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دانلود کتاب Sabiston textbook of surgery : the biological basis of modern surgical practice
دانلود کتاب کتاب درسی جراحی سابیستون: مبنای بیولوژیکی عمل جراحی مدرن
مشخصات کتاب
Sabiston textbook of surgery : the biological basis of modern surgical practice
ویرایش: 20 نویسندگان: Jr. Courtney M. Townsend (editor), B. Mark Evers (editor), Kenneth L. Mattox (editor), R. Daniel Beauchamp (editor) سری: ISBN (شابک) : 9780323401630, 0323401635 ناشر: Elsevier Inc. سال نشر: 2017 تعداد صفحات: 2136 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 180 مگابایت
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Sabiston Textbook of Surgery Copyright Page Dedication Contributors A Score of Scores Preface Acknowledgments Video Contents 1 The Rise of Modern Surgery: Chapter Outline The Beginnings Knowledge of Anatomy Control of Bleeding Control of Pain Control of Infection Other Advances That Furthered the Rise of Modern Surgery X-Rays Blood Transfusion Frozen Section Ascent of Scientific Surgery Standardized Postgraduate Surgical Education and Training Programs Experimental Surgical Research Laboratories Specialty Journals, Textbooks, Monographs, and Treatises Professional Societies and Licensing Organizations The Modern Era Diversity The Future Selected References 2 Ethics and Professionalism in Surgery Outline The Importance of Ethics in Surgery End-of-Life Care Resuscitation in the Operating Room Cultural Sensitivity Shared Decision Making Professionalism Conclusion Selected References References 3 The Inflammatory Response Outline Components of the Immune System Acute Inflammation Recognition of Stimuli and Activation of the Acute Inflammatory Response Early Manifestations of Acute Inflammation Tumor Necrosis Factor-α and Interleukin-1 High-Mobility Group Box 1 Interleukin-18 Interleukin-6 Interleukin-8 Interleukin-12 Interleukin-17 Interferon-γ Macrophage Migration Inhibitory Factor Interleukin-4 Interleukin-10 Transforming Growth Factor-β Complement Immunotherapy for Sepsis Chronic Inflammation Chronic Inflammation by Organ System Pulmonary Pathophysiologic changes and immune reactions. Diagnosis of chronic obstructive pulmonary disease. Therapeutic approaches to chronic obstructive pulmonary disease. Pancreas Inflammatory Bowel Disease Pathophysiologic Changes Clinical Presentation and Diagnosis Immune Activation in Inflammatory Bowel Disease Immune Therapy for Inflammatory Bowel Disease Chronic Gastritis Histologic Changes Clinical Manifestations Immunologic Changes Treatment Chronic Vascular Inflammation Cellular Differentiation Involved in Chronic Vascular Inflammation Indirect Mechanism of Activation Therapeutic Options Chronic Hepatic Inflammation and Cirrhosis Overview of Cirrhosis and Hepatic Immune Cell Organization Immune-Mediated Hepatic Degradation Systemic Immune System Effects of Cirrhosis Clinical Manifestations of Cirrhosis Chronic Renal Inflammation Role of Innate Immunity in the Development of Chronic Renal Disease Adaptive Immunity in Renal Inflammation Pathophysiologic Changes Caused by Chronic Renal Inflammation Immune Therapy for Chronic Renal Disease Sterile Inflammation Examples of Sterile Inflammation Pathways Involved in Sterile Inflammation Natural Progression of Sterile Inflammation Selected References References 4 Shock, Electrolytes, and Fluid Outline History Resuscitation Shock Fluids Blood Transfusions Physiology of Shock Bleeding Shock Index Lactate and Base Deficit Compensatory Mechanisms Lethal Triad Acidosis Hypothermia Coagulopathy Oxygen Delivery Optimization (Supernormalization) Global Perfusion versus Regional Perfusion Septic Shock Problems with Resuscitation Bleeding Trauma Immunology and Inflammation Evolution of Modern Resuscitation Detrimental Impact of Fluids Damage Control Resuscitation Whole Blood Resuscitation Resuscitation With 1 : 1 : 1 Massive Transfusion Protocol Current Status of Fluid Types Crystalloids Hypertonic Saline Colloids Future Resuscitation Research Blood Substitutes Perfluorocarbons Novel Fluids Dried Plasma Pharmacologic Agents Suspended Animation Perioperative Fluid Management Body Water Maintenance Fluids Adrenal Gland Antidiuretic Hormone and Water Electrolytes Sodium Hyponatremia Hypernatremia Potassium Hypokalemia Treatment of acute hypokalemia. Hyperkalemia Treatment of hyperkalemia. Calcium Hypocalcemia Treatment of hypocalcemia. Hypercalcemia Treatment of hypercalcemia. Magnesium Hypomagnesemia Treatment of hypomagnesemia. Hypermagnesemia Treatment of hypermagnesemia. Selected References References 5 Metabolism in Surgical Patients Outline Videos Substrate Metabolism Carbohydrate Metabolism Lipid Metabolism Protein Metabolism Regulation of the Amino Acid Pool Glucose-Alanine and Glucose-Lactate Amino Acid Cycles Protein Turnover Proteolysis Vitamins and Micronutrients Malnutrition and Starvation Malnutrition Subtypes Starvation Kwashiorkor and Marasmus Stress-Induced Changes in Substrate Metabolism Nutritional Assessment and Monitoring Global Assessment and Nutritional Risk Screening Anthropometry Body Weight Ideal Body Weight Lean Body Mass Body Mass Index Clinical Imaging Dual-Energy X-Ray Absorptiometry Computed Tomography and Ultrasound Serum Albumin Level Pediatric Assessment Evaluating Metabolism and Energy Requirements Energy Expenditure Equations Harris-Benedict Equation Indirect Calorimetry Nitrogen Balance Serum Proteins Nutritional Support Preoperative Nutrition Nonmalnourished Patients Malnourished Patients Principles Guiding Routes of Nutrition: Enteral, Parenteral, or Both Enteral Nutrition Benefits of Enteral Nutrition (Trophic Feeding) Early Initiation of Enteral Nutrition Delivering Enteral Nutrition Oral Feeding Enteral Access for Feeding Ileus and Enteral Feeding Intolerance Early Initiation of Enteral Feeding Formulations Immunonutrition Complications Parenteral Nutrition Formulations Ordering Parenteral Nutrition Complications Carbohydrate Content Lipid Content Protein Content Fluid and Electrolytes Disease-Specific Concerns Antioxidant Therapy Burn Injury and the Metabolic Stress Response Organ Transplantation Inflammatory Bowel Disease Short Bowel Syndrome Hepatic Insufficiency Gastric Bypass Surgery Intensive Insulin and Glycemic Control Pancreatitis Obesity Comorbidities and Preexisting Conditions Type 2 Diabetes Mellitus Cardiovascular Disease Deep Vein Thrombosis and Embolism Hepatobiliary Disease Osteoarthritis Metabolic Syndrome Obese Surgical Patients Summary Selected References References 6 Wound Healing Outline Tissue Injury and Response Wound-Healing Phases Inflammatory Phase Hemostasis and Inflammation Increased Vascular Permeability Chemokines Polymorphonuclear Cells Macrophages Lymphocytes Proliferative Phase Angiogenesis Fibroplasia Epithelialization Extracellular Matrix Collagen structure. Collagen synthesis. Elastic fibers. Glycosaminoglycans and proteoglycans. Basal lamina. Degradation of the extracellular matrix. Maturational Phase Remodeling Abnormal Wound Healing Hypertrophic Scars and Keloids Prevention of Hypertrophic or Keloid Scars Linear Hypertrophic Scars Widespread Hypertrophic Scars Keloids Chronic Nonhealing Wounds Infection Other Causes of Abnormal Wound Healing Hypoxia Diabetes Ionizing Radiation Aging Malnutrition Drugs Treatment of Chronic Wounds Wound Dressings Other Therapies Hyperbaric Oxygen Therapy Negative Pressure–Assisted Wound Therapy Fetal Wound Healing New Horizons Tissue Engineering Bioengineered Skin Substitutes Epidermal Substitutes Dermal Substitutes Bilayer Substitutes Evidence for the Use of Skin Substitutes in Chronic Wounds Risks Associated With Skin Substitutes Future of Bioengineered Skin Substitutes Gene and Stem Cell Therapy Selected References References 7 Regenerative Medicine Outline Stem Cell Sources Embryonic Stem Cells Somatic Cell Nuclear Transfer Induced Pluripotent Stem Cells Fetal Stem Cells Adult Stem Cells Hematopoietic Stem Cells Skeletal Stem Cells Mesenchymal Stem Cells Adipose-Derived Stromal Cells Endothelial Progenitor Cells Miscellaneous Adult Stem Cells Stem Cells and Cancer Bioengineering for Regenerative Medicine Research Applications Biomaterials as Constructs for Cell Delivery and Directed Differentiation Organ-Level Tissue Engineering Clinical Applications of Stem Cells Embryonic Stem Cells Induced Pluripotent Stem Cells Multipotent Adult Stem Cells Selected References References 8 Evidence-Based Surgery Outline What is the Purpose of the Study? Is the Study Using the Right Data? Is the Study Making a Fair Comparison? Misclassification Time-Varying Exposures What is the Outcome of Interest? Patient-Reported Outcomes Costs, Charges, and Resource Utilization Safety Appropriateness Surrogate End Points Composite End Points What is the Study Design? Randomized Controlled Trials Efficacy and Effectiveness Variations on Randomized Trials Meta-Analysis Cross-Sectional Study Cohort Study Case-Control Study Case Reports and Case Series Was the Right Analysis Performed? Variable Types and Descriptive Statistics Hypothesis Testing Multivariable Analysis Propensity Score Analysis Instrumental Variable Analysis Missing Data Correlated Data How Should I Use This Information in My Practice? Confounding Generalizability Determining Causality Using Observational Data Is There Conflict of Interest? Evolving With the Evidence Conclusions Selected References References 9 Safety in the Surgical Environment Outline Fostering a Culture of Safety Through Leadership Local Organizational Structures to Promote Perioperative Safety National and Health Care System–Level Safety Initiatives System-Level Interventions Improve Safety Conclusions Selected References References 10 Principles of Preoperative and Operative Surgery Outline Preoperative Preparation of the Patient Principles of and Preparation for Surgery Determining the Need for Surgery Perioperative Decision Making Preoperative Evaluation Universal Surgical Risk Calculator Perioperative Mortality Predictor Optimal Preoperative Assessment of Geriatric Surgical Patients Cognitive Impairment and Dementia Depression Postoperative Delirium Alcohol and Substance Abuse Cardiac Evaluation Pulmonary Evaluation Functional Status, Mobility, and Fall Risk Frailty Nutritional Status Medication Management Patient Counseling Preoperative Testing Systems Approach to Preoperative Evaluation Cardiovascular System Perioperative Beta Blocker Therapy Recommendation Pulmonary System Renal System Hepatobiliary System Endocrine System Perioperative Diabetic Management Management of Other Endocrinopathies Immune System HIV-Infected Patients and Surgery Hematologic System Acute Bleeding and Trauma Antiplatelet Management in Noncardiac Surgery Patients Anticoagulation Management in Noncardiac Surgery Patients Oral Direct Thrombin and Factor Xa Inhibitors Dabigatran Rivaroxaban Apixaban Venous Thromboembolism Prophylaxis in Surgical Patients Additional Preoperative Considerations Nutritional Status Nutritional Interventions Obesity Preoperative Checklist Antibiotic Prophylaxis Review of Medications Preoperative Fasting Potential Causes of Intraoperative Instability Myocardial Infarction Pulmonary Embolism Pneumothorax Anaphylaxis and Latex Allergy Malignant Hyperthermia Wrong-Site Surgery and Universal Protocol Operating Room Maintenance of Normothermia Preoperative Skin Preparation Hemostasis Wound Closure Staplers Surgical Adhesives Surgical Devices and Energy Sources Electrosurgery and Electrocautery Lasers Argon Beam Coagulator Photodynamic Therapy High-Frequency Sound Wave Techniques Harmonic Scalpel Ultrasonic Cavitation Devices Radiofrequency Ablation Cryoablation Microwave Ablation and Radiosurgery Outpatient Surgery Selected References References 11 Surgical Infections and Antibiotic Use Outline Risk Factors for Infection Host Factors Genetics and Genomics of Trauma and Sepsis Interactions Between the Host and Therapy Blood Transfusion Control of Blood Glucose Concentration Infection Control Catheter Care Specific Infections Surgical Site Infection Postoperative Pneumonia Central Line–Associated Bloodstream Infection Urinary Tract Infection Intra-abdominal Infection Antibiotic Use Pharmacokinetic and Pharmacodynamic Principles Antibiotic Prophylaxis Principles of Antibiotic Therapy Evaluation of Possible Infection Blood Cultures Empirical Antibiotic Therapy Choice of Antibiotic Duration of Therapy Disease-, Pathogen-, and Antibiotic-Specific Considerations Pneumonia Central Line–Associated Bloodstream Infection Intra-abdominal Infection Clostridium difficile–Associated Disease Complicated Skin and Soft Tissue Infections Antibiotic Activity Spectra Cell Wall–Active Agents β-Lactam antibiotics. Penicillins. Cephalosporins. Third-generation cephalosporins. Fourth-generation cephalosporins. Monobactams. Carbapenems. Lipoglycopeptides. Cyclic lipopeptides. Polymyxins. Protein Synthesis Inhibitors Aminoglycosides. Tetracyclines. Oxazolidinones. Macrolide-lincosamide-streptogramin family Clindamycin. Drugs That Disrupt Nucleic Acids Fluoroquinolones. Cytotoxic Antibiotics Metronidazole. Trimethoprim-sulfamethoxazole. Antibiotic Toxicities β-Lactam Allergy Red Man Syndrome Nephrotoxicity Ototoxicity Avoiding Toxicity: Adjustment of Antibiotic Dosage Hepatic Insufficiency Renal Insufficiency Important Pathogens of Critically Ill Patients Vancomycin-Resistant Enterococci Staphylococcus aureus Pseudomonas aeruginosa Multidrug-Resistant Enterobacteriaceae, Including Klebsiella Species Stenotrophomonas maltophilia Acinetobacter baumannii Complex Fungal Infections Risk Factors Diabetes Mellitus Neutropenia Organ Transplantation and Immunosuppression Malignant Disease Central Venous Catheters Prediction of Invasive Candida Infection Intensive Care Unit and Invasive Mechanical Ventilation Fungal Pathogens Candida albicans Non-albicans Candida Aspergillus Other Emerging Fungal Pathogens Prophylaxis Antifungal Prophylaxis of Solid Organ Transplant Recipients Antifungal Therapy References 12 Surgical Complications Outline Surgical Wound Complications Seroma Causes Presentation and Management Hematoma Causes Presentation and Management Acute Wound Failure (Dehiscence) Causes Presentation and Management Surgical Site Infection (Wound Infection) Causes Presentation Treatment Complications of Thermal Regulation Hypothermia Causes Presentation Treatment Malignant Hyperthermia Causes Presentation and Management Postoperative Fever Causes Presentation and Management Treatment Respiratory Complications General Considerations Atelectasis and Pneumonia Diagnosis Treatment Aspiration Pneumonitis and Aspiration Pneumonia Causes Presentation and Diagnosis Treatment Pulmonary Edema, Acute Lung Injury, and Adult Respiratory Distress Syndrome Causes Presentation and Management Pulmonary Embolism and Venous Thromboembolism Causes Presentation and Diagnosis Treatment Cardiac Complications Postoperative Hypertension Causes Presentation and Management Perioperative Ischemia and Infarction Cause Presentation and Diagnosis Treatment Cardiogenic Shock Causes Presentation and Management Postoperative Cardiac Arrhythmias Causes Presentation Treatment Postoperative Heart Failure Causes Presentation Treatment Renal and Urinary Tract Complications Urinary Retention Causes Presentation and Management Acute Renal Failure Causes Presentation and Management Endocrine Gland Dysfunction Adrenal Insufficiency Causes Presentation and Diagnosis Treatment Hyperthyroid Crisis Causes Presentation and Diagnosis Treatment Hypothyroidism Causes Presentation and Diagnosis Treatment Syndrome of Inappropriate Antidiuretic Hormone Secretion Causes Presentation Treatment Gastrointestinal Complications Ileus and Early Postoperative Bowel Obstruction Causes Presentation Treatment Acute Abdominal Compartment Syndrome Cause Diagnosis Treatment Postoperative Gastrointestinal Bleeding Causes Presentation and Diagnosis Treatment Stomal Complications Causes Presentation and Diagnosis Treatment Clostridium difficile Colitis Causes Presentation and Diagnosis Treatment Anastomotic Leak Causes Presentation and Diagnosis Treatment Intestinal Fistulas Causes Presentation and Diagnosis Treatment Pancreatic Fistulas Hepatobiliary Complications Bile Duct Injuries Causes Presentation and Diagnosis Treatment Neurologic Complications Delirium, Cognitive Disorder, and Psychosis Cause Presentation and Diagnosis Treatment Seizure Disorders Causes Presentation and Management Stroke and Transient Ischemic Attacks Causes Presentation and Management Ear, Nose, and Throat Complications Epistaxis Acute Hearing Loss Nosocomial Sinusitis Parotitis Selected References References 13 Surgery in the Geriatric Patient Outline Focusing Thinking about Surgery in Older Adults Pattern, Presentation, and Natural History of Disease Surgical Decision Making Palliative Care Physiologic Decline Cardiovascular System Respiratory System Renal System Hepatobiliary System Immune Function Glucose Homeostasis Preoperative Assessment Cognitive Assessment Cognitive Decline and Dementia Capacity Depression Delirium Comorbidity Cardiovascular Disease Pulmonary Complications Function American Society of Anesthesiologists Classification Activities of Daily Living Exercise Tolerance Gait, Mobility, and Fall Risk Assessment Frailty Nutritional Status Medication Management Patient Counseling Advance Directives Postoperative Discharge Planning Specific Postoperative Complications Delirium Risk Factors Precipitating Factors Diagnosis and Treatment Aspiration Deconditioning Surgery of Major Organ Systems Endocrine Surgery Thyroid Disease Parathyroid Disease Breast Disease Epidemiology. Presentation and screening. Pathology and treatment overview. Surgery. Radiation therapy. Chemotherapy. Gastrointestinal Surgery Esophagus Motility disorders. Gastroesophageal reflux disease. Paraesophageal hernias. Dysphagia. Esophageal cancer. Stomach Peptic ulcer. Gastric cancer. Biliary Tract Disease Liver Small Bowel Obstruction Appendicitis Carcinoma of the Colon and Rectum Abdominal Wall Hernia Vascular Surgery Abdominal Aortic Aneurysm Carotid Artery Disease Peripheral Vascular Disease Cardiothoracic Disease Coronary Artery Disease Valve Replacement Lung Cancer Trauma Transplantation Selected References References 14 Anesthesiology Principles, Pain Management, and Conscious Sedation Outline Pharmacologic Principles Inhalational Agents Nitrous Oxide Isoflurane Sevoflurane Desflurane Intravenous Agents Induction Agents Opioids Neuromuscular Blockers Anesthesia Equipment Patient Monitoring during and after Anesthesia Blood Pressure Monitoring Electrocardiography Ventilation Monitoring Oxygenation Monitoring Temperature Monitoring Neuromuscular Blockade Monitoring Central Nervous System Monitoring Preoperative Evaluation Airway Examination Cardiovascular Disease Endocarditis Prophylaxis Pulmonary Disease Renal and Hepatic Disease Nutrition, Endocrinology, and Metabolism Fasting Before Surgery Assessment of Physical Status Selection of Anesthetic Techniques and Drugs Risk of Anesthesia Selection of a Specific Technique Airway Management Regional Anesthesia Local Anesthetic Drugs Spinal Anesthesia Epidural Anesthesia Peripheral Nerve Blocks Conscious Sedation Postanesthesia Care Postoperative Agitation, Delirium, and Cognitive Decline Respiratory Complications Postoperative Nausea and Vomiting Hypothermia Circulatory Complications Postoperative Visual Loss Acute Pain Management Mechanisms of Acute Pain Methods of Analgesia Opioids Nonsteroidal Anti-Inflammatory Drugs N-methyl-D-aspartate antagonists. α2-adrenergic agonists. Local Anesthetics for Management of Acute Pain Combination Analgesic Therapy Neuraxial Analgesia Intravenous Patient-Controlled Analgesia Selection of Methods of Postoperative Analgesia Chronic Pain Specific Types of Patients With Acute Pain Patients With a History of Chronic Pain Patients With a History of Substance Abuse Pediatric Patients Elderly Patients Conclusion Selected References References 15 Emerging Technology in Surgery Outline Video Significant Advances in Surgical Technology Minimally Invasive Surgery Digitally Augmented Surgery Optimizing Minimally Invasive Surgery Catheter-Based Therapies Image-Guided Ablative Therapies Evolving Innovative Technologies in Surgery Flexible Endoscope as a Surgical Platform Minimally Invasive Robotic Surgery Influence of Robotics on Other Domains in Surgery Three-Dimensional Printing and Bioprinting Measuring and Predicting Innovation in Surgery Simulation for Surgical Training and Operative Planning Simulation Training for Minimally Invasive Surgery Teaching Fundamental Skills With Part Task Trainers Simulation for Endovascular Procedures Urology Simulators Flexible Gastrointestinal and Respiratory Endoscopy Simulators Simulation for Surgical Planning Measuring Surgical Performance During Simulation Summary Selected References References 16 Management of Acute Trauma Outline Overview and History Trauma Systems Injury Scoring Prehospital Trauma Care Initial Assessment and Management Airway Breathing Circulation Disability and Exposure Resuscitative Thoracotomy Secondary Survey Management of Specific Injuries Damage Control Principles Injuries to the Brain Immediate Management Evaluation Management Injuries to the Spinal Cord and the Vertebral Column Immediate Management Evaluation Management Injury to the Maxillofacial Region Immediate Management Evaluation Management Injuries to the Neck Immediate Management Evaluation Management Injuries to the Chest Immediate Management Evaluation Management Chest wall and pleural space injuries. Pulmonary injuries. Cardiac injuries. Thoracic aortic injuries. Tracheobronchial injuries. Esophageal injuries. Diaphragmatic injuries. Injuries to the Abdomen Immediate Management Blunt Abdominal Trauma Evaluation Penetrating Abdominal Trauma Evaluation Management Splenic injuries. Hepatic injuries. Gastric injuries. Duodenal injuries. Pancreatic injuries. Small bowel injuries. Colon injuries. Abdominal great vessel injuries. Genitourinary injuries. Injuries to the Pelvis and Extremities Rehabilitation Selected References References 17 The Difficult Abdominal Wall Outline Video Suture Material Closure Technique Abdominal Fascial Dehiscence Temporary Abdominal Closure Assessing Readiness for Abdominal Closure Timing of Reoperation Synthetic Mesh Failure Biologic Mesh Seroma and Skin Necrosis Preparation for Abdominal Wall Reconstruction Definitive Repair: Creating a Dynamic Abdominal Wall Modified Rives-Stoppa and Transversus Abdominis Release Techniques Adjuncts to Repair Summary Selected References References 18 Emergency Care of Musculoskeletal Injuries Outline Epidemiology of Orthopedic Injuries Terminology Fracture Types Other Injuries Fixation Principles External Fixation Internal Fixation Pins and Screws Plates Tension Bands Intramedullary Nails Patient Evaluation History Trauma Room Evaluation Diagnostic Imaging Shoulder Elbow Pelvis and Acetabulum Hip Knee Ankle Foot Spine Intra-Articular Fractures Stress Radiographs Vascular Injuries Initial Management Wound Management Reduction and Immobilization Traction Prioritization of Surgical Care Orthopedic Emergencies Open Fractures Classification Initial Management Limb Salvage versus Primary Amputation Fractures Secondary to Firearm Injury Skeletal Stabilization Acute Compartment Syndrome Pathogenesis Diagnosis Tissue Pressure Measurement Technique Surgical Treatment Pelvic Ring Disruption Classification Management Initial stabilization. Definitive management. Spinal Injuries Evaluation Management Dislocations Patient Evaluation Treatment Vascular Injuries Incidence Management Common Long Bone Fractures Femur Fractures Epidemiology and Significance Initial Management Definitive Stabilization Tibial Shaft Fractures Epidemiology and Significance Blood Supply Associated Soft Tissue Injuries Management and Treatment Humeral Shaft Fractures Epidemiology and Significance Treatment Challenges and Complications Missed Injuries Drug and Alcohol Use Thromboembolic Complications Pulmonary Failure: Fat Emboli Syndrome and Adult Respiratory Distress Syndrome Postoperative Mobilization Summary Selected References References 19 Burns Outline Etiology of Burn Injury Pathophysiology of Burn Injury Local Changes Burn Depth Burn Size Systemic Changes Hypermetabolic Response to Burn Injury Inflammation and Edema Effects on Cardiovascular System Effects on the Renal System Effects on the Gastrointestinal System Effects on the Immune System Basic Treatment of Burn Injury Prehospital Management Initial Assessment Initial Wound Care Transport Resuscitation Escharotomies Specific Treatment of Burns Inhalation Injury Wound Care Antimicrobials Burn Wound Excision Tangential excision. Full-thickness excision. Fascial excision. Burn Wound Coverage Multiorgan Failure Etiology and Pathophysiology Prevention Organ Failure Renal Failure Pulmonary Failure Hepatic Failure Hematologic Failure Central Nervous System Failure Attenuation of the Hypermetabolic Response Nonpharmacologic Modalities Nutritional Support Environmental Support Exercise and Adjunctive Measures Pharmacologic Modalities Recombinant Human Growth Hormone Insulin-like Growth Factor Oxandrolone Propranolol Attenuation of Hyperglycemia after Burn Injury Insulin Metformin Novel Therapeutic Options Special Considerations: Electrical and Chemical Burns Electrical Burns Initial Treatment Delayed Effects Chemical Burns Alkali Acids Hydrocarbons Outcomes Burn Units Summary Selected References References 20 Bites and Stings Outline Snakebites Epidemiology Venomous Species Indigenous to United States Pathophysiology Clinical Manifestations Management Antivenin Therapy Coagulopathy of Envenomation Fasciotomy Mammalian Bites Epidemiology Treatment Evaluation Wound Care Microbiology Antibiotics Rabies Arthropod Bites and Stings Black Widow Spiders Toxicology Clinical Manifestations Treatment Brown Recluse Spiders Toxicology Clinical Manifestations Treatment Scorpions Toxicology Clinical Manifestations Treatment Ticks Hymenoptera Toxicology Clinical Reactions Treatment Marine Bites and Stings Initial Assessment Microbiology General Management Wound Care Antivenom Injuries from Nonvenomous Aquatic Animals Sharks Moray Eels Alligators and Crocodiles Miscellaneous Envenomation by Invertebrates Coelenterates Sponges Echinodermata Mollusks Annelid Worms (Bristleworms) Envenomation by Vertebrates Stingrays Miscellaneous Fish Sea Snakes Selected References References 21 Surgical Critical Care Outline Neurologic System Dysfunction Analgesia, Sedation, and Neuromuscular Blockade Alcohol Withdrawal and Opioid Dependence Cardiovascular System Comorbidities, Events, and Risk Mitigation Dysfunction: Ischemic Disease, Non–ST-Segment Elevation Myocardial Infarction, and Arrhythmias Shock and Hemodynamic Monitoring Resuscitation Hemodynamic Support Respiratory System Respiratory Failure Noninvasive and Mechanical Ventilation Weaning and Extubation Pneumonia, Acute Respiratory Distress Syndrome, Salvage Modes of Ventilation, and Extracorporeal Membrane Oxygenation Special Issues: Tracheostomy and Obesity Gastrointestinal System Background, Malnutrition, and Catabolism of Critical Illness Assessment of Malnutrition and Energy Requirements Enteral Feeding Parenteral Nutrition Renal System Hepatic System Cirrhosis and Perioperative Liver Decompensation Hematologic System Review of Clotting Mechanisms and Thromboembolism Heparin-Induced Thrombocytopenia Critical Illness Anemia and Transfusion Massive Transfusion Strategies and Anticoagulation Reversal Endocrine System Glucose Control Adrenal Insufficiency Infection in the Intensive Care Unit Fever and Approach to Infections Sepsis Strategies Antibiotic Stewardship Prophylaxis in the Intensive Care Unit Stress Ulcer Prophylaxis Venous Thromboembolism Prophylaxis Special Issues Long-Term Intensive Care Unit Outcomes End-of-Life Care Selected References References 22 Bedside Surgical Procedures Outline Rationale for Bedside Surgical Procedures Taking the Operating Room to the Bedside Safety Practices for Bedside Surgical Procedures Selection of Patients for Bedside Surgical Procedures Bedside Laparotomy Tracheostomy Percutaneous Endoscopic Gastrostomy Bronchoscopy Selected References References 23 The Surgeon’s Role in Mass Casualty Incidents Outline Key Concepts Classification of Disasters and Implications for Trauma Care Multiple Casualty Incidents Mass Casualty Incidents Major Medical Disasters Injury Severity Distribution Modern Trauma Care in Mass Casualty Goal of the Hospital Disaster Response Understanding the Trauma Service Line in Disasters Casualty Load and Surge Capacity Mass Casualty and Modern Trauma Systems Medical Response at the Scene Trauma Aspects of Hospital Disaster Plans Hospital Disaster Response Preparing to Receive Casualties Incident Command and Clinical Decision Making Hospital Triage Trauma Care in the Initial Phase “Minimal Acceptable Care” Other Aspects of Hospital Response Definitive Care Phase Surgeon’s Role in Natural Disasters Injury Patterns in Natural Disasters Initiating the Medical Relief Effort Trauma Care in the Disaster Area Blast Trauma: Clinical Patterns and System Implications Primary Blast Injury Secondary Blast Injury Tertiary and Quaternary Blast Injuries Conclusion Selected References References 24 Transplantation Immunobiology and Immunosuppression Outline Video The Immune Response Innate Immunity Monocytes Dendritic Cells Natural Killer Cells Acquired Immunity Major Histocompatibility Locus: Transplant Antigens Human Histocompatibility Complex Class I Major Histocompatibility Complex Class II MHC HLA Typing: Implications for Transplantation Cellular Components of the Acquired Immune System T Cell Receptor T Cell Activation Costimulation T Cell Effector Functions Cytokines B Cells B cell receptor or antibody. B cell activation. Transplant Immunity Rejection Hyperacute Rejection Acute Rejection Chronic Rejection Immunosuppression Corticosteroids Antiproliferative Agents Azathioprine Mycophenolate Mofetil Calcineurin Inhibitors Cyclosporine Tacrolimus Lymphocyte Depletion Preparations Antilymphocyte Globulin OKT3 Anti–IL-2 Receptor Antibodies Other Immunoglobulin Therapies Rituximab Alemtuzumab Intravenous Immune Globulin Mammalian Target of Rapamycin Inhibitors Newer Immunosuppressive Agents Belatacept Fingolimod (FTY720) Eculizumab JAK3 Kinase Inhibition Protein Kinase C Inhibition Complications of Immunosuppression Risk of Infection Risk for Malignant Disease Nonimmune Side Effects Tolerance T Cell Ablation Costimulation Blockade Mixed Chimerism Xenotransplantation Concordant Xenografts Discordant Xenografts New Areas of Transplantation Islet Cell Transplantation Vascularized Composite Tissue Transplantation Conclusion Selected References References 25 Liver Transplantation Outline History Indications and Contraindications Indications Fulminant Hepatic Failure Hepatitis C and Liver Transplantation Hepatitis B Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Alcoholic Liver Disease Nonalcoholic Steatohepatitis Biliary Atresia Contraindications Organ Shortage, Model for End-Stage Liver Disease, and Liver Distribution Model for End-Stage Liver Disease Formula Live Donor Liver Transplantation Technical Aspects of Liver Transplantation Split Liver Transplant Live Donor Operation Right Lobe Dissection for Live Donor Liver Transplantation Left Lobe Dissection for Live Donor Liver Transplantation Implantation of Partial Liver Graft Early Complications of Liver Transplantation Outcome Extended Criteria Donors Evaluation of Abnormal Liver Function Test Results Immunosuppression after Liver Transplantation Retransplantation and Recurrent Disease Role of Liver Transplantation for Hepatocellular Carcinoma Role of Cellular Transplantation in Liver Replacement Selected References References 26 Kidney and Pancreas Transplantation Outline Historical Perspective Kidney Transplantation Indications Patient Selection Living Donor Selection Laparoscopic Surgical Technique Open Surgical Technique Postoperative Care and Follow-up Deceased Donors Kidney Procurement and Preparation Preservation and Storage Recipient Operation Postoperative Surgical Complications Hemorrhage Venous Thrombosis Arterial Thrombosis Arterial Stenosis Urologic Complications Lymphocele Infections Outcomes Kidney Allocation Pancreas Transplantation Patient Selection Pancreas Donor Pancreas Procurement, Preparation, and Transplantation Drainage Techniques: Endocrine and Exocrine Secretions Enteric Drainage or Bladder Drainage Systemic Drainage versus Portal Drainage Surgical Complications Leak Vascular Complications Thrombosis. Bleeding. Other Considerations Infection. Pancreatitis. Bowel obstruction. Outcomes Islet Transplantation Isolation Techniques Islet Transplantation Technique Outcomes Selected References References 27 Small Bowel Transplantation Outline History Indications for Intestine Transplantation Evaluation Recipient Evaluation Donor Evaluation Donor and Recipient Surgical and Technical Considerations Isolated Intestine Transplantation Intestine Allograft in Combination With Other Abdominal Organs Other Technical Variations Immunosuppression Complications Surgical and Perioperative Complications Monitoring and Rejection Infection Outcomes Patient and Graft Survival Costs and Quality of Life Conclusions Selected References References 28 Tumor Biology and Tumor Markers Outline Epidemiology Global Burden of Cancer Aging and Cancer Obesity and Cancer Tumor Biology Sustaining Proliferative Signaling Evading Growth Suppressors Resisting Cell Death Enabling Replicative Immortality Inducing Angiogenesis Activating Invasion and Metastasis Avoiding Immune Destruction Deregulating Cellular Energetics Genomic Instability and Mutation Tumor-Promoting Inflammation Carcinogenesis Cancer Genetics Selected Familial Cancer Syndromes Retinoblastoma Li-Fraumeni Syndrome Familial Adenomatous Polyposis Hereditary Nonpolyposis Colorectal Cancer BRCA1 and BRCA2 Multiple Endocrine Neoplasia Type 1 Multiple Endocrine Neoplasia Type 2 Von Hippel–Lindau Syndrome Cancer Epigenetics Carcinogens Chemical Carcinogens Radiation Carcinogenesis Infectious Carcinogens Viral carcinogenesis. Tenets of viral carcinogenesis (Box 28-1). Small DNA tumor viruses. Hepatitis B virus. RNA viruses. Hepatitis C virus. Helicobacter pylori. Chronic Inflammation Tumor Markers Protein Tumor Markers Carcinoembryonic Antigen Testing. Screening. Prognosis. Monitoring. α-Fetoprotein Testing. Screening. Prognosis. Monitoring. Carbohydrate Antigen 19-9 Testing. Screening. Prognosis. Monitoring. Prostate-Specific Antigen Testing. Screening. Monitoring response to therapy. Carbohydrate Antigen 125 Testing. Screening. Prognosis. Monitoring response to therapy. AFP and Human Chorionic Gonadotropin in Testicular Germ Cell Tumors Diagnosis. Prognosis. Monitoring. DNA-Based Markers Epigenetic Changes Potential Applications Early detection. Prediction of response to therapy. Prognostication. RNA-Based Markers Proteomic Profiling Selected References References 29 Tumor Immunology and Immunotherapy Outline Overview of Tumor Immunology T Lymphocytes and Natural Killer Cells Antigen-Presenting Cells Antibody Tumor Antigens Immunosuppressive Tumor Microenvironment Immunotherapy Cytokine Therapy Vaccines Targeting Immunomodulatory Pathways T Cell Adoptive Therapy Monoclonal Antibody Therapy Factors Governing the Therapeutic Potential of Monoclonal Antibodies Unconjugated Antibodies Immunoconjugates Conclusion Selected References References 30 Melanoma and Cutaneous Malignant Neoplasms Outline Cutaneous Melanoma Epidemiology Precursor Lesions Pathogenesis Initial Evaluation Biopsy Pathology Prognostic Factors and Staging AJCC Staging T stage. N stage. M stage. Additional Factors Staging Beyond TNM Additional Workup and Imaging Treatment Wide Local Excision Technique. Management of the Regional Lymph Nodes Elective lymph node dissection. Sentinel lymph node biopsy. Multicenter Selective Lymphadenectomy Trial. Indications. Thin melanoma. Thick melanoma. Technical details. Lymph Node Dissection Completion lymphadenectomy. Therapeutic lymph node dissection. Extent. Adjuvant Therapy Interferon alfa-2b. Radiation Therapy Follow-Up after Treatment of Melanoma Treatment of Recurrent Disease Local recurrence. In-transit disease. Regional nodal recurrence. Treatment of Metastatic Disease Systemic therapy. Immunotherapy. Targeted therapy. Metastasectomy. Special Situations and Noncutaneous Melanoma Unknown Primary Melanoma Melanoma and Pregnancy Noncutaneous Melanomas Cutaneous Malignant Neoplasms: Nonmelanoma Skin Cancer Squamous Cell Carcinoma and Basal Cell Carcinoma Squamous Cell Carcinoma Basal Cell Carcinoma Treatment Options for Squamous and Basal Cell Carcinoma Uncommon Cutaneous Malignant Neoplasms Selected References References 31 Soft Tissue Sarcoma Outline Epidemiology Core Concepts Germline Mutations Neurofibromatosis Type 1 Li-Fraumeni Syndrome Familial Adenomatous Polyposis and Gardner Syndrome Radiation Carcinogens Staging Tumor Grade Clinical Evaluation Lipomatous Tumors MFH Reclassification Trunk and Extremity Sarcoma Malignant Peripheral Nerve Sheath Tumors Desmoid Tumor Angiosarcoma Dermatofibrosarcoma Protuberans Retroperitoneal and Visceral Sarcoma Gastrointestinal Stromal Tumor Leiomyosarcoma Summary Selected References References 32 Bone Tumors Outline Overview Bone Microenvironment Bone Macroenvironment Biopsy Staging Oncologic Resection Skeletal Reconstruction Benign Bone Tumors Enchondroma Osteochondroma Osteoid Osteoma Giant Cell Tumor Skeletal Sarcomas Osteosarcoma Ewing Sarcoma Chondrosarcoma Bone Metastases Conclusion Selected References References 33 Head and Neck Outline Normal Histology Epidemiology Carcinogenesis Staging Clinical Overview Evaluation Positron Emission Tomography Lymphatic Spread Therapeutic Options Anatomic Sites Lip Oral Cavity Oral Tongue Floor of the Mouth Alveolus Buccal Mucosa Palate Oropharynx Hypopharynx Larynx Nasal Cavity and Paranasal Sinuses Nasopharynx Pituitary Surgery Ear and Temporal Bone Salivary Gland Neoplasms Neck and Unknown Primary Tracheotomy Vocal Cord Paralysis Reconstruction Selected References References 34 Diseases of the Breast Outline Anatomy Microscopic Anatomy Breast Development and Physiology Normal Development and Physiology Fibrocystic Changes and Breast Pain Abnormal Development and Physiology Absent or Accessory Breast Tissue Gynecomastia Nipple Discharge Galactocele Diagnosis of Breast Disease Patient History Physical Examination Biopsy Fine-Needle Aspiration Biopsy Core Needle Biopsy Excisional Biopsy Breast Imaging Screening Mammography Ultrasonography Magnetic Resonance Imaging Nonpalpable Mammographic Abnormalities Image-Localized Surgical Excision of Nonpalpable Breast Lesions Identification and Care of High-Risk Patients Risk Factors for Breast Cancer Age and Sex Personal History of Breast Cancer Histologic Risk Factors Family History of Breast Cancer and Genetic Risk Factors Reproductive Risk Factors Exogenous Hormone Use Risk Assessment Care of High-Risk Patients Close Surveillance Chemoprevention for Breast Cancer Prophylactic Mastectomy Summary: Risk Assessment and Management Benign Breast Tumors and Related Diseases Breast Cysts Fibroadenomas and Other Benign Tumors Hamartomas and Adenomas Breast Infections and Abscess Papillomas and Papillomatosis Sclerosing Adenosis Radial Scars Fat Necrosis Epidemiology and Pathology of Breast Cancer Epidemiology Pathology Noninvasive Breast Cancer Invasive Breast Cancer Molecular Markers and Breast Cancer Subtypes Other Tumors of the Breast Phyllodes tumors. Angiosarcoma. Staging of Breast Cancer Surgical Treatment of Breast Cancer Historical Perspective Surgical Trials of Local Therapy for Operable Breast Cancer Radical Mastectomy versus Total Mastectomy, With or Without Radiation Therapy Mastectomy versus Breast-Conserving Therapy Planning Surgical Treatments Selection of Surgical Therapy Factors Influencing Eligibility for Breast Conservation Tumor Size Margins Histology Patient Age Breast-Conserving Surgery Technical Aspects Cosmetic Challenges Extent of breast resection. Breast size and body habitus. Tumor location. Timing of Oncoplastic Surgery Mastectomy Indications Postmastectomy Breast Reconstruction Technical Details Lymph Node Staging Historical Perspective Sentinel Lymph Node Dissection Lymphatic Mapping Technique and Selection of Patients for Sentinel Lymph Node Dissection Outcomes of Sentinel Lymph Node Dissection Treatment of Ductal Carcinoma in Situ Mastectomy Breast-Conserving Therapy Role of Tamoxifen Sentinel Node Surgery Radiation Therapy for Breast Cancer Radiation Therapy After Breast-Conserving Surgery Postmastectomy Radiation Therapy Systemic Therapy for Breast Cancer Goals of Therapy and Assessment of Potential Benefits and Risks from Therapy Chemotherapy Trastuzumab-Based Targeted Therapy Endocrine Therapy Tamoxifen Aromatase Inhibitors Ovarian Ablation Neoadjuvant Systemic Therapy for Operable Breast Cancer Systemic Therapy for Early-Stage Breast Cancer Treatment of Locally Advanced and Inflammatory Breast Cancer Treatment of Special Conditions Breast Cancer in Older Adults Paget Disease Breast Cancer in Men Selected References References 35 Breast Reconstruction Outline Role of the General Surgeon in Breast Reconstruction History Patient Selection Timing Procedure Selection and Surgical Planning Implant-Based Reconstructions Combination Reconstruction Autologous Reconstruction Pedicled Flap Abdominal-Based, Gluteal-Based, and Inner Thigh–Based Flaps Abdominal-based flaps. Gluteal-based flaps. Inner thigh–based flaps. Oncoplastic Surgery Complications Nipple-Areolar Reconstruction Management of the Contralateral Breast Surveillance Conclusions Selected References References 36 Thyroid Outline Historical Perspective Anatomy Embryology Adult Surgical Anatomy Innervation Superior Laryngeal Nerve Recurrent Laryngeal Nerve Blood Supply Lymphatic System Parathyroid Glands Physiology of the Thyroid Gland Iodine Metabolism Thyroid Hormone Synthesis Thyroglobulin Calcitonin Regulation of Thyroid Hormone Secretion Peripheral Action of Thyroid Hormones Tests of Thyroid Function Evaluation of the Pituitary-Thyroid Feedback Loop Serum Triiodothyronine and Thyroxine Levels Calcitonin Radioactive Iodine Uptake Thyroid Autoantibody Levels Disorders of Thyroid Metabolism— Benign Thyroid Disease Hypothyroidism Metabolic Consequences of Iodine Deficiency Postradiation Hypothyroidism Postsurgical Hypothyroidism Pharmacologic Hypothyroidism Antithyroid drugs. Amiodarone, lithium, interferon-α, interleukin-2, antineoplastic drugs. Diagnosis Treatment Thyroiditis Hashimoto Thyroiditis Acute Suppurative Thyroiditis Subacute Thyroiditis Riedel Struma Hyperthyroidism Hyperthyroid Disorders Graves disease. Toxic nodular goiter and toxic adenoma. Diagnosis. Treatment. Nonfunctioning Goiter Multinodular Goiter Substernal Goiter Evaluation of a Thyroid Nodule Incidence Initial Evaluation Laboratory Evaluation Thyroid Imaging Ultrasound Radioisotope Scanning Computed Tomography and Magnetic Resonance Imaging Fine-Needle Aspiration Biopsy Decision Making and Treatment Thyroid Malignancies Thyroid Oncogenesis Genetic Alterations Ionizing Radiation Papillary Thyroid Carcinoma Pathologic Classification Clinical Features Follicular Thyroid Carcinoma Pathologic Classification Clinical Features Treatment of Differentiated Thyroid Carcinoma (Papillary and Follicular) Extent of Thyroid Resection Lymph Node Dissection Completion Thyroidectomy Radioactive Iodine Therapy Thyroid-Stimulating Hormone Suppression Medullary Thyroid Carcinoma Clinical Features Treatment Poorly Differentiated Thyroid Carcinoma Anaplastic Thyroid Carcinoma Pathology Treatment Thyroid Lymphoma Workup and Diagnosis Treatment Thyroid Disease in Pregnancy Physiologic Changes of the Thyroid Gland During Pregnancy Hypothyroidism in Pregnancy Hyperthyroidism in Pregnancy Thyroid Nodules and Thyroid Carcinoma in Pregnancy Surgical Approaches to the Thyroid Standard Cervical Thyroidectomy Lateral Neck Dissection Substernal Goiter Intraoperative Neuromonitoring Postoperative Care Alternative Approaches to Thyroid Surgery Complications of Thyroid Surgery Hypocalcemia and Hypoparathyroidism Nerve Injury Superior Laryngeal Nerve Recurrent Laryngeal Nerve Bleeding Selected References References 37 The Parathyroid Glands Outline History Anatomy Embryology Surgical Anatomy Physiology of the Parathyroid Glands Calcium Homeostasis Calcium Regulation Disorders of Parathyroid Metabolism Hypoparathyroidism Congenital Hypoparathyroidism Pseudohypoparathyroidism Hyperparathyroidism Nonparathyroidal Hypercalcemia Primary Hyperparathyroidism Secondary and Tertiary Hyperparathyroidism Hypercalcemic Crisis Calciphylaxis Diagnosis of Primary Hyperparathyroidism Parathyroid Gland Localization Noninvasive Preoperative Localization Invasive Preoperative Localization Negative Imaging Parathyroidectomy—Surgical Options Bilateral Neck Exploration Minimally Invasive (Open) Parathyroidectomy Endoscopic Parathyroidectomy Video-Assisted Parathyroidectomy Other Minimally Invasive Techniques Ectopic Parathyroid Glands Remedial Parathyroidectomy Operative Adjuncts Intraoperative PTH Assessment Gamma Probe Localization Recurrent Laryngeal Nerve Monitoring Outcomes after Parathyroid Surgery Cure Rates Nerve Injury—Recurrent Laryngeal Nerve Injury, Bilateral Nerve Injury, Injury to External Branch of the Superior Laryngeal Nerve Postoperative Hypocalcemia Bleeding or Hematoma Inherited Parathyroid Disease Multiple Endocrine Neoplasia Multiple Endocrine Neoplasia Type 1 Multiple Endocrine Neoplasia Type 2A Other Familial Hyperparathyroidism Disorders Parathyroid Carcinoma Medical Alternatives Controversies in Parathyroid Surgery Unilateral versus Bilateral Neck Exploration Does Asymptomatic Primary Hyperparathyroidism Really Exist? Selected References References 38 Endocrine Pancreas Outline Histomorphology of Islets Embryology of the Endocrine Pancreas Endocrine Physiology Glucose Homeostasis: Insulin and Glucagon Insulin Glucagon Other Influences on Glucose Homeostasis Somatostatin Pancreatic Polypeptide Other Peptide Hormones Pancreatic Neuroendocrine Tumors Overview and History Histopathology and Staging Molecular Genetics of Islet Cell Tumors General Principles of Diagnosis and Treatment of Pancreatic Neuroendocrine Tumors Diagnosis and Evaluation Screening for Functional Tumors Localization Treatment Nonmetastatic disease localized preoperatively. Nonmetastatic disease not localized preoperatively. Metastatic disease. Incidentally found, small pancreatic neuroendocrine tumors. Diagnosis and Treatment of Specific Functional Pancreatic Neuroendocrine Tumors Insulin-Secreting Pancreatic Neuroendocrine Tumor (Insulinoma) Diagnosis. Localization and treatment. Gastrin-Secreting Pancreatic Neuroendocrine Tumor (Gastrinoma) Diagnosis. Localization and treatment. Vasoactive Intestinal Peptide–Secreting Pancreatic Neuroendocrine Tumor Diagnosis and treatment. Glucagon-Secreting Pancreatic Neuroendocrine Tumor (Glucagonoma) Somatostatin-Secreting Pancreatic Neuroendocrine Tumor (Somatostatinoma) Other Functional Pancreatic Endocrine Tumors Pancreatic Neuroendocrine Tumor Associated With Multiple Endocrine Neoplasia Type 1 Noninsulinoma Pancreatogenous Hypoglycemia Syndrome Endocrine Complications of Surgical Therapy Post–Gastric Bypass Noninsulinoma Pancreatogenous Hypoglycemia Syndrome Endocrine Insufficiency After Surgical Resection Surgical Treatment of Diabetes Autologous Islet Cell Transplantation Immune Therapy, Pancreatic Transplantation, and Islet Allotransplantation Selected References References 39 The Adrenal Glands Outline History Anatomy and Embryology General and Developmental Aspects Relationships Vasculature Normal Histopathology Biochemistry and Physiology Adrenal Steroid Biosynthesis Steroid Hormone Physiology and Metabolism Glucocorticoids Mineralocorticoids Adrenal Sex Steroids Catecholamine Biosynthesis and Physiology Catecholamine Clearance Adrenal Insufficiency Types of Adrenal Insufficiency Primary Adrenal Insufficiency (Addison Disease) Secondary Adrenal Insufficiency Adrenal Insufficiency in the Critically Ill Adrenal Crisis Diagnosis and Treatment Diagnosis Treatment Perioperative Steroid Administration Diseases of the Adrenal Cortex Primary Hyperaldosteronism Epidemiology and Clinical Features Diagnosis and Localization Biochemical diagnosis. Localization. Surgical Management and Outcomes Cushing Syndrome Epidemiology and Clinical Features Biochemical Diagnosis and Localization Surgical Management and Outcomes Special Case: Subclinical Cushing Syndrome Sex Steroid Excess Adrenocortical Carcinoma Diseases of the Adrenal Medulla Pheochromocytoma Epidemiology and Clinical Features Biochemical Diagnosis and Localization Perioperative Care Surgical Management and Outcomes Molecular Genetics of Pheochromocytoma Malignant Pheochromocytoma Other Adrenal Diseases Incidentally Discovered Adrenal Mass (Incidentaloma) Epidemiology and Differential Diagnosis Clinical Evaluation and Surgical Management Metastases to the Adrenal Gland Epidemiology and Clinical Features Clinical Evaluation and Surgical Management Technical Aspects of Adrenalectomy Choice of Operative Approach Laparoscopic Lateral Transabdominal Adrenalectomy Patient Preparation and Positioning Technique Left adrenal. Right adrenal. Posterior Retroperitoneoscopic Adrenalectomy Complications and Postoperative Care Open Anterior Transabdominal Adrenalectomy Patient Preparation and Positioning Technique Left adrenal. Right adrenal. Complications and Postoperative Care Selected References References 40 The Multiple Endocrine Neoplasia Syndromes Outline Videos Multiple Endocrine Neoplasia Type 1 Genetic Studies and Pathogenesis Clinical Features and Management Parathyroid Glands Enteropancreatic Neuroendocrine Tumors Pituitary Gland Other Tumors Multiple Endocrine Neoplasia Type 2 Syndromes General RET Proto-Oncogene MEN2A and FMTC MEN2B RET Mutations in Sporadic Thyroid Carcinomas Screening and Genetic Testing for MEN2 Medullary Thyroid Carcinoma Surgery for Established Medullary Thyroid Carcinoma in MEN2 and FMTC Preventive Surgery Follow-Up Management of Recurrent and Metastatic Disease Pheochromocytoma Primary Hyperparathyroidism Conclusions Selected References References 41 Esophagus Outline Diagnosis and Management of Esophageal Motility Disorders Diagnosis Motility Disorders of the Esophageal Body Diffuse Esophageal Spasm Nutcracker Esophagus Motility Disorders of the Lower Esophageal Sphincter Hypertensive Lower Esophageal Sphincter Motility Disorders Affecting Both Body and Lower Esophageal Sphincter Achalasia Ineffective Esophageal Motility Diverticular Disorders Pharyngoesophageal (Zenker) Diverticulum Midesophageal Diverticula Epiphrenic Diverticula Gastroesophageal Reflux Disease Medical Management Workup Surgical Therapy Complicated GERD Acquired Benign Disorders of the Esophagus Acquired Esophageal Disease Perforation Caustic Ingestion Foreign Body Ingestion, Benign Tracheoesophageal Fistula, and Schatzki Ring Esophageal Neoplasms and Diagnostic Approaches to Esophageal Cancer Epidemiology Diagnosis and Staging Benign Tumors of the Esophagus Other Malignant Tumors of the Esophagus Approach to Early-Stage Esophageal Cancer High-Grade Dysplasia and Superficial Cancers Therapeutics Ablation. Cryotherapy. Endoscopic mucosal resection. Esophagectomy. Locally Advanced Esophageal Cancer The Evolution and Principles of Multimodality Therapy for Locally Advanced Esophageal Carcinoma Treatment Modalities Used in Locally Advanced Esophageal Cancer Radiation therapy. Chemotherapy. Chemoradiation alone. Chemoradiation and surgery. The Role of Surgery in Trimodality Therapy and Salvage Surgery Surveillance Palliative Options for Esophageal Carcinoma Summary Selected References References 42 Gastroesophageal Reflux Disease and Hiatal Hernia Outline Gastroesophageal Reflux Disease Pathophysiology Clinical Presentation Typical Symptoms of GERD Extraesophageal Symptoms of GERD Pulmonary Disease, GERD, and Antireflux Surgery Physical Examination Preoperative Diagnostic Testing Ambulatory pH and Impedance Monitoring Esophageal Manometry Esophagogastroduodenoscopy Barium Esophagram Additional Preoperative Considerations Dysphagia Obesity Partial versus Complete Fundoplication Barrett Esophagus Treatment of Gastroesophageal Reflux Disease Medical Management Surgical Management Operative technique. Creation of a 360-degree fundoplication. Creation of a partial fundoplication. Intraoperative management of short esophagus. Postoperative Care and Recovery Clinical Outcomes of Antireflux Surgery Operative Complications and Side Effects of Antireflux Surgery Operative Complications Pneumothorax. Gastric and esophageal injuries. Splenic and liver injuries or bleeding. Side Effects Bloating. Dysphagia. Failed Antireflux Surgery Novel Therapies for GERD EsophyX LINX Paraesophageal Hernia Pathophysiology Clinical Presentation Preoperative Evaluation Operative Repair Acute Gastric Volvulus and Strangulation Summary Selected References References 43 Abdominal Wall, Umbilicus, Peritoneum, Mesenteries, Omentum, and Retroperitoneum Outline Abdominal Wall and Umbilicus Embryology Anatomy Subcutaneous Tissues Muscle and Investing Fasciae Preperitoneal Space and Peritoneum Vessels and Nerves of the Abdominal Wall Vascular Supply Innervation Abnormalities of the Abdominal Wall Congenital Abnormalities Umbilical hernias. Omphalocele. Gastroschisis. Infantile umbilical hernia. Acquired umbilical hernia. Abnormalities resulting from persistence of the omphalomesenteric duct. Abnormalities resulting from persistence of the allantois. Acquired Abnormalities Diastasis recti. Anterior abdominal wall hernias. Rectus sheath hematoma. Malignant Neoplasms of the Abdominal Wall Desmoid Tumor Abdominal Wall Sarcoma Metastatic Disease Symptoms of Intra-abdominal Disease Referred to the Abdominal Wall Peritoneum and Peritoneal Cavity Anatomy Physiology Peritoneal Disorders Ascites Pathophysiology and cause. Clinical presentation and diagnosis. Ascitic fluid analysis. Treatment of ascites in cirrhotic patients. Chylous ascites. Peritonitis Spontaneous bacterial peritonitis. Tuberculous peritonitis. Peritonitis associated with chronic ambulatory peritoneal dialysis. Malignant Neoplasms of the Peritoneum Pseudomyxoma peritonei. Malignant peritoneal mesothelioma. Mesentery and Omentum Embryology and Anatomy Physiology Diseases of the Omentum Omental Cysts Omental Torsion and Infarction Omental Neoplasms Omental Grafts and Transpositions Diseases of the Mesentery Mesenteric Cysts Acute Mesenteric Lymphadenitis Sclerosing Mesenteritis Intra-abdominal (Internal) Hernias Internal Hernias Caused by Developmental Defects Mesocolic (paraduodenal) hernias. Mesenteric hernias. Acquired Internal Hernias Malignant Neoplasms of the Mesentery Mesenteric and Intra-abdominal Desmoid Tumors Retroperitoneum Anatomy Operative Approaches Retroperitoneal Disorders Retroperitoneal Abscesses Retroperitoneal Hematomas Retroperitoneal Fibrosis Retroperitoneal Malignant Neoplasms Retroperitoneal sarcoma. Selected References References 44 Hernias Outline Inguinal Hernias Incidence Anatomy of the Groin External Oblique Muscle and Aponeurosis Internal Oblique Muscle and Aponeurosis Transversus Abdominis Muscle and Aponeurosis and Transversalis Fascia Pectineal (Cooper) Ligament Inguinal Canal Preperitoneal Space Femoral Canal Diagnosis Classification Treatment Nonoperative Management Operative Repair Anterior repairs. Tissue repairs. Tension-free anterior inguinal hernia repair. Preperitoneal repair. Laparoscopic repair. Results of Hernia Repair Femoral Hernias Special Problems Sliding Hernia Recurrent Hernia Strangulated Hernia Bilateral Hernias Complications Surgical Site Infection Nerve Injuries and Chronic Pain Syndromes Ischemic Orchitis and Testicular Atrophy Injury to the Vas Deferens and Viscera Hernia Recurrence Quality of Life Ventral Hernias Incidence Anatomy Diagnosis Classification Umbilical Hernia Epigastric Hernia Incisional Hernia Treatment: Operative Repair Prosthetic Materials for Ventral Hernia Repair Synthetic materials. Biologic materials. Operative Technique Ventral hernias. Intraperitoneal mesh placement. Myofascial releases. Posterior rectus sheath incision with retromuscular mesh placement. Posterior component separation. Anterior component separation. Endoscopic component separation. Results of Incisional Hernia Repairs Unusual Hernias Types Spigelian Hernia Obturator Hernia Lumbar Hernia Interparietal Hernia Sciatic Hernia Perineal Hernia Loss of Domain Hernias Parastomal Hernia Repair Complications Mesh Infection Seromas Enterotomy Selected References References 45 Acute Abdomen Outline Anatomy and Physiology History Physical Examination Laboratory Studies Imaging Studies Intra-Abdominal Pressure Monitoring Diagnostic Laparoscopy Differential Diagnosis Preparation for Emergency Operation Atypical Patients Pregnancy Pediatrics Acute Abdomen in the Critically Ill Immunocompromised Patients With Acute Abdomen Acute Abdomen in the Morbidly Obese Algorithms in the Acute Abdomen Summary Common Pitfalls Selected References References 46 Acute Gastrointestinal Hemorrhage Outline Management of Patients With Acute Gastrointestinal Hemorrhage Initial Assessment Resuscitation History and Physical Examination Localization Risk Stratification Acute Upper Gastrointestinal Hemorrhage Specific Causes of Upper Gastrointestinal Hemorrhage Nonvariceal Bleeding Peptic ulcer disease. Management. Medical management. Endoscopic management. Surgical management. Duodenal ulcer. Gastric ulcer. Mallory-Weiss tears. Stress gastritis. Esophagitis. Dieulafoy lesion. Gastric antral vascular ectasia. Malignancy. Aortoenteric fistula. Hemobilia. Hemosuccus pancreaticus. Iatrogenic bleeding. Bleeding Related to Portal Hypertension Management. Medical management. Endoscopic management. Other management. Prevention of rebleeding. Acute Lower Gastrointestinal Hemorrhage Diagnosis Colonoscopy Radionuclide Scanning Computed Tomography Angiography Mesenteric Angiography Treatment Specific Causes of Lower Gastrointestinal Tract Bleeding Colonic Bleeding Diverticular disease. Angiodysplasia. Neoplasia. Anorectal disease. Colitis. Mesenteric ischemia. Acute Gastrointestinal Hemorrhage from an Obscure Source Diagnosis Repeated Endoscopy Conventional Imaging Small Bowel Endoscopy Video Capsule Endoscopy Intraoperative Endoscopy Treatment Specific Causes of Small Bowel Bleeding Angiodysplasias Neoplasia Crohn’s Disease Meckel’s Diverticulum Diverticula Selected References References 47 Morbid Obesity Outline Videos Obesity: the Magnitude of the Problem Pathophysiology and Associated Medical Problems Medical versus Surgical Therapy Mechanism of Action of Bariatric Surgery Preoperative Evaluation and Selection Eligibility General Bariatric Preoperative Evaluation and Preparation Evaluation of Specific Comorbid Conditions Special Equipment Clinic Operating Room Operative Procedures Vertical Banded Gastroplasty Laparoscopic Adjustable Gastric Banding Roux-en-Y Gastric Bypass Biliopancreatic Diversion Duodenal Switch Laparoscopic Sleeve Gastrectomy Postoperative Care and Follow-Up Results Laparoscopic Adjustable Gastric Banding Roux-en-Y Gastric Bypass Biliopancreatic Diversion and Duodenal Switch Laparoscopic Sleeve Gastrectomy Complications Laparoscopic Adjustable Gastric Banding Roux-en-Y Gastric Bypass Laparoscopic Sleeve Gastrectomy Biliopancreatic Diversion Reoperative Surgery Controversies in Bariatric Surgery Investigational Bariatric Procedures Conclusion Selected References References 48 Stomach Outline Anatomy Gross Anatomy Divisions Blood Supply Lymphatic Drainage Innervation Gastric Morphology Gastric Microscopic Anatomy Physiology Regulation of Gastric Function Gastric Peptides Gastrin Somatostatin Gastrin-Releasing Peptide Histamine Ghrelin Gastric Acid Secretion Stimulated Acid Secretion Cephalic phase. Gastric phase. Intestinal phase. Activation and Secretion by the Parietal Cell Pharmacologic Regulation Other Gastric Secretory Products Gastric juice. Intrinsic factor. Pepsinogen. Mucus and bicarbonate. Gastric Motility Fasting Gastric Motility Postprandial Gastric Motility Abnormal Gastric Motility Gastric-Emptying Studies Treatment Gastric Barrier Function Peptic Ulcer Disease Epidemiology Pathogenesis Helicobacter pylori Infection Nonsteroidal Anti-Inflammatory Drugs Acid Duodenal Ulcer Clinical Manifestations Abdominal pain. Diagnosis Upper gastrointestinal radiography. Flexible upper endoscopy. Helicobacter pylori testing. Invasive Tests Urease assay. Histology. Culture. Noninvasive Tests Serology. Urea breath test. Stool antigen. Treatment Medical management. Antacids. Sucralfate. H2 receptor antagonists. Proton pump inhibitors. Treatment of helicobacter pylori infection. Complicated Ulcer Disease Hemorrhage. Perforation. Gastric outlet obstruction. Intractable peptic ulcer disease. Surgical procedures for peptic ulcers. Truncal vagotomy. Selective vagotomy. Highly selective vagotomy (parietal cell vagotomy). Truncal vagotomy and antrectomy. Gastric Ulcers Clinical Manifestations Diagnosis and Treatment Type I gastric ulcers. Type II and type III gastric ulcers. Type IV gastric ulcers. Bleeding gastric ulcers. Perforated gastric ulcer. Giant gastric ulcers. Zollinger-ellison syndrome. Stress Gastritis Pathophysiology Presentation and Diagnosis Prophylaxis Treatment Postgastrectomy Syndromes Dumping Syndrome Metabolic Disturbances Afferent Loop Syndrome Efferent Loop Obstruction Alkaline Reflux Gastritis Gastric Atony Gastric Cancer Epidemiology and Risk Factors Incidence Risk Factors Helicobacter pylori Infection Dietary Factors Hereditary Risk Factors and Cancer Genetics Other Risk Factors Polyps. Proton pump inhibitors. Pathology Diagnosis and Workup Signs and Symptoms Staging Staging Workup Endoscopy and endoscopic ultrasound. Computed tomography. Positron emission tomography. Laparoscopy. Treatment Surgical Therapy Endoscopic Resection Clinical Decision Making Lymph node dissection. Adjuvant and Neoadjuvant Therapy Palliative Therapy and Systemic Therapy Complicated Gastric Cancer Locally advanced gastric cancer. Complications Outcomes Recurrence Surveillance. Gastric Lymphoma Epidemiology Pathology Evaluation Staging Treatment Mucosa-Associated Lymphoid Tissue Lymphomas Treatment Gastrointestinal Stromal Tumors Adjuvant Therapy Other Neoplasms Gastric Carcinoid Heterotopic Pancreas Other Gastric Lesions Hypertrophic Gastritis (Ménétrier Disease) Mallory-Weiss Tear Dieulafoy Gastric Lesion Gastric Varices Gastric Volvulus Bezoars Selected References References 49 Small Intestine Outline Embryology Anatomy Gross Anatomy Neurovascular-Lymphatic Supply Microscopic Anatomy Physiology Digestion and Absorption Carbohydrates Protein Fats Emulsification. Micelle formation. Intracellular processing. Enterohepatic circulation. Water, Electrolytes, and Vitamins Motility Endocrine Function Gastrointestinal Hormones Receptors Immune Function Obstruction Causes Pathophysiology Clinical Manifestations and Diagnosis History Physical Examination Radiologic and Laboratory Studies Simple Versus Strangulating Obstruction Treatment Fluid Resuscitation and Antibiotics Tube Decompression Operative Management Management of Specific Problems Recurrent Intestinal Obstruction Acute Postoperative Obstruction Ileus Inflammatory and Infectious Diseases Crohn’s Disease History Incidence and Epidemiology Causes Infectious agents. Immunologic factors. Genetic factors. Pathology Gross pathologic features. Microscopic features. Clinical Manifestations Diagnosis Management Medical therapy. Aminosalicylates. Corticosteroids. Antibiotics. Immunosuppressive agents. Anticytokine and cytokine therapies. Novel therapies. Nutritional therapy. Smoking cessation. Surgical treatment. Specific Problems Acute ileitis (nonstricturing, nonpenetrating). Stricturing disease. Penetrating disease. Perforation. Gastrointestinal bleeding. Urologic complications. Cancer. Colorectal disease. Perianal disease. Duodenal disease. Prognosis Typhoid Enteritis Enteritis in the Immunocompromised Host Protozoa Bacteria Mycobacteria Viruses Fungi Neoplasms General Considerations Clinical Manifestations Diagnosis Benign Neoplasms Stromal Tumors Adenomas. Lipomas. Peutz-Jeghers syndrome. Hemangiomas. Malignant Neoplasms Neuroendocrine Tumors Pathology. Clinical manifestations. Malignant carcinoid syndrome. Diagnosis. Treatment Surgical therapy. Medical therapy. Prognosis. Adenocarcinomas Lymphoma Gastrointestinal Stromal Tumors Metastatic Neoplasms Diverticular Disease Duodenal Diverticula Incidence and Cause Clinical Manifestations Treatment Jejunal and Ileal Diverticula Incidence and Cause Clinical Manifestations Treatment Meckel’s Diverticulum Incidence and Cause Clinical Manifestations Diagnostic Studies Treatment Miscellaneous Problems Small Bowel Ulcerations Ingested Foreign Bodies Small Bowel Fistulas Clinical Manifestations Treatment Stabilization. Staging and supportive care. Definitive management. Pneumatosis Intestinalis Blind Loop Syndrome Radiation Enteritis Short Bowel Syndrome Treatment Vascular Compression of the Duodenum Selected References References 50 The Appendix Outline Videos Anatomy and Embryology Appendicitis History Pathophysiology and Bacteriology Differential Diagnosis Presentation History Physical Examination Laboratory Studies Imaging Studies Treatment of Appendicitis Acute Uncomplicated Appendicitis Perforated Appendicitis Laparoscopic versus Open Appendectomy Delayed Presentation of Appendicitis The Normal-Appearing Appendix at Operation Nonoperative Treatment of Uncomplicated Appendicitis “Chronic” Appendicitis as a Cause of Abdominal Pain Incidental Appendectomy Appendicitis in Special Populations Appendicitis in the Pregnant Patient Appendicitis in the Elderly Appendicitis in the Immunocompromised Patient Neoplasms of the Appendix Selected References References 51 Colon and Rectum Outline Embryology of the Colon and Rectum Anatomy of the Colon, Rectum, and Pelvic Floor Pararectal Fascia Pelvic Floor Arterial Supply and Venous and Lymphatic Drainage Nerves Physiology of the Colon Recycling of Nutrients Colonic Flora Prebiotics and Probiotics Fermentation Short-Chain Fatty Acids Urea Recycling Absorption Secretion Motility Formation of Stool Defecation Preoperative Workup and Stoma Planning Nutritional Assessment Preoperative Bowel Preparation Planning Intestinal Stomas Stoma Types Physiologic Considerations and Practical Implications Colostomy Ileostomy Technical Considerations End Descending Colostomy Loop Colostomy Ileostomy Postoperative Management Protocols Diverticular Disease Background Pathophysiology Evaluation Management Uncomplicated Diverticulitis Complicated Diverticulitis Abscess. Fistula. Obstruction. Special Considerations The Immunocompromised Patient Right-Sided Diverticulitis Diverticulitis in Young Patients Colonic Volvulus Large Bowel Obstruction and Pseudo-Obstruction Inflammatory Bowel Disease Ulcerative Colitis Epidemiology and Cause Pathologic Features Gross appearance. Histologic appearance. Clinical Presentation Extraintestinal Manifestations Diagnosis Risk for Carcinoma Treatment Medical therapy. Aminosalicylates. Corticosteroids. Immunomodulators Thiopurines. Methotrexate. Tacrolimus. Cyclosporine. Biologics. Indications for surgery. Fulminant colitis and toxic megacolon. Massive bleeding. Intractability. Dysplasia or carcinoma. Surgical procedures. Total proctocolectomy with end ileostomy. Total proctocolectomy with continent ileostomy. Total proctocolectomy with ileal pouch–anal anastomosis. Summary of elective operations. Postoperative care. Laparoscopic Approaches for Ulcerative Colitis Crohn’s Colitis Epidemiology and Cause Pathologic Features Gross appearance. Histologic appearance. Clinical Presentation Diagnosis Treatment Medical therapy. Indications for surgery. Intractability. Intestinal obstruction. Intra-abdominal abscess. Fistulas. Fulminant colitis and toxic megacolon. Massive bleeding. Cancer. Extracolonic manifestations. Growth retardation. Surgical procedures. Ileocecal resection. Total proctocolectomy with end ileostomy. Total abdominal colectomy with ileorectal anastomosis. Segmental colon resection. Postoperative recurrence. Minimally Invasive Approaches to Surgical Management of Crohn’s Disease Infectious Colitis Clostridium difficile Infection Other Colonic Infections Ischemic Colitis Anatomy Causes Classification Presentation and Diagnosis Treatment Neoplasia Colorectal Cancer Genetics Specific Genes and Mutations Tumor Suppressor Genes MYH Mutations and MYH-Associated Polyposis Mismatch Repair Genes Oncogenes Adenoma-Carcinoma Sequence Colorectal Polyps Hereditary Cancer Syndromes (Table 51-4) Familial Adenomatous Polyposis Lynch Syndrome Peutz-Jeghers Syndrome Juvenile Polyposis Syndrome Sporadic Colon Cancer Staging Rules for Classification Clinical staging. Pathologic staging. Tumor regression grade. Obstructing Colon Cancers Treatment and Follow-up Rectal Cancer Local Excision Transanal Endoscopic Microsurgery Fulguration Abdominal Perineal Resection Low Anterior Resection Sphincter-Sparing Abdominal Perineal Resection With Coloanal Anastomosis Pelvic Floor Disorders and Constipation Diagnosis: Testing and Evaluation Anorectal Physiology Laboratory Testing Defecography Rectal Prolapse (Procidentia) Causes and Symptoms Anatomy and Pathophysiology Differential Diagnosis and Investigation Operative Repair Abdominal approaches Ripstein repair and anterior mesh repairs. Resection rectopexy. Perineal approaches Perineal proctosigmoidectomy and the Altemeier procedure. Anal encirclement. Internal Prolapse and Solitary Rectal Ulcer Syndrome Rectocele Constipation Transit Studies Slow-transit constipation: colonic inertia. Slow-transit constipation: colonic inertia with megacolon. Selected References References 52 Anus Outline Disorders of the Anal Canal Anatomy Physiology Diagnostic Evaluation of the Anus History Physical Examination Pelvic Floor Disorders Incontinence Clinical Evaluation Treatment Medical management. Surgical repair. Prolapse of the Rectum Pathogenesis and Clinical Presentation Preoperative Evaluation Surgical Correction Perineal procedures. Abdominal procedures. Incontinence and Biofeedback Rectocele Clinical Evaluation Treatment Surgical treatment. Common Benign Anal Disorders Hemorrhoids Presentation and Evaluation Treatment Nonoperative management. Surgical treatment. Anal Fissures Presentation and Evaluation Pathogenesis Treatment Medical management. Surgical management. Anorectal Suppuration Clinical Presentations of Various Types of Abscesses Treatment Fistula in Ano Clinical Presentations Treatment Pilonidal Disease Treatment Acute management. Surgical management. Less Common Benign Anal Disorders Rectovaginal Fistula Surgical Repair Sexually Transmitted Diseases and Acquired Immunodeficiency Syndrome Clinical Presentation AIDS. Hidradenitis Suppurativa Clinical Presentation Treatment Crohn’s Disease of the Anorectum Clinical Presentation Evaluation and Treatment Neoplastic Disorders Clinical Evaluation Anal Margin (Perianal) Tumors Condyloma Acuminatum Clinical presentation. Diagnostic evaluation. Treatment. Anal Intraepithelial Neoplasia Treatment. Verrucous Carcinoma Squamous Cell Carcinoma Paget Disease Basal Cell Carcinoma Malignant Anal Canal Neoplasms Squamous Cell Carcinoma Melanoma Adenocarcinoma Selected References References 53 The Liver Outline Historical Perspective Anatomy and Physiology Anatomy Gross Anatomy General description and topography. Normal development and embryology. Functional Anatomy Portal vein. Hepatic artery. Hepatic veins. Biliary system. Nerves. Lymphatics. Microscopic Anatomy Functional unit of the liver. Hepatic microcirculation. Hepatocytes. Functions Energy Functional Heterogeneity Blood Flow Bile Formation Enterohepatic Circulation Bilirubin Metabolism Carbohydrate Metabolism Lipid Metabolism Protein Metabolism Vitamin Metabolism Coagulation Metabolism of Drugs and Toxins (Xenobiotics) Regeneration Future Developments Assessment of Liver Function Routine Screening Tests Specific Diagnostic Tests Quantitative Tests Portal Hypertension Definition Pathophysiology Assessment of Chronic Liver Disease and Portal Hypertension Variceal Hemorrhage Treatment Endoscopy. Pharmacotherapy. Variceal tamponade. Interventional approaches. Operative approaches. Prevention of Recurrent Variceal Hemorrhage Pharmacotherapy. Endoscopic therapy. Interventional therapy. Surgical therapy. Nonselective shunts. Selective shunts. Partial shunts. Hepatic transplantation. Algorithm for Management of Variceal Hemorrhage Infectious Diseases Pyogenic Abscess Epidemiology Pathogenesis Pathology and Microbiology Clinical Features Differential Diagnosis Treatment Outcomes Amebic Abscess Epidemiology Pathogenesis Pathology Clinical Features Differential Diagnosis Treatment Outcomes Hydatid Cyst Recurrent Pyogenic Cholangitis Neoplasms Solid Benign Neoplasms Liver Cell Adenoma Focal Nodular Hyperplasia Hemangioma Other Benign Tumors Primary Solid Malignant Neoplasms Hepatocellular Carcinoma Epidemiology. Causative factors. Clinical presentation. Diagnosis. Pathology. Treatment. Distinct variants of HCC. Intrahepatic Cholangiocarcinoma Other Primary Malignant Neoplasms Metastatic Tumors Colorectal Metastases Neuroendocrine Metastases Noncolorectal, Non-Neuroendocrine Metastases Cystic Neoplasms Simple Cyst Cystadenoma and Cystadenocarcinoma Polycystic Liver Disease Bile Duct Cysts Principles of Hepatic Resection Hemobilia Causes Clinical Presentation Diagnostic Workup Treatment and Outcomes Bilhemia Viral Hepatitis and the Surgeon Definition Diagnosis Epidemiology and Transmission Pathogenesis and Clinical Presentation Prevention Treatment Selected References References 54 Biliary System Outline Anatomy and Physiology Vascular Anatomy Physiology General Considerations in Biliary Tree Pathophysiology Symptoms Pain Fever Jaundice Laboratory Tests Imaging Studies Plain Films Ultrasound Hepatic Iminodiacetic Acid Scan Computed Tomography Magnetic Resonance Imaging and Magnetic Resonance Cholangiopancreatography Endoscopic Retrograde Cholangiopancreatography Percutaneous Transhepatic Cholangiography Intraoperative Cholangiography Endoscopic Ultrasound Fluorodeoxyglucose Positron Emission Tomography Bacteriology Benign Biliary Disease Calculous Biliary Disease Natural History Nonoperative Treatment of Cholelithiasis Chronic Cholecystitis Diagnosis Treatment Acute Calculous Cholecystitis Presentation Diagnosis Treatment Choledocholithiasis Diagnosis Treatment Endoscopic retrograde cholangiopancreatography. Laparoscopic common bile duct exploration. Open common bile duct exploration. Gallstone Pancreatitis Biliary Dyskinesia Sphincter of Oddi Dysfunction Surgery for Calculous Biliary Disease Laparoscopic Cholecystectomy Open Cholecystectomy Laparoscopic Common Bile Duct Exploration Open Common Bile Duct Exploration Postcholecystectomy Syndromes Bile Duct Injury Presentation. Treatment Recognized at the time of cholecystectomy. Identified after cholecystectomy Diagnosis and management. Interventional radiologic and endoscopic techniques. Outcomes. Lost Stones Postcholecystectomy Pain Retained Biliary Stones Biliary Leak Gallstone Ileus Presentation and diagnosis. Treatment. Acute Cholangitis Diagnosis. Treatment. Recurrent Pyogenic Cholangitis Presentation. Treatment. Noncalculous Biliary Disease Acute Acalculous Cholecystitis Primary Sclerosing Cholangitis Clinical presentation. Treatment. Biliary Strictures Biliary Cysts Presentation. Treatment. Polypoid Lesions of the Gallbladder Benign Biliary Masses Malignant Biliary Disease Gallbladder Cancer Incidence Cause Pathology and Staging Clinical Presentation Diagnosis Treatment Patients with incidental findings Gallbladder polyp. Gallbladder cancer after cholecystectomy. Patients suspected of having gallbladder cancer preoperatively. Patients with advanced disease at presentation. Survival Bile Duct Cancer Risk Factors Staging and Classification Clinical Presentation Diagnosis and Assessment of Resectability Treatment Operative management. Distal cholangiocarcinoma. Proximal cholangiocarcinoma. Palliation. Medical treatment. Outcomes Metastatic and Other Tumors Selected References References 55 Exocrine Pancreas Outline Videos Anatomy Arterial Blood Supply Venous Drainage Embryology Pancreas Divisum Annular Pancreas Ectopic Pancreas Physiology Major Components of Pancreatic Juice Phases and Regulation of Pancreatic Secretion Acute Pancreatitis Pathophysiology Risk Factors Biliary or Gallstone Pancreatitis Alcohol-Induced Injury Anatomic Obstruction Endoscopic Retrograde Cholangiopancreatography– Induced Pancreatitis Drug-Induced Pancreatitis Metabolic Factors Miscellaneous Conditions Clinical Manifestations Diagnosis Imaging Studies Assessment of Severity of Disease Treatment Special Considerations Endoscopic retrograde cholangiopancreatography. Laparoscopic cholecystectomy. Complications Sterile and Infected Peripancreatic Fluid Collections Pancreatic Necrosis and Infected Necrosis Pancreatic Pseudocysts Pancreatic Ascites and Pancreaticopleural Fistulas Vascular Complications Pancreatocutaneous Fistula Chronic Pancreatitis Risk Factors Alcohol Abuse Smoking Gene Mutations Types of Chronic Pancreatitis Autoimmune Pancreatitis Tropical Pancreatitis Idiopathic Pancreatitis Clinical Manifestations Diagnosis Imaging Studies Functional Tests Treatment Medical Treatment Interventional Therapy: Endoscopic Treatment Surgical Treatment Pancreatic duct dilation secondary to duct stones or strictures. Pancreatic duct dilation secondary to a single stricture or stone. Focal inflammatory mass without significant dilation of the pancreatic duct. Diffuse glandular involvement without dilation of the pancreatic duct. Biliary strictures. Duodenal stenosis. Pancreatic pseudocyst. Cystic Neoplasms of the Pancreas Types of Cystic Neoplasms Mucinous Cystic Neoplasm Serous Cystic Neoplasm Intraductal Papillary Mucinous Neoplasm Branch duct intraductal papillary mucinous neoplasm. Main duct intraductal papillary mucinous neoplasm. Mixed-type intraductal papillary mucinous neoplasm. Treatment: Surgical Resection for Intraductal Papillary Mucinous Neoplasm Adenocarcinoma of the Exocrine Pancreas Epidemiology Risk Factors Environmental Risk Factors and Causes Hereditary Risk Factors Hereditary pancreatitis (PRSS1 and SPINK1 gene mutation). Peutz-Jeghers syndrome (STK11 gene mutation). Cystic fibrosis (CFTR gene mutation). Familial atypical mole and multiple melanoma syndrome (CDKN2A gene mutation). Hereditary breast and ovarian cancer (BRCA2 gene mutation). Lynch syndrome (mismatch repair gene mutations). Familial adenomatous polyposis (APC gene mutation). Familial pancreatic cancer (unknown gene). Pathogenesis of Sporadic Pancreatic Cancer Genetic Progression of Pancreatic Intraepithelial Neoplasia to Invasive Pancreatic Ductal Adenocarcinoma Clinical Presentation Diagnosis Laboratory Evaluation Imaging Studies Biologic imaging. Staging Laparoscopy Treatment Surgery for Tumors of the Head of the Pancreas Surgical technique. Reconstruction. Surgery for Tumors of the Body and Tail of the Pancreas Laparoscopic Distal Pancreatectomy Outcomes Perioperative Mortality: Long-Term Survival Morbidity Controversies Pylorus-Preserving versus Non–Pylorus-Preserving Whipple Procedure Pancreaticojejunostomy versus Pancreatogastrostomy Use of Somatostatin Analogues to Reduce Pancreatic Fistula Extent of Lymphadenectomy Laparoscopic and Robotic Pancreaticoduodenectomy Antecolic versus Retrocolic Duodenojejunostomy Drain versus No Drain Adjuvant Therapy for Pancreatic Cancer Chemotherapy and Radiation Therapy Role of Neoadjuvant Therapy Chemotherapy for Metastatic Pancreatic Adenocarcinoma Palliative Therapy for Pancreatic Cancer Biliary Obstruction Gastric Outlet Obstruction Pain Relief Pancreatic Trauma Selected References References 56 The Spleen Outline Splenic Anatomy Splenic Function Splenectomy Benign Hematologic Conditions Immune Thrombocytopenic Purpura Hereditary Spherocytosis Hemolytic Anemia Caused by Erythrocyte Enzyme Deficiency Hemoglobinopathies Malignant Disease Lymphomas Hodgkin disease. Non-Hodgkin lymphomas. Leukemia Hairy cell leukemia. Chronic lymphocytic leukemia. Chronic myelogenous leukemia. Nonhematologic Tumors of the Spleen Miscellaneous Benign Conditions Splenic Cysts Splenic Abscess Wandering Spleen Other Considerations Splenic Trauma Elective Laparoscopic Splenectomy Robotic Splenectomy Late Morbidity after Splenectomy Prophylactic Treatment of Splenectomized Patients Immunization Antibiotics Selected References References 57 Lung, Chest Wall, Pleura, and Mediastinum Outline Videos Anatomy Selection of Patients for Thoracic Operations Physiologic Evaluation Cardiopulmonary Exercise Testing Thoracic Incisions Lung Congenital Lesions of the Lung Congenital Cystic Lesions Congenital Bronchopulmonary Malformations Congenital Abnormalities of the Trachea and Bronchi Congenital Vascular Disorders Lung Cancer Pathology Screening Diagnosis Staging Evaluation of Tumor (T) Stage Evaluation of Nodal (N) Stage Current American Joint Committee on Cancer Seventh Edition Staging System Tumor (T) Lymph Nodes (N) Metastases (M) Results of Treatment of Lung Cancer Local Therapy for Early-Stage Non–Small Cell Lung Cancer Neoadjuvant and Adjuvant Therapy Treatment of Metastatic Disease Trachea Tracheal Trauma Pulmonary Infections Bronchiectasis Lung Abscess Other Bronchopulmonary Disorders Mycobacterial Infections Fungal and Parasitic Infections Massive Hemoptysis Emphysema and Diffuse Lung Disease Emphysema Diffuse Lung Disease Adult Respiratory Distress Syndrome Pulmonary Metastases Surgical Treatment Miscellaneous Lung Tumors Chest Wall Pectus Excavatum Chest Wall Tumors Bone Tumors Soft Tissue Tumors Metastatic Tumors Reconstruction Chest Wall Infections Chest Wall Trauma Thoracic Outlet Syndrome Diagnosis Management Pleura Pleural Effusions Benign Pleural Effusions Malignant Pleural Effusion Empyema Chylothorax Pneumothorax Mesothelioma Mediastinum Anterosuperior Compartment Middle Compartment Posterior or Paravertebral Sulci Compartment Clinical Manifestations and Diagnosis Evaluation and Diagnostic Imaging Histologic Diagnosis Primary Mediastinal Cysts Primary Mediastinal Neoplasms Thymoma Germ Cell Tumors Teratomas Malignant Nonteratomatous Germ Cell Tumors Seminomas Nonseminomatous Tumors Neurogenic Tumors Neuroblastoma Ganglion Tumors Paraganglioma (Pheochromocytoma) Lymphomas Endocrine Tumors Thyroid Tumors Parathyroid Tumors Neuroendocrine Tumors Selected References References 58 Congenital Heart Disease Outline History and Other Considerations Pathways for Practicing Congenital Heart Surgery Anatomy, Terminology, and Diagnosis Anatomy and Terminology Diagnosis Physical Examination Diagnostic Tests Pulse oximetry. Plain radiography. Electrocardiography. Echocardiography. Magnetic resonance imaging and computed tomography. Cardiac catheterization. Perioperative Care Anesthesia Pitfalls Neurologic Outcomes Lesion Overview Defects Associated With Increased Pulmonary Blood Flow Persistent Arterial Duct (Patent Ductus Arteriosus) Aortopulmonary Septal Defect (Aortopulmonary Window) Atrial Septal Defect Ventricular Septal Defect Perimembranous Ventricular Septal Defect Muscular Ventricular Septal Defect Subarterial (Supracristal or Outlet) Ventricular Septal Defect Atrioventricular Septal Defect (Atrioventricular Canal Defect) Adult Patients With Atrioventricular Septal Defect Persistent Arterial Trunk (Truncus Arteriosus) Abnormalities of Venous Drainage Total Anomalous Pulmonary Venous Return Obstructed total anomalous pulmonary venous return. Cor triatriatum. Anomalous Systemic Venous Drainage Cyanotic Congenital Heart Disease Tetralogy of Fallot Pulmonary Atresia and Intact Ventricular Septum Pulmonary Atresia With Ventricular Septal Defect Valvular Pulmonic Stenosis Conotruncal Anomalies Transposition of the Great Arteries Transposition of the great arteries–intact ventricular septum. Transposition of the great arteries–ventricular septal defect with or without arch hypoplasia. Transposition of the great arteries–ventricular septal defect with pulmonary stenosis–left ventricular outflow tract obstruction or pulmonary atresia. Transposition of the great arteries in adults. Double-Outlet Right Ventricle Congenitally Corrected Transposition of the Great Arteries (l-Transposition) Congenitally corrected transposition of the great arteries with intact ventricular septum. Congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonic stenosis. Left Ventricular Outflow Tract Obstruction Valvular Aortic Stenosis Fibromuscular Subaortic Stenosis Tunnel Subaortic Stenosis Aortic Arch Anomalies Aortic Coarctation Interrupted Aortic Arch Single Ventricle Tricuspid Atresia Hypoplastic Left Heart Syndrome Neonatal Cardiac Transplantation Norwood Reconstruction Sano Modification of the Norwood Operation Hybrid Procedure Fontan Operation Miscellaneous Anomalies Vascular Rings and Pulmonary Artery Slings Vascular Rings Pulmonary Artery Slings Diagnosis and Indications for Intervention Surgery Coronary Artery Anomalies Anomalous Left Coronary Artery Rising From the Pulmonary Artery Anatomy and pathophysiology. Diagnosis and indications for intervention. Surgery. Coronary Arteriovenous Fistula and Aneurysms Diagnosis and indications for intervention. Surgery. Ebstein Anomaly of the Tricuspid Valve Diagnosis and Intervention Surgery Mitral Valve Anomalies Mitral Stenosis Summary Selected References References 59 Acquired Heart Disease Outline Coronary Artery Anatomy and Physiology Anatomic Considerations Physiology and Regulation of Coronary Blood Flow History of Coronary Artery Bypass Surgery Atherosclerotic Coronary Artery Disease Pathogenesis Fixed Coronary Obstructions Clinical Manifestations and Diagnosis of Coronary Artery Disease Clinical Presentation Physical Examination Diagnostic Testing Biochemical Studies Chest Radiography Resting Electrocardiography Functional (Stress) Tests Exercise versus pharmacologic testing. Diagnostic accuracy of stress testing for SIHD Exercise electrocardiography (Bruce protocol). Exercise and pharmacologic stress echocardiography. Exercise and pharmacologic stress nuclear myocardial perfusion imaging. Echocardiography Multidetector Computed Tomography Magnetic Resonance Imaging Cardiac Catheterization and Intervention Fractional Flow Reserve Intravascular Ultrasonography Hybrid Imaging Indications for Coronary Artery Revascularization Coronary Artery Bypass Grafting versus Contemporaneous Medical Therapy Percutaneous Coronary Intervention versus Medical Therapy Coronary Artery Bypass Grafting versus Balloon Angioplasty or Bare-Metal Stents Coronary Artery Bypass Grafting versus Drug-Eluting Stents Left Main Coronary Artery Disease CABG or PCI versus Medical Therapy for Left Main CAD Studies Comparing PCI versus CABG for Left Main CAD Revascularization Options for LCA CAD Proximal Left Anterior Descending Artery Disease Completeness of Revascularization Left Ventricular Systolic Dysfunction Revascularization Options for Previous CABG Unstable Angina/Non–ST-Segment Elevation Myocardial Infarction ST-Segment Elevation Myocardial Infarction–Acute Myocardial Infarction Percutaneous Coronary Intervention versus Medical Management for Acute Myocardial Infarction Role of Coronary Artery Bypass Grafting Preoperative Evaluation Technique of Myocardial Revascularization: Conventional On-Pump Cardiopulmonary Bypass Positioning and Draping Cardiopulmonary Bypass Neurologic Protection During Cardiopulmonary Bypass Median Sternotomy Conduit Choice and Harvesting Left internal mammary artery. Bilateral internal mammary artery. Greater saphenous vein. Other conduits Radial artery. Gastroepiploic artery. Total Arterial Revascularization Cannulation for Cardiopulmonary Bypass Cardiac Arrest and Myocardial Protection Target Identification and Distal Anastomosis Separation from Cardiopulmonary Bypass Hemostasis Sternal Closure and Completion of Surgery Adjuncts to Coronary Artery Bypass Grafting Transesophageal Echocardiography Inotropes and Pharmacotherapy Intra-Aortic Balloon Pump Postoperative Care Pulmonary Care Discharge from the Intensive Care Unit Outcomes Hospital Mortality Long-Term Survival Morbidity Tamponade. Postoperative bleeding. Neurologic complications. Mediastinitis. Renal dysfunction. Medical Adjuncts for Postoperative Management Alternative Methods for Myocardial Revascularization Cardiopulmonary Bypass With Hypothermic Fibrillatory Arrest On-Pump Beating-Heart Bypass Off-Pump Coronary Artery Bypass Grafting Minimally Invasive Direct Coronary Artery Bypass Robotics: Totally Endoscopic Coronary Artery Bypass Transmyocardial Laser Revascularization Hybrid Procedures Technical Aspects of Reoperative Coronary Artery Bypass Grafting Mechanical Complications of CORONARY Artery Disease Left Ventricular Aneurysm Ventricular Septal Defect Mitral Regurgitation Coronary Artery Bypass Grafting and Special Populations of Patients Patients With Diabetes Older Patients Women Patients With Renal Disease Obese Patients Acknowledgments Selected References References 60 Acquired Heart Disease Outline History of Heart Valve Surgery Valve Anatomy Surgical Anatomic Relationships Pathology and Etiology of Valvular Heart Disease Pathophysiology of Valvular Heart Disease Heart Failure Valve Disease Syndromes Mitral Stenosis Diagnosis of Mitral Stenosis Symptoms and signs. Physical examination. Diagnostic testing. Natural History Treatment Medical management. Interventional management. Percutaneous balloon mitral commissurotomy. Open mitral commissurotomy. Mitral valve replacement. Mitral Regurgitation Diagnosis of Mitral Regurgitation Symptoms and signs. Physical examination. Diagnostic testing. Natural History Treatment Medical treatment. Surgical treatment. Aortic Stenosis Diagnosis of Aortic Stenosis Symptoms and signs. Physical examination. Diagnostic testing. Natural History Treatment Medical management. Surgical treatment. Aortic Insufficiency Diagnosis and Treatment of Aortic Insufficiency Symptoms and signs. Physical examination. Diagnostic testing. Natural History Treatment Medical management. Surgical treatment. Tricuspid Regurgitation and Other Right-Sided Valve Disease Diagnosis of Tricuspid Valve Disease Symptoms and signs. Physical examination. Diagnostic testing. Natural History Treatment Medical management. Surgical treatment. Mixed Valve Disease Operative Approaches Conduct of Surgery Mitral Valve Replacement and Repair Mitral Valve Replacement Mitral Valve Repair Surgical Aortic Valve Replacement and Aortic Valve Repair Prosthetic Valves Transcatheter Aortic Valve Replacement and Other Emerging Technologies Percutaneous Mitral Interventions Acknowledgment Selected References References 61 The Aorta Outline Video Aneurysmal Disease Risk of Rupture Diagnosis Screening and Surveillance Recommendations Medical Therapy Surgical Treatment Preoperative Evaluation Technique of Open Surgical Repair of Abdominal Aortic Aneurysms Management of the Ruptured Aneurysm Postoperative Management Endovascular Repair Thoracic Aortic Aneurysm Open Repair of Thoracic and Thoracoabdominal Aneurysms Endovascular Management of Thoracic Aneurysms Endovascular Repair of Aneurysms Involving the Visceral Segment: Snorkels, Fenestrations, and Branched Grafts Blunt Thoracic Aortic Injury Aortoiliac Occlusive Disease Presentation and Evaluation Technique of Open Reconstruction Aortofemoral Bypass Grafting Axillofemoral Bypass Grafting Femoral-Femoral Artery Bypass Grafting Iliofemoral Artery Bypass Grafting Aortoiliac Endarterectomy Complications of Open Aortic Surgery Surgical Treatment of Aortic Graft Infection Aortic Dissection References 62 Peripheral Arterial Disease Outline Epidemiology Basic Science of Vascular Disease Vascular Wall Microanatomy Atherosclerosis Evaluating and Treating the Patient with Peripheral Arterial Disease History and Physical Examination Chronic Arterial Insufficiency Physiologic Testing and Imaging Imaging Studies Angiography. Computed tomography angiography. Magnetic resonance angiography. Carbon dioxide angiography. Intravascular ultrasound. Treatment Medical Treatment Revascularization: Surgical Treatment Intermittent claudication. Critical limb ischemia. Diabetic foot. Lower Extremity Amputations Ray amputation. Transmetatarsal amputation. Below-knee amputation. Above-knee amputation. Surgical Revascularization Procedures Open Surgical Management Aortoiliac disease. Lower extremity occlusive disease. Femoropopliteal bypass. Infrapopliteal bypass. Complications. Endovascular Management Subintimal angioplasty. Balloon angioplasty. Stenting. Stent graft. Cutting balloon. Atherectomy. Acute Limb Ischemia Other Causes of Acute and Chronic Limb Ischemia Nonatherosclerotic Arteriopathies Raynaud Syndrome Buerger Disease Vasculitis Large-Vessel Vasculitis Giant cell arteritis (temporal arteritis). Takayasu disease. Medium-Vessel Vasculitis Polyarteritis nodosa. Kawasaki disease. Behçet disease. Cogan syndrome. Small-Vessel Vasculitis Antineutrophil cytoplasmic antibody–associated vasculitides. Vasculitis Associated With Connective Tissue Diseases Heritable Arteriopathies Cystic Medial Necrosis Pseudoxanthoma Elasticum Arteria Magna Syndrome Congenital Conditions Affecting the Arteries Persistent Sciatic Artery Popliteal Entrapment Syndromes Adventitial Cystic Disease Peripheral Artery Aneurysms Femoral and Popliteal Artery Aneurysms Evaluating the Success of Revascularization Procedures Renal Artery Disease Diagnosis Magnetic Resonance Angiography Treatment Open Renal Artery Bypass Renal Artery Stenting Value, limitations, and techniques. Renal Angioplasty and Stent Procedure Renal artery access and guide sheath positioning. Renal angioplasty. Stent placement. Completion angiography. Technical Tips Splanchnic Aneurysms: Splenic, Mesenteric, and Renal Artery Aneuryms Carotid Artery Disease Pathophysiology Clinical Presentation Diagnosis Treatment Carotid Endarterectomy Indications. Proven indications Acceptable but not proven indications Uncertain indications Proven inappropriate indications Technique. Postoperative care. Complications. Carotid Angioplasty and Stent Procedure Indications and contraindications. Technique Carotid artery access and guide sheath positioning. Placement of embolic protection device. Carotid stent placement. Carotid angioplasty. Completion angiogram. Conclusions. Dialysis Access Dialysis Outcomes Quality Initiative Guidelines Nomenclature Superficial Venous System of the Upper Extremity Cephalic Vein Basilic Vein Median Antebrachial Vein Initial Evaluation for New Access Central Venous Catheters Types of Venous Transpositions Upper Arm Venous Transposition Forearm Venous Transpositions Lower Extremity Venous Transpositions Techniques of Venous Transposition Assessment of the Patient and Selection of Optimal Site Superficial Venous Transposition of the Forearm Superficial Venous Transposition of the Arm Follow-Up Patients With Failing or Failed Access Secondary Interventions in Autogenous Fistulas Complex Access Vascular Access Complications Conclusion Selected References References 63 Vascular Trauma Outline Mechanism of Injury and Pathophysiology Clinical Presentation Diagnosis Physical Examination Minimal Vascular Injury and Nonoperative Management Endovascular Management Endovascular Operating Rooms Endovascular Management of Torso Vascular Injuries Endovascular Management of Cerebrovascular Vascular Injuries Endovascular Management of Extremity Vascular Injuries Who Should Perform Endovascular Repairs? Open Surgical Management Preparation for Operative Management Vascular Exposure and Control Vascular Damage Control Choice of Repair and Graft Material Intraoperative Imaging and Noninvasive Evaluation Role of Tissue Coverage Role of Fasciotomy Role of Immediate Amputation Common Errors and Pitfalls Specific Injuries Head, Neck, and Thoracic Outlet Intrathoracic Great Vessels Abdominal Vascular Injury Upper Extremity Lower Extremity Operative Techniques for Extremity Fasciotomy Postoperative Management Outcomes and Follow-up Training and Preparation for Successful Management General Surgery Training Vascular Fellowship Training Vascular Trauma Realities Need for Remedial Training and Review The Need for Action Selected References References 64 Venous Disease Outline Videos Anatomy Superficial Venous System Deep Venous System Venous System Perforators Normal Venous Histology and Function Venous Insufficiency Primary Venous Insufficiency Pathology Mechanical abnormalities. Risk Factors Symptoms Physical Examination Diagnostic Evaluation of Venous Dysfunction Phlebography and venography. Magnetic resonance venous imaging. Classification Systems Treatment of Superficial Venous Insufficiency Nonoperative management. Treatment options for telangiectasias. Surgery for axial venous incompetence Vein stripping. Complications. Endovenous thermal ablation Percutaneous vein ablation. Technique. Ultrasound-guided sclerotherapy. Nontumescent ablation and future modalities for axial vein incompetence. Treatment of branch varicosities. Secondary Venous Insufficiency Treatment Surgery for deep venous insufficiency. Direct venous reconstruction. Deep Venous Thrombosis Lower Extremity Deep Venous Thrombosis Causes Stasis. Hypercoagulable state. Venous injury. Diagnostic Considerations Incidence. Clinical diagnosis. Imaging Studies and Laboratory Tests Venography. Impedance plethysmography. Fibrin and fibrinogen assays. Duplex ultrasound. Magnetic resonance venous imaging. Prophylaxis Treatment Thrombolysis. Endovascular reconstruction. Upper Extremity Deep Venous Thrombosis Treatment Vena cava filter. Retrievable vena cava filters. Superficial Thrombophlebitis Conclusion Selected References References 65 The Lymphatics Outline Embryology and Anatomy Function and Structure Pathophysiology and Staging Differential Diagnosis Classification Diagnostic Tests New Diagnostic Tests Therapy General Therapeutic Measures Elevation and Compression Garments Complex Decongestive Physical Therapy Compression Pump Therapy Drug Therapy Molecular Lymphangiogenesis Operative Treatment Chylothorax Chyloperitoneum Tumors of the Lymphatics Selected References References 66 Pediatric Surgery Outline Newborn Physiology Cardiovascular Pulmonary Immunology Fluids, Electrolytes, and Nutrition Fluid and Electrolytes Nutrition Calorie Requirements Carbohydrate Protein Fat Total Parenteral Nutrition Head and Neck Lesions Dermoid and Epidermoid Cysts Lymphadenopathy Cystic Hygroma Thyroglossal Duct Cyst Branchial Cleft Remnants Torticollis Extracorporeal Life Support Indications Physiology Complications Congenital Diaphragmatic Hernia Pathogenesis Clinical Presentation and Diagnosis Treatment Surgical Repair Bronchopulmonary Malformations Bronchogenic Cyst Congenital Pulmonary Airway Malformation Pulmonary Sequestration Congenital Lobar Emphysema Alimentary Tract Conditions Esophageal Atresia and Tracheoesophageal Fistula Clinical Presentation and Diagnosis Management Gastroesophageal Reflux Clinical Presentation Diagnosis Treatment Hypertrophic Pyloric Stenosis Clinical Presentation Management Intestinal Atresia Intestinal Malrotation and Midgut Volvulus Abnormal Intestinal Rotation Clinical Presentation Diagnosis Surgical Management Necrotizing Enterocolitis Clinical Presentation and Diagnosis Medical Management Surgical Management Short Bowel Syndrome Surgical Management Bianchi procedure. Serial transverse enteroplasty. Meconium Ileus Clinical Presentation Simple Meconium Ileus Surgical management. Complicated Meconium Ileus Meconium Plug Syndrome Hirschsprung’s Disease Clinical Presentation Diagnosis Surgical Management Anorectal Malformation Embryology Classification Evaluation Surgical Management Low lesions. Intermediate or high lesions. Intussusception Clinical Presentation and Diagnosis Management Surgical management. Meckel’s Diverticulum Diagnosis Surgical Management Hepatobiliary Conditions Extrahepatic Biliary Atresia Pathophysiology Clinical Presentation and Diagnosis Surgical Management Choledochal Cyst Pathogenesis Clinical Presentation and Diagnosis Treatment Hereditary Pancreatitis and Pancreas Divisum Biliary Dyskinesia Abdominal Wall Conditions Abdominal Wall Defects Omphalocele Gastroschisis Hernias Inguinal Hernia Clinical presentation. Surgical management. Umbilical Hernia Chest Wall Deformities Surgical Management Genitourinary Tract Conditions Cryptorchidism Diagnosis and Treatment Testicular Torsion Testicular Tumors Pediatric Solid Tumors Neuroblastoma Clinical Presentation Genomics Diagnosis Staging Treatment Wilms Tumor Genomics Clinical Presentation Diagnosis Pathology Staging Treatment Rhabdomyosarcoma Pathology Clinical Presentation Diagnosis and Staging Treatment Liver Tumors Clinical Presentation Diagnosis and Staging Treatment Teratoma Sacrococcygeal Teratomas Ovarian Neoplasms Germ cell tumors. Sex cord tumors. Epithelial tumors. Diagnosis Treatment Pediatric Trauma ABCs of Trauma Head and Spine Injuries Thoracic Trauma Abdominal Trauma Treatment of Solid Organ Injuries Pancreatic Injury Renal Injury Fetal Surgery Selected References References 67 Neurosurgery Outline Intracranial Dynamics Cerebrovascular Disorders Arteriovenous Malformations Cavernous Malformations Capillary Telangiectasia Developmental Venous Anomaly: Venous Angioma Traumatic Fistula Aneurysms Saccular Aneurysms Spontaneous Intracerebral Hemorrhage Mycotic Aneurysms Moyamoya Disease Dural Arteriovenous Malformations Central Nervous System Tumors Intracranial Tumors Clinical Presentation Imaging Studies Surgery Primary Brain Tumors Intra-Axial Brain Tumors Astrocytic Tumors Glioblastoma multiforme. Anaplastic astrocytoma. Pilocytic astrocytoma. Oligodendroglioma Ependymoma Choroid Plexus Papilloma and Carcinoma Pediatric Brainstem Gliomas Neuronal and Mixed Neuronal-Glial Tumors Ganglioglioma and Gangliocytoma Central Neurocytoma Dysembryoplastic Neuroepithelial Tumor Paraganglioma Pineal Region Tumors Pineocytoma Pineoblastoma Papillary Tumor of the Pineal Region Primitive Neuroectodermal Tumors Tumors of Cranial and Spinal Nerves Schwannoma Neurofibroma Tumors of the Meninges Meningiomas Hemangioblastoma Lymphomas and Hematopoietic Tumors Primary Central Nervous System Lymphoma Plasmacytoma Germ Cell Tumors Tumors of the Sellar Region Central Nervous System Metastasis Traumatic Brain Injury Epidemiology Pathophysiology Prehospital and Emergency Department Management Treatment Degenerative Disorders of the Spine Relevant Spinal Anatomy Pathophysiology of the Degenerative Diseases of the Spine Cervical Disc Prolapse, Cervical Spondylosis, and Cervical Stenosis Diagnosis Management Options Lumbar Disc Prolapse and Lumbar Degenerative Conditions Lumbar Disc Prolapse Lumbar Canal Stenosis Localization and Diagnosis Management Functional and Stereotactic Neurosurgery Brain Stimulation Implantable Pumps Destructive Lesions Epilepsy Trigeminal Neuralgia Hydrocephalus Communicating and obstructive hydrocephalus. Acute and chronic hydrocephalus. Congenital and acquired hydrocephalus. Hydrocephalus ex vacuo or compensatory hydrocephalus. Porencephaly. Arrested hydrocephalus. Clinical Features of Hydrocephalus Investigations Treatment Cerebrospinal Fluid Shunts Alternatives to Shunting Special Types of Hydrocephalus Benign external hydrocephalus. Normal-pressure hydrocephalus. Shunts and Intra-Abdominal Surgeries Surgeries on patients in whom the shunt tube is not exposed. Surgeries on patients in whom the shunt tube will be exposed or may be exposed. Shunts and Appendicitis Hernia, Hydrocele, and Shunts Pediatric Neurosurgery Spinal Dysraphism Spina Bifida Aperta Myelomeningocele. Meningocele. Spinal Bifida Occulta Simple spina bifida occulta. Dermal sinus. Diastematomyelia. Lipomyelomeningocele. Cranial Dysraphism Chiari Malformation Chiari I Malformation Chiari II Malformation Craniosynostosis Central Nervous System Infections Intracranial Infections Cranial Epidural Abscess Subdural Empyema Meningitis Brain Abscess Ventriculitis Postoperative Infections Post-Traumatic Meningitis Spinal Infections Vertebral Osteomyelitis Discitis Spinal Epidural Abscess Acquired Immunodeficiency Syndrome Selected References References 68 Plastic Surgery Outline Reconstructive Techniques Primary Wound Closure Skin Grafts Skin Flap Surgery Skin Flaps Muscle and Musculocutaneous Flaps Fascia and Fasciocutaneous Flaps Perforator Flaps Microvascular Free Tissue Transfer Supermicrosurgery Tissue Expansion Alloplastic Materials Pediatric Plastic Surgery Craniofacial Surgery Congenital Ear Deformities Craniofacial Microsomia Cleft Lip and Palate Vascular Anomalies Pediatric Neck Masses Melanocytic Nevi Plastic Surgery of the Head and Neck Maxillofacial Trauma Emergent Management Evaluation and Diagnosis Soft Tissue Injuries Craniofacial Fractures Scalp Reconstruction Facial Reconstruction Facial Transplantation Facial Aesthetic Surgery Forehead and Brow Lift Blepharoplasty Facelift Rhinoplasty Skin Resurfacing Injectable Fillers Plastic Surgery of the Trunk Reconstruction of the Chest Wall Sternotomy Wounds: Treatment and Prevention Breast Surgery Reduction Mammaplasty Breast Augmentation Breast Ptosis and Mastopexy Fat Grafting to the Breast Gynecomastia Congenital and Developmental Deformities Abdominal Wall Surgery Components Separation and Flap Coverage Abdominoplasty Reconstruction of the Perineum Surgery of Back Defects Meningomyelocele Pressure Sores Stages of Pressure Ulcers Reconstruction of the Lower Extremity Soft Tissue Coverage of Traumatic Wounds Soft Tissue Reconstruction in the Groin and Thigh Soft Tissue Coverage of the Knee, Leg, and Foot Body Contouring Body Contouring After Bariatric Surgery Suction-Assisted Lipectomy Conclusions Selected References References 69 Hand Surgery Outline Basic Anatomy Examination and Diagnosis Evaluation Neurovascular Examination Musculoskeletal Examination Special Investigations Principles of Treatment Anesthesia Tourniquet Application Incisions Dressings and Splints Trauma Emergency Control of Bleeding Lacerations, Fingertip Injuries, and Complex Soft Tissue Injuries Tendon Injuries Flexor Tendons Extensor Tendons Nerve Injuries Nerve Transfers Vascular Injuries Replantation and Amputations Fractures and Dislocations Distal Phalangeal Fractures Middle Phalanx and Proximal Phalanx Fractures Metacarpal Fractures Scaphoid Fractures Fractures in Children Dislocations Infections Superficial Paronychial Infections Infections of Intermediate-Depth Spaces Deep Infections Palmar Space Infections Pyogenic Flexor Tenosynovitis Chronic and Atypical Infections Herpetic Whitlow Animal and Human Bites Compartment Syndrome, High-Pressure Injection Injuries, and Extravasation Injuries High-Pressure Injection Injuries Extravasation Injuries Compartment Syndrome Tenosynovitis de Quervain Disease Intersection Syndrome Trigger Thumb and Fingers Other Sites of Tenosynovitis Nerve Compression Syndromes Carpal Tunnel Syndrome Pronator Syndrome Ulnar Nerve Compression Guyon Canal Compression Cubital Tunnel Syndrome Radial Nerve Compression Thoracic Outlet Compression Tumors Soft Tissue Tumors Ganglion Cysts Giant Cell Tumor Epidermal Inclusion Cysts Lipoma Pyogenic Granuloma Verruca Vulgaris Seborrheic Keratoses Keratoacanthoma Dermatofibroma Vascular Malformations and Hemangiomas Malignant Skin Tumors Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanomas Bone Tumors Osteoid Osteoma Aneurysmal Bone Cyst Enchondroma Primary Bone Sarcomas Secondary (Metastatic) Bone Tumors Congenital Anomalies Osteoarthritis and Rheumatoid Arthritis Contractures Conclusion Selected References General Soft Tissue Flexor Tendons Extensor Tendons Nerve Injuries Replantation Fractures Infections Compartment Syndrome Entrapment Neuropathy Vascular Tumors Congenital Anomalies Osteoarthritis Rheumatoid Arthritis Contractures References 70 Gynecologic Surgery Outline Videos Pelvic Embryology and Anatomy Embryology Anatomy External Genitalia Internal Genitalia Ovary. Fallopian tubes. Uterus and cervix. Vagina. Reproductive Physiology Ovarian Cycle Endometrial Cycle Early Pregnancy Amenorrhea and Abnormal Menses Clinical Evaluation Diagnostic Considerations Bleeding Without Pain Bleeding Associated With Midline Suprapubic Pain Bleeding Associated With Lateralized Pelvic Pain Bleeding Associated With Generalized Pelvic Pain Midline Pelvic Pain Without Bleeding Lateralized Pelvic Pain Without Bleeding Generalized Abdominal Pain Without Bleeding Obstipation Flank Pain Other Acute Clinical Presentations Acute Vulvovaginitis Necrotizing Fasciitis Pelvic Masses History Age Pregnancy History Menstrual History Sexual History Contraception Prior Gynecologic Diseases and Procedures History of Present Illness Bleeding Pain Physical Examination Ancillary Tests Imaging Pregnancy Tests Serum Hormone Assays Cervicovaginal Cultures, Gram Staining, and Vaginal Wet Mount Lower Genital Cytology Alternatives to Surgical Intervention Dysfunctional Uterine Bleeding Spontaneous Abortion Ectopic Pregnancy Pelvic Infection Functional Ovarian Cysts Uterine Leiomyomas Endometriosis and Endometriomas Technical Aspects of Surgical Options Surgical Approaches Surgery for Menorrhagia or Abnormal Uterine Bleeding Technique: Dilation and Curettage Potential Complications Treatment of Bartholin Gland Cyst or Abscess Cone Procedure Surgery for Ovarian Cysts Technique Ovarian cyst drainage. Oophorectomy with or without salpingectomy. Ovarian cystectomy. Potential Complications Surgery for the Fallopian Tube or Ectopic Pregnancy Technique Salpingostomy. Segmental resection. Salpingectomy. Potential Complications Hysterectomy Technique Potential Complications Radical Hysterectomy Management of a Pelvic Mass Surgery During Pregnancy Physiologic Changes Cardiovascular System Respiratory System Gastrointestinal Tract Coagulation Changes Renal Changes Diagnostic Considerations and Evaluation Imaging Techniques Clinical Evaluation Common Surgical Complications of Pregnancy Appendicitis Cholelithiasis Intestinal Obstruction Ovarian Masses Obstetric Complications Resulting in Abdominal Pain Placental Abruption Pregnancy-Related Hepatic Complications Trauma Common Obstetric Surgical Procedures Other Procedures Acknowledgment Selected References References 71 Surgery in the Pregnant Patient Outline Physiologic Changes of Pregnancy Diagnostic Imaging Considerations Anesthesia Safety Concerns Prevention of Preterm Labor Abdominal Pain and the Acute Abdomen Minimally Invasive Surgery: Special Considerations in Pregnancy Breast Masses Hepatobiliary Disease Cholelithiasis Acute Pancreatitis Liver Acute Fatty Liver of Pregnancy HELLP Syndrome Hepatic Adenomas Endocrine Disease Adrenal Disorders Thyroid Small Bowel Obstruction Inflammatory Bowel Disease Ulcerative Colitis Crohn’s Disease Surgery Colon and Rectum Appendicitis Colonic Pseudo-obstruction Colon Cancer Vascular Disease Trauma in Pregnancy Summary Selected References References 72 Urologic Surgery Outline Urologic Anatomy for the General Surgeon Upper Abdomen and Retroperitoneum Adrenal Kidney Ureter Pelvis Bladder and Prostate Urethra, Male Genitalia, and Perineum Endoscopic Urologic Surgery Urologic Infectious Disease Uncomplicated Urinary Tract Infection Premenopausal Patients Postmenopausal Patients Complicated Urinary Tract Infection Urinary Tract Infection in Men Specific Complicated Genitourinary Infectious States Pyelonephritis Male Genital Organ Infection Fournier Gangrene Atypical Urinary Tract Infections Fungal Infection Tuberculosis Parasitic Infection Voiding Dysfunction, Neurogenic Bladder, Incontinence, and Benign Prostatic Hyperplasia Neurogenic Bladder Problems With Bladder Storage Urinary Incontinence Benign Prostatic Hyperplasia Male Reproductive Medicine and Sexual Dysfunction Male Infertility: Evaluation and Treatment Basic Laboratory Assessment Treatment Male Sexual Dysfunction and Treatment Urolithiasis Background Acute Presentation and Management Elective Diagnostic Evaluation and Management Elective Surgical Management Urologic Trauma Core Guideline and Consensus Statements for Urologic Trauma Management Renal Injuries Imaging Management: Operative versus Nonoperative Surgical Exploration and Operative Approach Ureteral Injuries Imaging Management Surgical Exploration and Operative Approach Bladder Injuries Imaging Management: Operative versus Nonoperative Surgical Exploration and Operative Approach Urethral Injuries Imaging Management Surgical Exploration and Operative Approach Genital Injuries Imaging Management Damage Control Techniques for Urologic Injuries Nontraumatic Urologic Emergencies Testicular Torsion Gross Hematuria With Urinary Retention from Blood Clots Priapism Urologic Oncology Renal Tumors Staging Management Bladder Cancer Non–Muscle Invasive Bladder Cancer Muscle Invasive Bladder Cancer Management. Prostate Cancer Evaluation Treatment Testicular Cancer Treatment Selected References References
