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دانلود کتاب Principles & practice of surgery
دانلود کتاب اصول و عمل جراحی
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Principles & practice of surgery
ویرایش: [6 ed.] نویسندگان: O James Garden, Andrew W. Bradbury, John L.R. Forsythe, Rowan W. Parks (eds.) سری: A Davidson Title ISBN (شابک) : 9780702043161, 0702043168 ناشر: Churchill Livingstone/Elsevier سال نشر: 2014 تعداد صفحات: [521] زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 88 Mb
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Front Cover Principles & Practice of Surgery Copyright Contents Preface Contributors Section 1: Principles of perioperative care Chapter 1: Metabolic response to injury, fluid and electrolyte balance and shock The metabolic response to injury Features of the metabolic response to injury Factors mediating the metabolic response to injury The acute inflammatory response The endothelium and blood vessels Afferent nerve impulses and sympathetic activation The endocrine response to surgery Consequences of the metabolic response to injury Hypovolaemia Fluid-conserving measures Blood flow-conserving measures Increased energy metabolism and substrate cycling Catabolism and starvation Catabolism Carbohydrate metabolism Fat metabolism Protein metabolism Starvation Changes in red blood cell synthesis and coagulation Factors modifying the metabolic response to injury Anabolism Fluid and electrolyte balance Normal water and electrolyte balance Assessing losses in the surgical patient Insensible fluid losses The effect of surgery The stress response ‘Third-space’ losses Loss from the gastrointestinal tract Intravenous fluid administration Types of intravenous fluid Crystalloids Colloids Maintenance fluid requirements Treatment of postoperative hypovolaemia and/or hypotension Specific water and electrolyte abnormalities Sodium and water Water depletion Water excess Hypernatraemia Hyponatraemia Potassium Hyperkalaemia Hypokalaemia Other electrolyte disturbances Calcium Magnesium Phosphate Acid–base balance Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis Mixed patterns of acid–base imbalance Shock Definition Types of shock Septic shock Cardiogenic shock Anaphylactic shock Neurogenic shock Pathophysiology Macrocirculation Microcirculation Cellular function The effect of shock on individual organ systems Cardiovascular Respiratory Renal Nervous system Gastrointestinal Hepatobiliary Management General principles Airway and breathing Circulation Hypovolaemic shock Septic shock Cardiogenic shock Anaphylactic shock Chapter 2: Transfusion of blood components and plasma products Introduction Blood donation Blood components Red blood cells in additive solution Platelets Fresh frozen plasma (FFP) Cryoprecipitate Plasma products Human albumin Factor VIII and Factor IX concentrates Prothrombin complex concentrates Immunoglobulin preparations (90% IgG) Red cell serology ABO antigens Rhesus antigens (RH) Other red cell antigens Pretransfusion testing Maximal Surgical Blood Ordering Schedule (MSBOS) Indications for transfusion Blood administration Adverse effects of transfusion Autologous transfusion Preoperative donation Isovolaemic haemodilution Cell salvage Transfusion requirements in special surgical settings Massive transfusion Cardiopulmonary bypass Methods to reduce the need for blood transfusion Acute volume replacement Mechanisms for reducing blood use in surgery Preoperative Intraoperative Postoperative Better blood transfusion Future trends Chapter 3: Nutritional support in surgical patients Introduction Assessment of nutritional status Assessment of nutritional requirements Causes of inadequate intake Methods of providing nutritional support Enteral nutrition Oral route Methods of administration of enteral feeds Nasogastric or nasojejunal tubes Gastrostomy and jejunostomy Complications of enteral nutrition Parenteral nutrition Indications for TPN Composition of TPN solutions Administration of TPN Complications of TPN Catheter problems Thrombophlebitis Infection Metabolic complications Peripheral venous nutrition Monitoring of nutritional support Chapter 4: Infections and antibiotics Importance of infection Biology of infection Bacterial factors Host defence systems Preventing infection in surgical patients Preoperative MRSA screening Aseptic technique Hand decontamination Personal protective equipment (PPE) for staff Skin preparation Surgical instruments Terminology Creutzfeldt–Jakob disease (CJD) and other prion diseases Prophylactic use of antibiotics Timing and dose Antibiotic choice Carriage of resistant organisms and prophylaxis Prophylaxis for immunosuppressed patients Management of surgical infections Diagnosis Antibiotic therapy Specific infections in surgical patients Surgical site infection (SSI) Diagnosis Treatment Prevention Urinary tract infections (UTI) Respiratory tract infections Clostridium difficile infection (CDI) Fungal infections Infections of prosthetic devices Infections primarily treated by surgical management Necrotizing fasciitis Diabetic foot infections Gas gangrene Infections following trauma Tetanus HEALTHCARE Associated Infections (HCAI) Chapter 5: Ethics, preoperative considerations, anaesthesia and analgesia Ethical and legal principles for surgical patients Principles in surgical ethics Principalism Autonomy Beneficence: doing good Non-malfeasance: avoiding harm Justice: promoting fairness Informed consent General considerations Consent in specific circumstances Children Mental illness Transient / irreversible cognitive impairment Confidentiality Specific topics Euthanasia and ‘end-of-life’ issues Abortion Negligence Human Tissue Act Completion of a death certificate Post-mortem examination Research governance Ethics committees Preoperative assessment Assessment of operative fitness and perioperative risk Oxygen delivery in minimizing operative risk Systematic preoperative assessment Cardiovascular system Respiratory system Smoking Preoperative exercise Alcohol Nutritional status Obesity Drug therapy Long-term steroid therapy Antiplatelet therapy and anticoagulants Oral contraceptives and hormone replacement therapy Psychiatric drugs Allergies Pregnancy Previous operations and anaesthetics Preoperative investigations Haematology Full blood count Coagulation screen Cross matching Biochemistry Urea and electrolytes Liver function tests Cardiac investigations Respiratory investigations The high risk patient Preoperative MRSA screening Assessment of the patient for emergency surgery The preoperative ward round Venous thromboembolism prophylaxis Antibiotic prophylaxis Preoperative anxiolytic medication Preoperative fasting Perioperative implications of chronic disease Cardiovascular disease Ischaemic heart disease Myocardial infarction Angina Coronary artery bypass graft (CABG), percutaneous angioplasty and stenting Congestive cardiac failure Valvular heart disease Pacemakers Hypertension Perioperative management of patients with cardiovascular disease Drug therapy Beta-blockers Angiotensin-converting enzyme (ACE) inhibitors Cardiovascular management Minimizing myocardial oxygen demand Maximizing myocardial oxygen supply Respiratory disease Anaesthetic technique Postoperative analgesia Physiotherapy Postoperative ventilation Diabetes mellitus Diabetic comorbidity Vascular disease Renal disease Neuropathy Infection Effect of surgical stress on diabetic control Principles of perioperative diabetes management Methods of insulin administration Chronic renal failure Dialysis dependent patients Non-dialysis dependent patients Jaundice Hepatitis Coagulopathy Acute renal failure Cirrhosis Abnormal coagulation Anticoagulant therapy Inherited disorders of coagulation Acquired coagulopathy Anaemia Musculoskeletal disease Miscellaneous conditions Anaesthesia and the operation General anaesthesia Local anaesthetic agents Spinal and epidural anaesthesia Spinal anaesthesia Epidural anaesthesia Peripheral nerve block Local infiltration Topical anaesthesia Postoperative analgesia Pain assessment Postoperative analgesic strategy Epidural analgesia Patient-controlled analgesia (PCA) Parenteral and oral opioid regimens Strong opioids Weak opioids Paracetamol, NSAIDs and selective Cox-2 inhibitors Neuropathic pain Postoperative nausea and vomiting Chapter 6: Principles of the surgical management of cancer The biology of cancer The adenoma–carcinoma progression Invasion and metastasis Natural history and estimate of cure The management of patients with cancer Screening Screening for inherited cancer The cancer patient's journey Symptoms that may initiate a patient's ‘cancer journey’ Local effects Systemic effects Consultation with the GP Referral to a specialist/cancer centre Investigations Diagnostic investigations Staging investigations Treatment Benign tumours Malignant tumours Adjuvant treatment Surgery for metastases Follow-up Palliation of advanced cancer Prognosis and counselling Care of the dying Chapter 7: Trauma and multiple injury Trauma epidemiology Injury biomechanics and accident prevention Alcohol and drugs Wounds Classification and production Gunshot wounds Falls Injury severity assessment Prehospital care and transport Trauma centres Resuscitation in the emergency department The first 10 minutes Airway Control of the cervical spine Advanced airway techniques Breathing Circulation Analgesia The next phase Imaging and other diagnostic AIDS After the resuscitation room Chapter 8: Practical procedures and patient investigation Introduction General precautions Aseptic technique Local anaesthesia Suturing Suture materials Non-absorbable sutures Absorbable sutures Suturing the skin Airway procedures Maintaining the airway Procedure Ventilation by mask Procedure The laryngeal mask airway Procedure Endotracheal intubation Procedure Surgical airway Procedure Changing a tracheostomy tube Procedure Thoracic procedures Intercostal tube drainage Procedure Removal of an intercostal drainage tube Procedure Pleural aspiration Procedure Abdominal procedures Nasogastric tube insertion Procedure Fine-bore nasogastric tubes Procedure Gastric lavage Procedure Oesophageal tamponade Procedure Abdominal paracentesis Procedure Diagnostic peritoneal lavage Procedure Vascular procedures Venepuncture Procedure Safety measures Venepuncture for blood culture Procedure Peripheral venous cannulation Procedure Venous cutdown Procedure Central venous catheter insertion Internal jugular vein cannulation Procedure Subclavian vein cannulation Procedure Peripheral venous catheterization Procedure Arterial blood sampling Procedure Needle pericardiocentesis Procedure Urinary procedures Urethral catheterization Procedure in the male Procedure in the female Suprapubic catheterization Procedure Central nervous system procedures Lumbar puncture Procedure Excision of lumps and swellings (e.g. sebaceous cyst, lipoma, dermoid, lymph node) Imaging Plain radiography Contrast studies Computed tomography (CT) Ultrasonography Magnetic resonance imaging (MRI) Radioisotope imaging Positron emission tomography (PET) Chapter 9: Postoperative care and complications Introduction Immediate postoperative care Airway obstruction Haemorrhage Surgical ward care General care Tubes, drains and catheters Fluid balance Blood transfusion Nutrition Complications of anaesthesia and surgery General complications Pulmonary complications Pulmonary collapse Pulmonary infection Respiratory failure Acute respiratory distress syndrome (ARDS) Pleural effusion Pneumothorax Cardiac complications Myocardial ischaemia/infarction Cardiac failure Arrhythmias Postoperative shock Urinary complications Postoperative urinary retention Urinary tract infection Renal failure Cerebral complications Cerebrovascular accidents (CVA) Neuropsychiatric disturbances Delirium tremens (acute alcohol withdrawal syndrome) Venous thrombosis and pulmonary embolism Deep venous thrombosis (DVT) Pulmonary embolism Wound complications Infection Dehiscence Postoperative fever Chapter 10: Day surgery Introduction Facilities for day surgery Free-standing units Hospital integrated units The patient pathway First patient contact Exclusion criteria for ambulatory surgery Bmi ASA status Pre-assessment Basic health screen Medication Warfarin Anti-platelet agents Past medical history Heart disease Diabetes Social factors Investigations The surgical waiting list Admission for surgery Scheduling for theatre Anaesthesia and analgesia Recovery Discharge criteria Day surgery procedures 23-hour surgery Section 2: Gastrointestinal surgery Chapter 11: The abdominal wall and hernia Umbilicus Developmental abnormalities Persistent vitello-intestinal duct Urachus Umbilical sepsis Umbilical tumours Disorders of the rectus muscle Haematoma of the rectus sheath Desmoid tumour Abdominal hernia Inguinal hernia Surgical anatomy Indirect inguinal hernia Clinical features Direct inguinal hernia Clinical features Management of uncomplicated inguinal hernia Indirect inguinal hernia Direct hernia Sportsman's hernia Femoral hernia Clinical features Surgical repair of femoral hernia Ventral hernia Epigastric hernia Umbilical hernia Para-umbilical hernia Incisional hernia Parastomal hernia Rare external hernia Internal hernia Complications of hernia Irreducibility Obstruction Strangulation Management of complicated hernia Chapter 12: The acute abdomen and intestinal obstruction Introduction Aetiology Pathophysiology of abdominal pain Somatic pain Visceral pain Pathogenesis Inflammation Peritonitis Clinical features Infarction Clinical features Perforation Clinical features Obstruction Clinical assessment History Site of pain Nature of pain Radiation of pain Onset of pain Severity of pain Progression of pain Movement of pain Examination Inspection of the abdomen Palpation Percussion Auscultation Rectal examination Specific clinical signs in acute abdominal pain Murphy’s sign Boas’s sign Grey Turner’s and Cullen’s signs Rovsing’s sign Investigations Blood tests FBC, C-reactive protein and U&Es Serum amylase Liver function tests Blood gas analysis Serum calcium Sickle tests Blood glucose Urinalysis Dipstick testing Bacteriology Pregnancy test Urinary porphobilinogen Radiological investigations Plain X-rays Contrast radiology Ultrasonography Computed tomography (CT) Angiography Endoscopic investigations Peritoneal investigations Peritoneal lavage Laparoscopy Management Peritonitis Primary peritonitis Postoperative peritonitis Intra-abdominal abscess Acute appendicitis Epidemiology Aetiology Pathogenesis Clinical features History Examination Variations in clinical features Complications Investigations Management Prognosis Non-specific abdominal pain (NSAP) Gynaecological causes of the acute abdomen Mittelschmerz and ruptured corpus luteum Ruptured ectopic pregnancy Complications of an ovarian cyst Acute salpingitis Chapter 13: The oesophagus, stomach and duodenum Surgical anatomy Oesophagus Stomach and duodenum Surgical physiology Oesophagus Stomach Gastric secretions History and symptoms Dysphagia Odynophagia Heartburn Dyspepsia Regurgitation and Vomiting Abdominal pain Examination Investigations Helicobacter pylori tests Chest X-ray Contrast swallow/meal Endoscopy Computed tomography (CT) Gastric emptying studies Endoluminal ultrasound Manometry and pH studies Diagnosis and management – oesophagus Gastro-oesophageal reflux disease (GORD) and Barrett's oesophagus Diagnosis and management Anti-reflux surgery Hiatus hernia Clinical features Management Achalasia Clinical features Management Diffuse oesophageal spasm Management Nutcracker oesophagus Plummer–Vinson syndrome Clinical features Investigations Management Pouches Clinical features Investigations Management Perforation Aetiology Intraluminal Outside the wall Spontaneous Clinical features Investigations Erect chest X-ray CT scan and contrast swallow Management Tumours of the oesophagus Benign tumours Carcinoma of the oesophagus Clinical features Investigations Management Surgical resection Postoperative care Radiotherapy and chemotherapy Palliation Diagnosis and management – gastroduodenal Peptic ulceration Pathology Aetiology Helicobacter pylori Nonsteroidal anti-inflammatory drugs (NSAIDs) Smoking Genetic factors Zollinger–Ellison syndrome Other factors Clinical features Diagnosis Special forms of ulceration Management of uncomplicated peptic ulcer disease Medical management Eradication of H. pylori Duodenal ulcers Gastric ulcers Gastric ulceration Surgical management Dumping Diarrhoea Weight loss Anaemia Osteoporosis and osteomalacia Carcinoma Complications of peptic ulceration requiring operative intervention Perforation Duodenal ulcers Gastric ulcers Clinical features Diagnosis Management Duodenal ulcers Gastric ulcers Acute haemorrhage Diagnosis History and examination Blood tests Management Resuscitation Detection and endoscopic treatment Surgical management Gastric neoplasia Benign gastric neoplasms Malignant gastric neoplasms Gastric carcinoma Epidemiology Aetiology Early gastric cancer Advanced gastric cancer Factors affecting survival in advanced gastric cancer Clinical features of gastric malignancy Diagnosis Staging of gastric carcinoma Treatment with curative intent Palliation Prognosis Other gastric tumours Lymphomas Carcinoid tumours Miscellaneous disorders of the stomach Ménétrier's disease Gastritis Dieulafoy's lesion Bezoars Miscellaneous conditions of the duodenum Duodenal obstruction Duodenal diverticula Duodenal trauma Surgery for obesity Operations for obesity Complications of obesity surgery Chapter 14: The liver and biliary tract The liver Anatomy Segmental anatomy Blood supply and function Jaundice Diagnosis History and clinical examination Biochemical and haematological investigations Radiological investigations Ultrasonography Magnetic resonance imaging (MRI) Endoscopic retrograde cholangiopancreatography (ERCP) Percutaneous transhepatic cholangiography (PTC) Computed tomography (CT) Other radiological investigations Liver biopsy Laparoscopy Laparotomy Congenital abnormalities Liver trauma Hepatic infections and infestations Pyogenic liver abscess Clinical features Investigations Management Amoebic liver abscess Clinical features Investigations Management Hydatid disease Clinical features Investigations Management Portal hypertension Effects of portal hypertension Clinical features Acute variceal bleeding Management Active resuscitation Endoscopy and control of bleeding Prevention of further bleeding Emergency portosystemic shunting Types of shunt procedure Ascites Tumours of the liver Benign hepatic tumours Cavernous haemangioma Biliary hamartoma Focal nodular hyperplasia (FNH) Liver cell adenoma Primary malignant tumours of the liver Hepatocellular carcinoma (hepatoma) Clinical features Investigations Management Cholangiocarcinoma Other primary malignant tumours Metastatic tumours Liver resection Liver transplantation The gallbladder and bile ducts Anatomy of the biliary system Physiology Bile salts and the enterohepatic circulation Congenital abnormalities Biliary atresia Choledochal cysts Gallstones Pathogenesis Cholesterol stones Pigment stones Pathological effects of gallstones Acute cholecystitis and its complications Chronic cholecystitis Mucocoele Choledocholithiasis Gallstone ileus Common clinical syndromes associated with gallstones Biliary colic Acute cholecystitis Chronic cholecystitis Choledocholithiasis Courvoisier's law Other benign conditions of the gallbladder Cholesterosis Adenomyomatosis Acute acalculous cholecystitis Investigation of patients with suspected gallstones Blood tests Plain abdominal X-ray Ultrasonography Cholangiography Surgical treatment of gallstones Open cholecystectomy Laparoscopic cholecystectomy Exploration of the common bile duct Complications of cholecystectomy Haemorrhage Infective complications Bile leakage Retained stones Bile duct stricture Post-cholecystectomy syndrome Management of acute cholecystitis Atypical ‘biliary’ pain Non-surgical treatment of gallstones Management of acute cholangitis Other benign biliary disorders Asiatic cholangiohepatitis Primary sclerosing cholangitis Tumours of the biliary tract Carcinoma of the gallbladder Carcinoma of the bile ducts Clinical features Management Chapter 15: The pancreas and spleen The pancreas Surgical anatomy Surgical physiology Exocrine function Endocrine function Pancreatic pain Congenital disorders of the pancreas Pancreatitis Acute pancreatitis Aetiology Gallstone pancreatitis Alcohol-associated pancreatitis Other causes Clinical features of acute pancreatitis Diagnosis Radiology Differentiation between gallstone- and alcohol-associated pancreatitis Assessment of severity Management Conservative treatment Endoscopic treatment Surgical treatment Complications Infected pancreatic necrosis Surgical debridement Percutaneous drainage/debridement Endoscopic drainage Pancreatic pseudocyst Pancreatic abscess Progressive jaundice Persistent duodenal ileus Gastrointestinal bleeding Gastrointestinal ischaemia/fistulae Prognosis Chronic pancreatitis Aetiology Pathophysiology Clinical features Investigations and diagnosis Management Conservative management Endoscopic treatment Surgical treatment Neoplasms of the exocrine pancreas Adenocarcinoma of the pancreas Aetiology Pathology Pancreatic ductal adenocarcinoma (PDAC) Intraductal papillary mucinous neoplasm (IPMN) Mucinous cystic neoplasm Serous cystic neoplasm Metastases Solid pseudopapillary tumour of the pancreas Acinar cell carcinoma of the pancreas Ampullary tumours Cholangiocarcinoma Clinical features of pancreatic neoplasms Investigations and multidisciplinary management (MDM) planning Curative management Palliative treatment Pancreatic neuroendocrine tumours (PET) Non-functioning PET Functioning PET Insulinomas Gastrinomas Miscellaneous PETs Multiple endocrine neoplasia type 1 The spleen Surgical anatomy Physiology Circulatory filtration Immunological function Haemopoiesis Technique of splenectomy Preoperative preparation Open technique Laparoscopic splenectomy Postoperative course and complications Traumatic splenectomy Splenic conservation Indications for splenectomy (non-traumatic) The purpuras Idiopathic thrombocytopenic purpura (ITP) Secondary thrombocytopenia Haemolytic anaemias Hereditary spherocytosis Acquired haemolytic anaemias Hypersplenism Segmental portal hypertension Proliferative disorders Myelofibrosis Lymphomas Other tumours Miscellaneous conditions Cysts of the spleen Splenic infarct Abscess of the spleen Splenic artery aneurysm Other indications for splenectomy Post-splenectomy immunization Chapter 16: The small and large intestine Introduction Surgical anatomy and physiology Anatomy and function of the small intestine Anatomy and function of the large intestine and appendix Clinical assessment of the small and large intestine History Examination Investigation of the luminal gastrointestinal tract Principles of operative intestinal surgery Disorders of the appendix Appendicitis Appendiceal tumours Benign tumours of the appendix Pseudomyxoma peritonei Adenocarcinoma of appendix Inflammatory bowel disease Crohn's disease Pathology Clinical features Investigations Management Medical management Surgical management Ulcerative colitis Pathology Clinical features Investigations Management Medical management Surgical management Cancer surveillance in ulcerative colitis Disorders of the small intestine Small bowel neoplasms Benign tumours Malignant tumours Gastrointestinal stromal tumours (GIST) Small bowel adenocarcinoma Lymphoma Carcinoid tumour Peutz–Jeghers syndrome Pathology Clinical features Management Meckel's diverticulum Jejunal diverticulosis Radiation enteritis Small bowel ischaemia Clinical features Investigations and diagnosis Management Chronic mesenteric ischaemia Small and large bowel obstruction Pseudo-obstruction and nonmechanical gut functional disorder Paralytic ileus Pseudo-obstruction Non-neoplastic disorders of the large intestine Colonic diverticular disease Complicated diverticular disease Diverticulitis Perforation Stricture formation and obstruction Fistula Bleeding Large intestinal ischaemia Ischaemic colitis Gangrenous ischaemic colitis Ischaemic stricture of the colon Irritable bowel syndrome Volvulus Angiodysplasia Pseudomembranous colitis Microscopic colitis Hirschsprung's disease Acquired megacolon and idiopathic slow-transit constipation Intestinal stoma and fistula Stoma Intestinal fistula Polyps and polyposis syndromes of the large intestine Colorectal adenoma Clinical features Management Familial adenomatous polyposis (FAP) Extra-colonic features Diagnosis and management Peutz–Jeghers syndrome (PJS) Juvenile polyposis syndrome (JPS) Metaplastic (hyperplastic) polyposis and MUTYH-associated polyposis (MAP) Other rare polyposis syndromes Turcot's syndrome Cowden's disease Cronkhite–Canada syndrome Miscellaneous colorectal polyps Malignant tumours of the large intestine Colorectal adenocarcinoma Aetiology Diet Protective agents Smoking, alcohol and exercise Inflammatory bowel disease Genetic susceptibility Clinical features of established colorectal cancer Population screening for colorectal cancer Investigations Preoperative staging Management of colorectal adenocarcinoma Surgery Elective colorectal resection with curative intent Emergency colorectal resection Pathology and staging Adjuvant therapy Radiotherapy Adjuvant chemotherapy Palliative therapy Prognosis Other malignant tumours of the large intestine Squamous cancer of the large bowel Carcinoid tumour of the large bowel Lymphoma of the large intestine Gastrointestinal stromal tumours (including leiomyosarcoma) Chapter 17: The anorectum Introduction Applied surgical anatomy Anal musculature and innervation Anal canal epithelium The anal (haemorrhoidal) cushions Lymphatic drainage of the anal canal Anorectal disorders Haemorrhoids Clinical features History Examination Management Non-operative approaches Operative approaches Fissure-in-ano Clinical features and diagnosis Management Perianal abscess Clinical features Management Fistula-in-ano Clinical features and assessment Management Miscellaneous benign perianal lumps Perianal haematoma Anal warts Fibroepithelial anal polyp Anal skin tags Anal cancer Clinical features and assessment Staging Management Rectal prolapse Clinical features and assessment Management Childhood rectal prolapse Mucosal rectal prolapse Full-thickness rectal prolapse Solitary rectal ulcer syndrome Anal incontinence Clinical features and assessment Conservative management Surgical management Pruritus ani Management Pilonidal disease Clinical features Management Section 3: Surgical specialties Chapter 18: Plastic and reconstructive surgery Introduction Structure and functions of skin Wounds Types of wound Principles of wound healing Lag phase Incremental phase Plateau or maturation phase Hypertrophic scars Keloids Epidermis Primary and secondary intention Factors influencing wound healing Blood supply Infection Age Site of wound Nutritional status Intercurrent disease Surgical technique Choice of suture and suture materials Wound infection Classification Clinical features Prevention Management Involvement of other structures Devitalized skin flaps Wounds with skin loss Skin grafts Flaps Crushing/degloving injuries and gunshot wounds Burns Mechanisms Local effects of burn injury General effects of burn injury Classification Superficial partial-thickness burns Deep partial-thickness burns Full-thickness burns Determination of burn depth Mechanisms Appearance Sensation Prognosis Extent of the burn Depth of the burn Site of the burn Associated respiratory injury Management First aid Arrest the burning process Ensure an adequate airway Avoid wound contamination Transfer to hospital Adequate ventilation Initial assessment and management Prevention and treatment of burn shock Water replacement Blood transfusion Organ failure and burn shock Respiratory complications Renal failure Nutritional management Sepsis Curling's ulcer and gastric erosions Local management of burns Initial cleansing and debridement Prevention of contamination Exposure Evaporative dressings Semi-occlusive and occlusive dressings Topical antibacterial agents ‘Biological’ dressings Relief of constriction (escharotomy) Restoration of epidermal cover Functional and cosmetic result Skin and soft tissue lesions Diagnosis of skin swellings Cysts Sebaceous cysts Dermoid cysts Tumours of the skin Epidermal neoplasms arising from basal germinal cells Papillomas Infective warts Senile warts Pedunculated papillomas Keratoacanthoma (molluscum sebaceum) Actinic (solar) keratosis Intraepidermal cancer (carcinoma in situ) Cancer of the epidermis Basal cell carcinoma (rodent ulcer) Squamous cell carcinoma Epidermal neoplasms arising from melanocytes Benign pigmented moles Common moles Giant hairy naevus Blue naevus Halo naevus Malignant melanoma Hutchison's melanotic freckle (lentigo maligna) Superficial spreading melanoma Nodular melanoma Other types of malignant melanoma Spread of malignant melanoma Clinical and pathological staging Management of malignant melanoma Sentinel lymph node biopsy Vascular neoplasms (haemangiomas) Involuting haemangiomas Non-involuting haemangiomas Port-wine stain Cavernous haemangioma Tumours of nerves Neurilemmoma Neurofibroma Tumours of muscle and connective tissues Lipoma Liposarcoma Fibrosarcoma Rhabdomyosarcoma Chapter 19: The breast Anatomy and physiology Overview Anatomy Congenital abnormalities Hormonal control of breast development and function Evaluation of the patient with breast disease Clinical features Clinical examination Assessment of regional nodes Imaging Mammography Ultrasonography Magnetic resonance imaging (MRI) Ductoscopy, ductography and nipple cytology Fine needle cytology and biopsy Core biopsy Fine-needle aspiration cytology Open biopsy Frozen section One-stop clinics Accuracy of investigations Disorders of development Juvenile hypertrophy Fibroadenoma Disorders of cyclical change Cyclical mastalgia Nodularity Non-cyclical breast pain Disorders of involution Palpable breast cysts Sclerosis Duct ectasia Epithelial hyperplasia Benign neoplasms Duct papillomas Lipomas Phyllodes tumours Breast infection Lactating infection Non-lactating infection Central (periareolar) infection Mammary duct fistula Peripheral non-lactating abscesses Skin-associated infection Breast cancer Epidemiology Types of breast cancer Non-invasive Invasive Hormone and growth factors receptors Screening for breast cancer Mammographic features of breast cancer Staging The curability of breast cancer Prognostic factors Presentation of breast cancer Management of operable breast cancer In situ breast cancer Operable breast tumours Local therapy Breast-conserving treatment (wide local excision and radiotherapy) Mastectomy Systemic therapy Adjuvant chemotherapy Adjuvant hormone therapy Adjuvant anti- HER2 therapy Primary systemic therapy Complications of treatment Radiotherapy Chemotherapy Hormonal treatments Psychological aspects Follow-up Management of locally advanced breast cancer Breast cancer in pregnancy Pregnancy after treatment for breast cancer Management of metastatic or advanced breast cancer Chemotherapy Hormonal treatment Anti- HER2 therapy Specific problems Bone disease Hypercalcaemia Marrow infiltration Spinal cord compression Pleural effusion Liver metastases Brain metastases Miscellaneous tumours of the breast Lymphoma Sarcomas Malignant phyllodes tumours Secondary tumours Male breast Gynaecomastia Male breast cancer Chapter 20: Endocrine surgery Introduction Thyroid gland Surgical anatomy and development Thyroid function Assessment of thyroid disease ‘Physiological’ enlargement Enlargement of the thyroid gland (goitre) Non-toxic nodular goitre Aetiology Pathology Clinical features Investigations Management Thyrotoxic goitre Thyroiditis Subacute thyroiditis (de Quervain's disease) Autoimmune thyroiditis (Hashimoto's disease) Aetiology Clinical features Investigations Management Riedel's thyroiditis Solitary thyroid nodules Other forms of neoplasia Hyperthyroidism Primary thyrotoxicosis (Graves' disease) Pathophysiology Clinical features Metabolic effects Sympathetic effects Other features Diagnosis Management Antithyroid drugs Radioactive iodine Surgery Toxic multinodular goitre and toxic adenoma Pathophysiology Clinical features Diagnosis Management Malignant tumours of the thyroid Papillary carcinoma Clinical features Management Follicular carcinoma Clinical features Management Anaplastic carcinoma Clinical features Management Medullary carcinoma Clinical features Management Lymphoma Complications Haemorrhage Nerve damage Hypothyroidism Hypoparathyroidism Scar complications Patient information Thyroidectomy Parathyroid glands Calcium metabolism Hypercalcaemia and hypocalcaemia Primary hyperparathyroidism Pathology Clinical features Diagnosis Management Secondary and tertiary hyperparathyroidism Hypoparathyroidism Parathyroidectomy Patient information Pituitary gland Anterior pituitary Tumours of the anterior pituitary Pathophysiology Acromegaly Hyperprolactinaemia Cushing's disease Surgical hypophysectomy Radiation therapy Replacement therapy The posterior pituitary Adrenal gland Adrenal cortex Cortical function Cushing's syndrome Clinical features Investigations Management Adrenal adenoma Adrenal carcinoma Pituitary disease Hyperaldosteronism Primary hyperaldosteronism (Conn's syndrome) Clinical features Diagnosis Management Secondary hyperaldosteronism Adrenogenital syndrome (adrenal virilism) Pathophysiology Clinical features Management Adrenal feminization Adrenal medulla Phaeochromocytoma Pathology Clinical features Investigations Management Non-endocrine adrenal medullary tumours Ganglioneuromas Neuroblastomas Adrenal ‘incidentaloma’ Adrenalectomy Indications Technique Replacement therapy Patient information Other surgical endocrine syndromes Apudomas and multiple endocrine neoplasia The APUD cell series Multiple endocrine neoplasia (MEN) syndromes MEN type I MEN type II Carcinoid tumours and the carcinoid syndrome Chapter 21: Vascular and endovascular surgery Introduction Pathophysiology of arterial disease Pathology Endothelial injury Chemical injury Physical injury Lipid deposition Inflammatory cell infiltrate Smooth muscle cells Plaque rupture Clinical features Anatomical site Collateral supply Speed of onset Mechanism of injury Haemodynamic mechanism Thrombosis Atheroembolism Thromboembolism Chronic lower limb arterial disease Anatomy Clinical features Symptoms Examination findings Pulse status Ankle to brachial pressure index (ABPI) Intermittent claudication Clinical features Epidemiology Critical limb ischaemia Night and rest pain Diabetic vascular disease The diabetic foot Sensory neuropathy Motor neuropathy Autonomic neuropathy Management Management of lower limb ischaemia Medical management Endovascular management Intermittent claudication Critical limb ischaemia Indications for arterial reconstruction Intermittent claudication Principles of arterial reconstruction Endarterectomy Bypass grafting Extra-anatomic bypass Complications of arterial reconstruction Amputation Indications Level of amputation Surgical principles Rehabilitation and limb fitting Phantom pain Arterial disease of the upper limb Overview Management Cerebrovascular disease Definitions Stroke Transient ischaemic attack Amaurosis fugax Carotid artery disease Pathophysiology Assessment Management Medical therapy Carotid endarterectomy (CEA) Carotid stenting Asymptomatic carotid disease Vertebrobasilar disease Renal artery disease Pathophysiology Management Mesenteric artery disease Acute limb ischaemia Aetiology Classification Clinical features Management Acute embolus Thrombosis in situ Popliteal aneurysm Trauma Intra-arterial drug administration Thoracic outlet syndrome Postischaemic syndromes Reperfusion injury Compartment syndrome Aneurysmal disease Classification Site Aetiology Atherosclerotic Mycotic True aneurysms False aneurysms Abdominal aortic aneurysm (aaa) Epidemiology Clinical features Investigations Asymptomatic AAA Symptomatic AAA Ruptured AAA Open AAA repair (OR) Endovascular aneurysm repair (EVAR) Peripheral aneurysms Iliac aneurysms Femoral aneurysms Popliteal aneurysms Buerger's disease (thromboangiitis obliterans) Raynaud's phenomenon Primary Raynaud's phenomenon Secondary Raynaud's phenomenon Pathophysiology of venous disease Anatomy Physiology Varicose veins Classification Trunk varices Reticular varices Telangiectasia Epidemiology Clinical features Cosmetic issues Symptoms Complications Indications for treatment Aetiology Examination and investigation Management Conservative treatment Surgery Endovenous treatment Superficial thrombophlebitis Chronic venous insufficiency Pathophysiology Assessment History Examination Investigations Management Medical therapy Dressings Compression therapy Elastic compression hosiery Surgical and endovenous therapy Venous thromboembolism (VTE) Epidemiology Pathophysiology Aetiology Diagnosis Colour flow duplex ultrasound Venous gangrene Prevention Rationale General measures Physical methods Pharmacological methods Management Overview Uncomplicated DVT Complicated DVT Thrombolysis Surgical thrombectomy Pharmacomechanical thrombectomy Venous stenting Caval filters Other forms of venous thrombosis Superior vena cava thrombosis Subclavian and axillary vein thrombosis Lymphoedema Pathophysiology Primary lymphoedema Secondary lymphoedema Clinical features Symptoms Signs Investigations Management Physical methods Drugs Antibiotics Surgery Chapter 22: Cardiothoracic surgery Basic considerations Acquired cardiac disease Ischaemic heart disease Coronary artery disease (CAD) Assessment Indications Coronary bypass Results Surgery for the complications of coronary artery disease Mitral valve regurgitation (MR) Chronic Acute Postmyocardial infarction ventricular septal defect Left ventricular aneurysm Cardiac valvular disease Assessment Surgical management Endocarditis Aortic valve disease Stenosis Regurgitation Surgical outcomes Mitral valve disease Stenosis Regurgitation Surgical outcomes Tricuspid valve disease Multiple and repeat valve procedures Aortic aneurysm Tubulosaccular aneurysms False ‘aneurysms’ Aortic dissection Aorto-annulo ectasia Assessment Surgery for aortic pathology Pericardial pathology Pericardial effusion Pericardial constriction Cardiac trauma Cardiac tamponade with penetrating trauma Congenital cardiac disease Atrial septal defect Ventricular septal defect Patent ductus arteriosus Coarctation of the aorta Tetralogy of Fallot Thoracic surgery Assessment Bronchogenic carcinoma Assessment for pulmonary resection Fitness for resection Staging Resection Survival Infection Management Bronchiectasis Pain control Management of secretions Fluid management Late management Metastatic disease Other lung tumours Mesothelioma Mediastinum Pneumothorax Emphysema Interstitial lung disease Pleuropulmonary infection Chest wall deformities Postoperative care Cardiac and pulmonary transplantation Chapter 23: Urological surgery Assessment General points Urinary tract symptoms Pain Disorders of micturition Examination Investigations Urine Blood tests Intravenous urography (IVU) Ultrasonography CT Urogram Special radiological investigations Nuclear imaging Urodynamic studies Semen analysis Biochemical screening for stones Upper urinary tract (kidney and ureter) Anatomy Physiology Renal cysts Simple cysts Polycystic kidney disease Benign tumours Nephroblastomas Epidemiology Clinical features Investigations Management Renal adenocarcinoma Epidemiology Clinical features Investigations Management Renal and ureteric calculi Mechanism of stone formation Types and causes of stone formation Clinical features Investigations Management Upper tract obstruction Pelviureteric junction obstruction (idiopathic hydronephrosis) Clinical features Investigations Management Retroperitoneal fibrosis Pathology Clinical features Investigations Management Lower urinary tract (bladder, prostate and urethra) Anatomy Physiology Neurological control of micturition The micturition cycle Storage (or filling) phase Emptying (or micturition) phase Trauma Bladder Open injuries Closed injuries Clinical features Investigations Management Urethra Open injuries Closed injuries Clinical features Investigations Management Bladder tumours Pathology Staging Clinical features Investigations Management Superficial bladder tumours (T a , T 1) Invasive bladder tumour (T 2 –T 3s) Prognosis Carcinoma of the prostate Epidemiology Pathology Clinical features Investigations Management Organ confined / localized disease Locally advanced disease; no evidence of bone metastases Metastatic prostate cancer Prognosis Benign prostatic hyperplasia Pathology Clinical features Investigations Management Symptomatic only Acute retention Chronic retention Open prostatectomy Closed (endoscopic) prostatectomy Bladder neck obstruction Urethral obstruction Pathology Clinical features Investigations Management Disorders of micturition – incontinence Overview Structural disorders Clinical assessment Structural causes of incontinence in males Postprostatectomy Chronic outflow obstruction Carcinoma of the prostate Postmicturition dribble incontinence Chronic illness and debility Structural causes of incontinence in females Childbirth and operations Cystitis Ectopic ureter Cervical cancer Neurogenic disorders Clinical assessment Aetiology of abnormal micturition Impaired cortical control Emotional state Drugs Damage to the spinal cord Principles of management Neurologically intact patients Neuropathic patients External genitalia Anatomy Physiology Circumcision Congenital abnormalities of the penis Hypospadias Epispadias Disorders of erection (impotence) Priapism Peyronie's disease Carcinoma of the penis Inflammation of the penis Undescended testes (cryptorchidism) Retractile testis Torsion of the testis Testicular tumours Pathology Clinical features Investigations Management Prognosis Epididymo-orchitis Hydrocoele Cyst of the epididymis Varicocoele Chapter 24: Neurosurgery Introduction Surgical anatomy and physiology The skull The spine The brain The meninges and cerebrospinal fluid The cranial nerves The spinal cord Blood supply Anterior circulation Posterior circulation Intracranial pressure Brain herniation syndromes Subfalcine (cingulate gyral) herniation Transtentorial (uncal) herniation Foraminal (tonsillar) herniation Investigations Plain X-ray Computed tomography (CT) Magnetic resonance imaging (MRI) CT and MR angiography Cerebrovascular disease Subarachnoid haemorrhage Saccular intracranial aneurysms Investigations Management of aneurysmal SAH Primary intracerebral haemorrhage (ICH) Arteriovenous malformations Cavernomas Neurotrauma Assessment Glasgow Coma Score Neurological examination Other systems Management Skull fracture Extradural haematoma Subdural haematoma Intracerebral haematoma and contusions Diffuse axonal injury Traumatic spinal injury Cervical spinal injury Intracranial infections Bacterial infections Postsurgical infection Meningitis Intracranial tumours Tumours of the skull Gliomas Meningiomas Schwannomas Pituitary tumours Brain metastasis Clinical features of intracranial tumours Symptoms of raised ICP Focal neurological deficit Seizures Personality disintegration Endocrinopathy Diagnosis Management Paediatric neuro-oncology Spinal dysraphism Open spinal dysraphism Closed spinal dysraphism Hydrocephalus Management and prognosis Malformations of the skull Craniosynostosis Cranial dermal sinuses and angular dermoids Functional neurosurgery Movement disorders Epilepsy Vertebral column Spinal degenerative disease Aetiology and clinical features Management Peripheral nerve lesions Carpal tunnel syndrome Ulnar nerve compression at the elbow Meralgia paraesthetica Evidence-based neurosurgery Chapter 25: Transplantation surgery Introduction Transplant immunology The recipient's immune response to the donor organ Early events The afferent arm of the immune response Antigen presentation T-cell receptor binding and costimulation T-cell activation The efferent arm of the immune response Patterns of allograft rejection Hyperacute rejection Acute rejection Chronic allograft damage Testing for histocompatibility Immunosuppression Immunosuppressive drugs Steroids Antiproliferative agents Azathioprine Mycophenolate mofetil Calcineurin inhibitors (CNIs) Cyclosporin Tacrolimus Sirolimus Antibody therapies General risks of immunosuppresssion: Infection Malignancy The future of immunosuppression Organ donation Deceased donation Donor management Multiorgan retrieval Organ preservation Donation after circulatory death The extended criteria donor (ECD) Living donation Living donor kidney transplantation Donor selection Operative approaches Procedure-related morbidity and mortality Renal transplantation Indications and patient assessment Patient listing for transplantation The operative procedure Back table preparation Recipient operation Postoperative management Management of delayed graft function Complications Outcome Recent developments in renal transplantation Liver transplantation Indications and patient assessment Living donation for liver transplantation The operative procedure Postoperative management and complications Outcome Pancreas transplantation Indications and patient assessment The operative procedure Back table preparation Recipient operation Postoperative management and complications Outcome Pancreatic islet transplantation Heart and lung transplantation Indications and patient assessment Heart Lung The operative procedure Heart Lung Postoperative management and complications Heart Lungs Combined heart and lung transplant Outcome Summary Chapter 26: Ear, nose and throat surgery Ear Anatomy External ear Middle ear The inner ear Physiology Assessment Clinical features Examination Audiometry Temporal bone imaging Diseases of the pinna Bat ears Trauma Tumours Diseases of the external auditory meatus Wax Otitis externa Tumours Diseases of the middle ear Acute suppurative otitis media Otitis media with effusion (OME), or ‘glue ear’ Chronic suppurative otitis media Tubotympanic or mucosal disease Atticoantral or squamous disease Otosclerosis Diseases of the inner ear Deafness Vertigo Disorders of the facial nerve Nose Anatomy Physiology Assessment Clinical features Examination Imaging Diseases of the nose Trauma Chronic rhinitis Nasal polyps Epistaxis Paranasal sinuses Anatomy Diseases of the paranasal sinuses Sinusitis Tumours Nasopharynx Anatomy Diseases of the nasopharynx Adenoids Tumours Mouth Anatomy Diseases of the mouth Stomatitis and gingivitis Mouth ulcers Retention cysts Leukoplakia Tumours Oropharynx Anatomy Diseases of the oropharynx Pharyngitis Tonsillitis Snoring and sleep apnoea Tumours Hypopharynx Anatomy Physiology of swallowing Assessment Clinical features Examination Imaging Diseases of the hypopharynx Pharyngeal pouch Tumours Larynx Anatomy Physiology of voice Assessment Clinical features Examination Imaging Diseases of the larynx Congenital disorders Laryngitis Vocal cord palsy Tumours Tracheostomy Neck Anatomy Assessment Clinical features Examination Imaging Diseases of the neck Skin and subcutaneous swellings Thyroglossal cyst Branchial cyst and fistula Other cystic swellings Lymph node swellings Salivary gland disease Salivary gland tumours Carotid body tumours Chapter 27: Orthopaedic surgery Introduction History Age Birth history Childhood Dominant hand Occupation Trauma Details of previous treatment Past medical history Drug history Examination Look Feel Move (active and passive) Investigations Ultrasound Nerve conduction tests and electromyography (EMG) Computed tomography (CT) Magnetic resonance imaging (MRI) Bone scans Description of deformity Osteoarthritis: degenerative disease of the joints Medical management of OA Drug therapy Off-loading Injections Other conservative treatments Surgical management of OA Osteotomy Joint replacement Hemi-arthroplasty Total joint replacement Arthrodesis Interposition arthroplasty Excision arthroplasty Rheumatoid arthritis and inflammatory disease of joints Bone and joint infection Primary infection Secondary infection Overview of joint replacement surgery Overview of arthroscopic surgery Paediatric orthopaedic surgery Dysplastic disease of the hip (DDH) Perthes' disease Cerebral palsy (CP) Slipped upper femoral epiphysis (SUFE) Congenital club foot (talipes equinovarus or ctev) Scoliosis Angular deformities Musculoskeletal tumours The upper limb The shoulder Anterior dislocation Impingement syndrome Rotator cuff disease Osteoarthritis The elbow Tennis and golfers' elbow Rheumatoid elbow The hand and wrist Wrist disease Carpal tunnel disease Trigger finger Dupuytren's disease The lower limb The hip joint Avascular necrosis of the femoral head Hip arthroscopy The knee joint History Meniscal injuries Osteoarthritis The foot and ankle Trauma and fractures General approach Examination Joint dislocation Fracture management Classification Children Principles of fracture healing Compound fractures Intra-articular fractures Conservative treatment Compartment syndrome Operative treatment Some specific fractures Fractures of the femoral neck Colles' fractures Forearm fractures Scaphoid fractures Ankle fractures Tibial plateau fractures Index
