was drained percutaneously and she was treated with antibiotics. The kidney was later removed Pyonephrosis Perinephric abscess Urinary tract infection in the catheterised patient Genitourinary tuberculosis Pathophysiology of genitourinary tuberculosis Clinical features and investigation of genitourinary tuberculosis Management of genitourinary tuberculosis Schistosomiasis Clinical presentations of schistosomiasis Management of schistosomiasis Urethral infections and strictures Urethral infections Urethral stricture Chapter 39: Congenital disorders and diseases secondarily involving the urinary tract Congenital urinary tract disorders Introduction Polycystic kidneys Medullary sponge kidney Duplex systems Renal cysts Horseshoe kidney Renal ectopia and other renal abnormalities Urachal abnormalities (see Fig. 39.6) Diseases secondarily involving the urinary tract Introduction Tumours and inflammatory causes Retroperitoneal fibrosis (RPF) Section VI: Cardiovascular Disorders Chapter 40: Pathophysiology, clinical features and diagnosis of vascular disease affecting the limbs Introduction Vascular insufficiency of the limb (Table 40.1) Symptoms and signs in the limb Pain Intermittent claudication Chronic ischaemic rest pain Acute critical ischaemia Deep venous thrombosis (acute venous insufficiency) Skin changes Changes in skin colour and temperature (see Table 40.7) The acutely cold white foot Colour change in venous thrombosis The chronically cold foot Blue toes Black toes Redness The warm foot Abnormal pigmentation Lower limb ulceration (Box 40.1) History of the ulcer Site of the ulcer Characteristics of the ulcer Nature of the surrounding tissues Regional features Limb swelling Chapter 41: Managing lower limb arterial insufficiency, the diabetic foot and major amputations Introduction Chronic lower limb ischaemia Intermittent claudication Symptoms Physical signs of intermittent claudication Natural history of intermittent claudication The fate of the leg The fate of the patient Severe ischaemia Critical ischaemia Managing lower limb ischaemia Investigation of chronic lower limb arterial insufficiency The ankle brachial pressure index (ABPI) Duplex ultrasonography Arteriography (see Ch. 5) Approach to management of chronic lower limb arterial insufficiency Conservative management Mild to moderate claudication Disabling claudication Techniques of revascularisation for chronic arterial insufficiency Percutaneous transluminal angioplasty (PTA) Arterial reconstructive surgery Aorto-iliac disease Femoro-popliteal disease Complications of arterial surgery Other therapies for arterial insufficiency Intravenous and intra-arterial drug therapies Sympathectomy Acute lower limb ischaemia Pathophysiology Embolism Thrombosis Clinical features of acute lower limb ischaemia (Box 41.3) Principles of managing the acutely ischaemic limb Thrombosis or embolism? Embolectomy The diabetic foot Pathophysiology of the diabetic foot Identifying the causes of diabetic foot problems Clinical presentations of diabetic foot complications Management of neuropathic foot complications Control of infection Removal of necrotic tissue Prevention of the diabetic foot Lower limb amputation Level of amputation Chapter 42: Aneurysms and other peripheral arterial disorders Aneurysms (see Table 42.1) Pathology of aneurysms Clinical presentation of aneurysms (see Table 42.1) Principles of management of aneurysms Indications for operation (see Box 42.1) Investigation of aneurysms (see Fig. 42.2) Non-ruptured AAA Leaking or ruptured AAA Principles of aneurysm surgery Open abdominal aortic aneurysm surgery (Fig. 42.3) Endovascular aneurysm repair (see Fig. 42.5) Other applications of EVAR Upper limb problems (see Table 40.5, p. 488) Upper limb ischaemia Thoracic outlet compression Subclavian steal syndrome Extracranial cerebral arterial insufficiency Carotid artery insufficiency Pathophysiology of carotid artery disease Investigation of suspected carotid artery disease Treatment of carotid artery disease Medical versus surgical or radiological intervention Acute symptoms Asymptomatic carotid stenosis Technique of endarterectomy Carotid angioplasty and stenting Arterial insufficiency in other organs Mesenteric ischaemia Chronic mesenteric ischaemia Renal ischaemia Renal artery stenosis Pathophysiology of renal artery stenosis Treatment Complications of arterial surgery Systemic complications of arterial surgery Local complications of arterial surgery (Fig. 42.9) Haemorrhage Embolism Thrombosis Graft infection False aneurysm formation Long-term follow-up after arterial surgery Chapter 43: Venous disorders of the lower limb Venous thrombosis and the post-thrombotic limb Anatomy of the lower limb venous system Presentation and consequences of venous thrombosis (Table 43.1) Pathophysiology of post-thrombotic problems Investigation of venous insufficiency Management of post-thrombotic problems Venous ulcers Long-term care and prevention Axillary vein thrombosis Varicose veins Pathophysiology of varicose veins Symptoms and signs of varicose veins Investigation of varicose veins Management of varicose veins Indications for surgical treatment of varicose veins Endovenous treatment of varicose veins Perioperative management of the patient having varicose vein surgery Chapter 44: Cardiac surgery Introduction and cardiopulmonary bypass Assessing risk in cardiac surgery Congenital cardiac disease Types of congenital heart disease Cyanotic heart disease Acyanotic heart disease Management of congenital heart disease Palliating congenital cardiac disorders Correcting congenital cardiac disorders Acquired heart disease Coronary heart disease (see Table 44.3 for clinical presentations) Pathophysiology Control of predisposing factors Management of coronary artery disease Percutaneous angioplasty techniques Coronary artery bypass grafting (CABG) Surgical technique (Fig. 44.4) Other types of surgery for ischaemic heart disease Valvular heart disease Aortic valve disease Mitral valve disease Valve prostheses (Fig. 44.5) Indications for valve surgery Pericardial disease Disease of the thoracic aorta Aortic dissection Thoracic aneurysms Trauma to the thoracic aorta Pulmonary embolism Section VII: Disorders of the Breast and Skin Chapter 45: Disorders of the breast Introduction to breast disease Anatomy of the female breast Symptoms and signs of breast disease Special points in history taking Examination of the breasts Lumps Paget’s disease of the nipple Investigation of breast disorders Imaging Biopsy Breast cancer Introduction Risk factors Age Genetic factors Hormonal factors Social and geographic factors Epidemiology Environmental factors Pathology Tumour types In situ carcinoma Paget’s disease of the nipple Inflammatory carcinoma Tumour grade Natural history of breast cancer Principles of management of breast cancer (Boxes 45.5 and 45.6) Staging PROGNOSTIC STATUS Loco-regional treatment Breast conservation surgery Mastectomy Reconstructive surgery Axillary surgery Sentinel node biopsy Axillary clearance Radiotherapy Adjuvant systemic treatment Chemotherapy Hormonal therapy Biological therapies Control of advanced and disseminated disease (Figs 45.15–45.18) Long-term follow-up Life expectancy and prognosis Benign breast disorders Abnormalities of normal development and involution (ANDI) Pathology Clinical presentation and management Managing fibrocystic change Fibroadenoma Pathology Clinical presentation and management Duct papilloma Traumatic fat necrosis Infections of the breast Duct ectasia Male breast disorders Gynaecomastia (Fig. 45.26) Male breast cancer Chapter 46: Disorders of the skin Introduction Structure of normal skin (Fig. 46.1) Symptoms and signs of skin disorders History and examination Principles of managing skin lesions Lesions originating in the epidermis Benign epidermal lesions Skin tags (squamous cell papillomas) Warts Seborrhoeic keratosis Keratoacanthoma Melanotic lesions Benign naevi Lentigo Management of pigmented lesions Premalignant and malignant epidermal conditions Solar (senile) keratosis and intra-epidermal carcinoma Pathology and clinical features Management Squamous cell carcinoma Pathology Clinical presentation Management of squamous cell carcinoma Basal cell carcinoma (BCC) Pathology and clinical features Management of basal cell carcinomas Malignant melanoma Introduction and pathology Risk factors Melanoma subtypes Clinical features of malignant melanoma Prognostic factors Management of malignant melanoma Lesions originating in the dermis Cysts Epidermal cysts Surgical removal (see Ch. 10) Inflamed epidermal cysts Pilar cysts Infective lesions Pyogenic granuloma Furuncle (boil) and carbuncle Necrotising fasciitis Miscellaneous lesions Sebaceous hyperplasia Keloid scars Histiocytoma Dermoid cysts Implantation (epi)dermoids Malignant lesions Secondary (metastatic) carcinoma Kaposi’s sarcoma Lesions of the hypodermis and deeper tissues Cellulitis Cellulitis of the lower limb Lipoma and liposarcoma Neurofibroma, neurofibromatosis and schwannoma Ganglion Lesions of vascular origin Campbell de morgan spots Spider naevi Angiomas ‘Port-wine stains’ Strawberry naevi Cystic hygroma Congenital syndromes Glomus tumour Lesions derived from skin appendages Benign appendage tumours Disorders of the nails Ingrowing toenail Pathophysiology Management Conservative treatment Surgical treatment Onychogryphosis Subungual melanoma Section VIII: Disorders of the Head and Neck Chapter 47: Lumps in the head and neck and salivary calculi Introduction History and examination in the head and neck Special points in the history and examination Examination of the oral cavity Tumours of salivary glands Salivary gland tumours Pleomorphic adenoma Treatment Complications of parotid surgery Adenolymphoma (Warthin’s tumour) Malignant primary salivary tumours Secondary tumours in salivary glands Salivary gland stone disease (sialolithiasis) Pathophysiology Clinical features Management of salivary calculi Inflammatory disorders of salivary glands Acute bacterial sialadenitis Chronic sialadenitis Recurrent sialadenitis Autoimmune salivary gland disorders Salivary retention cysts Lymph node disorders of the head and neck Cervical tuberculosis Lymphomas Secondary (metastatic) tumours Miscellaneous causes of a lump in the neck Congenital cysts and sinuses Branchial cysts, sinuses and fistulae Fusion-line dermoid cysts Pre-auricular cysts and sinuses Cystic hygromas (lymphatic malformations) Actinomycosis Chapter 48: Disorders of the mouth Disorders of the oral cavity (excluding salivary calculi) Dental caries Pathophysiology and clinical features Management of dental caries Management of dental abscesses Tooth extraction and post-extraction problems Bleeding tooth socket after extraction Pain after tooth extraction Swelling after tooth extraction Inflammation of the periodontal tissues Gingivitis and periodontitis Management of gingivitis and periodontitis Pericoronitis Management of pericoronitis Acute ulcerative gingivitis (vincent’s infection) Management of acute ulcerative gingivitis Tumours of the oral mucosa Pathophysiology and aetiology Clinical features of oral cancer Management of oral cancer Leukoplakia Epulis Miscellaneous disorders causing intraoral swelling Retention cysts of accessory salivary glands Tumours of accessory salivary glands Bony exostoses Cysts and tumours of the jaws Chapter 49: Disorders of the thyroid and parathyroid glands Introduction Thyroid disorders Main clinical presentations of thyroid disease in surgical practice Diffuse or generalised enlargement of the thyroid Solitary thyroid nodule Other features associated with thyroid enlargement Hyperthyroidism Hypothyroidism Special points in examining a thyroid swelling Approach to investigation of a thyroid mass General thyroid status Morphology of the gland Tissue diagnosis Functional activity of glandular tissue Specific clinical problems of the thyroid and their management Hyperthyroidism (thyrotoxicosis) Treatment of hyperthyroidism Thyrotoxic eye disease Radioactive iodide therapy Unwanted effects Anti-thyroid drugs Surgical management Indications for surgery Preoperative assessment and management of thyrotoxicosis Subtotal thyroidectomy Thyroid malignancies (Table 49.2) Papillary carcinoma Symptoms and signs Management Follicular carcinoma Anaplastic carcinoma Medullary carcinoma Thyroid lymphoma Goitres and thyroid nodules Idiopathic non-toxic hyperplasia Surgical management of goitre Congenital thyroid disorders Embryology Thyroglossal cyst and ‘fistula’ Ectopic thyroid tissue Disorders of parathyroid glands Hyperparathyroidism Symptoms and signs Control of plasma calcium (Fig. 49.10) Types of hyperparathyroidism Primary hyperparathyroidism a. Single parathyroid adenoma b. Diffuse parathyroid hyperplasia c. Parathyroid carcinoma Secondary and tertiary hyperparathyroidism Malignant hypercalcaemia Management of hyperparathyroidism Surgical management Hypoparathyroidism Section IX: Neonatal and Paediatric Surgery Chapter 50: Acute surgical problems in children Introduction Physiological differences between infants and adults Fluid and electrolyte problems Blood glucose Temperature regulation Liver function Immunity Managing surgery in infants Abdominal emergencies in the newborn Intestinal obstruction Gastrointestinal atresias and stenoses Oesophageal abnormalities Duodenal obstruction Jejuno-ileal atresias Midgut malrotation with volvulus Pathophysiology Acute volvulus Intermittent obstruction Anorectal abnormalities Failure to pass meconium Meconium ileus Hirschsprung’s disease (congenital aganglionosis) Congenital diaphragmatic hernia Other surgical conditions causing respiratory problems in the newborn Vascular ring Congenital pulmonary airway malformations Congenital lobar emphysema Abdominal wall defects Exomphalos Gastroschisis Treatment of exomphalos major and gastroschisis Ectopia vesicae (bladder exstrophy) Necrotising enterocolitis Abdominal emergencies in infants and young children Incarcerated inguinal hernia Pathophysiology Clinical features Management Congenital hypertrophic pyloric stenosis Pathophysiology Clinical features Diagnosis Treatment Intussusception Pathophysiology Clinical features Management Swallowed foreign body Abdominal emergencies in older children The acute abdomen Differential diagnosis (Box 50.2) Principles of management Acute appendicitis (see also Ch. 26) Torsion of the testis Chapter 51: Non-acute abdominal and urological problems in children Introduction Problems with the groin and male genitalia Embryology Hernias and associated problems Patent processus vaginalis (PPV) Hydrocoele Inguinal hernia Femoral hernia Umbilical hernia Testicular maldescent Surgery for testicular maldescent Foreskin problems Phimosis Paraphimosis Renal, vesical and urethral abnormalities Renal dysplasia Neonatal hydronephrosis Vesicoureteric reflux (VUR) Pathophysiology Clinical presentation and investigation Management of vesicoureteric reflux Pelviureteric junction dysfunction Pathophysiology Clinical presentation and diagnosis Management Hypospadias and epispadias Posterior urethral valves (PUV) Abdominal problems Chronic and recurrent abdominal pain Chronic constipation Gastrointestinal bleeding in children (Table 51.2) Upper gastrointestinal bleeding Lower gastrointestinal bleeding Anal fissure Polyps Rectal prolapse Perianal abscess Meckel’s diverticulum Inflammatory bowel disease (see Ch. 28 for adult disease) Abdominal mass Nephroblastoma (wilms’ tumour) Neuroblastoma Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
نظرات کاربران
کتاب های مرتبط
دانلود کتاب Essential Surgical Practice: Higher Surgical Training in General Surgery, Fifth Edition
دانلود کتاب Conventional Warfare: Ballistic, Blast, and Burn Injury (Textbooks of military medicine)
دانلود کتاب Chirurgia Washington Manual Of Surgery
دانلود کتاب Master Techniques in Orthopaedic Surgery Reconstructive Knee Surgery
دانلود کتاب Operative Techniques: Orthopaedic Trauma Surgery
دانلود کتاب Atlas of orthopedic surgical procedures of the dog and cat
دانلود کتاب Handbook of Pediatric Surgery
دانلود کتاب Manual of Aesthetic Surgery 2
دانلود کتاب Practical Office Orthopedics
