The Mont Reid Surgical Handbook

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IFC
THE MONT REIDSURGICAL HANDBOOK
THE MONT REIDSURGICAL HANDBOOK
Copyright
FOREWORD
PREFACE
CONTENTS
THE MONT REIDSURGICAL HANDBOOK
I - Perioperative Care
	1 - Surgical History and Physical Examination
		I. INTRODUCTION AND INITIAL CONTACT
		II. HISTORY
			A. CHIEF COMPLAINT
			B. HISTORY OF PRESENT ILLNESS
			C. REVIEW OF SYSTEMS
			D. ALLERGIES
			E. MEDICATION
			F. PAST MEDICAL HISTORY
			G. PAST SURGICAL HISTORY
			H. FAMILY HISTORY
			I. SOCIAL HISTORY
		III. PHYSICAL EXAMINATION
			A. VITAL SIGNS
			B. GENERAL APPEARANCE
			C. HEAD AND NECK
			D. CHEST
			E. CARDIOVASCULAR
			F. ABDOMEN
			G. GENITOURINARY
			H. SKIN
			I. MUSCULOSKELETAL
			J. LYMPHATICS
			K. NEUROLOGIC
	2 - Fluids and Electrolytes
		I. BASIC PHYSIOLOGY
			A. BODY FLUID COMPOSITION
			B. SERUM OSMOLALITY AND TONICITY
			C. FLUID AND ELECTROLYTE HOMEOSTASIS
		II. ELECTROLYTE DISTURBANCES
			A. SODIUM
			B. POTASSIUM
			C. CALCIUM
			D. MAGNESIUM
			E. PHOSPHORUS
		III. PARENTERAL REPLACEMENT FLUID THERAPY
			A. CRYSTALLOIDS
			B. COLLOIDS
		IV. ACID-BASE DISORDERS
			A. PHYSIOLOGY
			B. PRIMARY METABOLIC DISORDERS
			C. PRIMARY RESPIRATORY DISORDERS
			D. MIXED ACID-BASE DISORDERS
			E. EVALUATION OF ACID-BASE DISORDERS (TABLE 2.3)
	3 - Nutrition
		I. NUTRITION BASICS
		II. DETERMINATION OF CALORIC NEEDS
		III. NUTRITIONAL ASSESSMENT
		IV. PREOPERATIVE NUTRITIONAL SUPPLEMENTATION
		V. POSTOPERATIVE NUTRITIONAL SUPPLEMENTATION
		VI. ENTERAL NUTRITION
		VII. SHORT-TERM SUPPLEMENTATION
		VIII. LONG-TERM SUPPLEMENTATION (>6 WEEKS)
		IX. PRODUCTS
		X. COMPLICATIONS OF ENTERAL FEEDING
		XI. PARENTERAL NUTRITION
		XII. BASIC COMPOSITION OF FORMULATIONS (TABLES 3.1 AND 3.2)
		XIII. CENTRAL FORMULAS
		XIV. PERIPHERAL PARENTERAL NUTRITION
		XV. INFUSION
		XVI. MONITORING
		XVII. COMPLICATIONS
		XVIII. IMMUNONUTRITION
		XIX. NUTRIENTS/MACROMINERALS/MICRONUTRIENTS/VITAMINS
	4 - Wound Healing
		I. PHASES OF WOUND HEALING
			A. HEMOSTASIS (5–10 MINUTES POST INJURY)
			C. PROLIFERATIVE (DAY 1–3 WEEKS POST INJURY)
		II. FACTORS THAT AFFECT WOUND HEALING
			A. OXYGENATION
			B. INFECTION
			C. NUTRITION
			D. STEROIDS
			E. SMOKING
			F. AGE
			G. FOREIGN BODIES
			H. EDEMA
			I. CHEMOTHERAPY
			J. RADIATION
			K. DIABETES MELLITUS
			L. GENERAL HEALTH
		III. WOUND PREPARATION
			A. IRRIGATION
			B. ANTIMICROBIALS
			C. DÉBRIDEMENT
		IV. TYPES OF WOUND CLOSURE
			A. PRIMARY: CLOSURE OF WOUND BY DIRECT APPROXIMATION OF WOUND EDGES
			B. SPONTANEOUS HEALING (SECONDARY INTENTION): SPONTANEOUS WOUND CONTRACTION AND EPITHELIALIZATION
			C. TERTIARY HEALING
		V. MANAGEMENT OF WOUND COMPLICATIONS
			A. INFECTION
			B. SEROMA
			C. DEHISCENCE
		VI. HYPERTROPHIC SCARS AND KELOIDS
			A. HYPERTROPHIC SCARS
			B. KELOIDS
	5 - Surgical Risk Assessment
		I. RISKS AND BENEFITS OF SURGERY
		II. SURGICAL RISK ASSESSMENT
		III. PREOPERATIVE PREPARATION
		IV. POSTOPERATIVE CARE
	6 - Suture Types, Needle Types, and Instruments
		I. SUTURE MATERIAL
			A. THE OPTIMAL SUTURE
			B. SUTURE CHARACTERISTICS
			C. ABSORBABLE SUTURE
			D. NONABSORBABLE SUTURE
			E. SUMMARY
		II. NEEDLES
		III. INSTRUMENTS
II - Anesthesia
	7 - Local Anesthesia
		I. INJECTABLE AGENTS
			A. MECHANISM OF ACTION
			B. CLASSES
			C. TOXICITY
			D. USE OF EPINEPHRINE
		II. TECHNIQUES
			A. BEFORE INJECTING LOCAL ANESTHETIC IN TRAUMATIC INJURIES, BE SURE TO PERFORM AND DOCUMENT A DETAILED SENSORY EXAMINATION, WHICH MAY BE SUBSEQUENTLY MASKED BY YOUR BLOCK
			B. OPTIMAL TIMING BETWEEN INJECTION AND INCISION
			C. GENERAL TECHNIQUES TO DECREASE PAIN
			D. FIELD BLOCKS
			E. NERVE BLOCKS FOR THE FACE
			F. NERVE BLOCKS FOR THE UPPER EXTREMITY
		III. TOPICAL AGENTS
			A. TOPICAL ANESTHESIA CAN AVOID THE PAIN AND ANXIETY OF NEEDLE INJECTION AND IS ESPECIALLY USEFUL IN THE PEDIATRIC POPULATION. IT CAN ALSO BE USED AS AN ADJUNCT TO DECREASE SUPERFICIAL SKIN PAIN BEFORE PERFORMING MORE TARGETED NERVE BLOCK WITH AN INJECTABLE LOCAL ANESTHETIC AGENT.
			B. SYSTEMIC BLOOD LEVELS OF THESE COMPOUNDED TOPICAL ANESTHETICS DEPEND ON THE ABSORPTION, PATIENT SIZE, RATE OF ELIMINATION, AN...
			C. COMMONLY USED PRODUCTS (10)
	8 - Conscious Sedation
		I. INTRODUCTION
			A. DEFINITION
			B. APPLICATIONS (SELECTED)
		II. PREPROCEDURAL EVALUATION
			A. HISTORY
			B. AIRWAY EXAMINATION
		III. MONITORING
			A. Best Achieved by Someone Other than Person Performing Procedure
			B. PREPROCEDURE
			C. CLINICAL ASSESSMENT
			F. BLOOD PRESSURE
		IV. AVAILABILITY OF EMERGENCY MEDICAL EQUIPMENT AND PERSONNEL
			A. Immediate Access to Suction, Bag-Mask Ventilation, Intubation Materials, Defibrillator, and Emergency (Advanced Cardiac Life ...
			B. Anesthesia or Other Trained Airway Staff in Close Proximity1397256787
		V. TRAINING IN AIRWAY MANAGEMENT
			A. GENERAL PRINCIPLES
			B. Experience in Controlled Setting with Skilled Experts
			C. Knowledge of Airway Adjuncts and their Appropriate Use1397256787
		VI. MEDICATIONS
			A. GENERAL PRINCIPLES
			B. NARCOTICS
			C. BENZODIAZEPINES
			D. OTHER COMMON NONBARBITURATE MEDICATIONS
		VII. REVERSAL MEDICATIONS
			A. NALOXONE (NARCAN)
			B. FLUMAZENIL (ROMAZICON)
		VIII. RECOVERY AND DISCHARGE
			A. GENERAL PRINCIPLES
			B. DISCHARGE GUIDELINES
	9 - General Anesthesia
		I. PREOPERATIVE ASSESSMENT AND PREPARATION
			A. SURGICAL INTERVENTION OR PROCEDURE BEING PERFORMED
			B. HISTORY AND CHART REVIEW
			C. PHYSICAL EXAMINATION
			D. LABORATORY DATA
			E. RADIOLOGY, CARDIOLOGY, OTHER PREOPERATIVE TESTING
			F. ASSESSMENT
			G. ANESTHETIC PLAN
			I. PREOPERATIVE PREPARATION
			J. PREOPERATIVE MEDICATION GOALS
		II. INTRAOPERATIVE MANAGEMENT
			A. EQUIPMENT
			B. TECHNIQUES OF ANESTHESIA
			C. INTRAOPERATIVE COMPLICATIONS
		III. PHARMACEUTICALS
			A. IV ANESTHESIA
			B. NEUROMUSCULAR BLOCKING DRUGS
			C. REVERSAL OF NEUROMUSCULAR BLOCKADE
			D. INHALATIONAL ANESTHESIA
			E. LOCAL ANESTHETICS
		IV. POSTOPERATIVE MANAGEMENT
			A. PAIN MANAGEMENT
			B. RESPIRATORY MONITORING
			C. HEMODYNAMIC INSTABILITY
			D. POSTOPERATIVE NAUSEA AND VOMITING
III - Surgical Critical Care
	10 - Surgical Infection
		I. BACKGROUND AND SCOPE OF PROBLEM
		II. MOST COMMON INFECTIONS AFFECTING SURGICAL PATIENTS
			A. CENTRAL LINE–ASSOCIATED BLOODSTREAM INFECTION
			B. SURGICAL SITE INFECTIONS
			C. CATHETER-ASSOCIATED URINARY TRACT INFECTIONS
			D. CLOSTRIDIUM DIFFICILE INFECTION
			E. VENTILATOR-ASSOCIATED PNEUMONIA
			F. PURULENT SKIN AND SOFT TISSUE INFECTIONS
			G. NECROTIZING SOFT TISSUE INFECTION
			H. INTRAABDOMINAL INFECTIONS
		III. SEPSIS
	11 - Hemorrhage and Coagulation
		I. GENERAL TOPICS
			A. NORMAL BLOOD VOLUME AND COMPOSITION
			B. CLASSES OF HEMORRHAGIC SHOCK (TABLE 11.1)
			C. TYPING, SCREENING, AND CROSSMATCHING
			D. GENERAL BLOOD PRODUCT ADMINISTRATION GUIDELINES
		II. LABORATORY TESTS AND REFERENCE VALUES
			A. COMPLETE BLOOD COUNT
			B. PROTHROMBIN TIME
			C. INTERNATIONAL NORMALIZED RATIO
			D. ACTIVATED PARTIAL THROMBOPLASTIN TIME
			E. ACTIVATED CLOTTING TIME
			F. BLEEDING TIME
			G. PLATELET FUNCTION TESTS
			H. THROMBIN TIME
			I. FIBRINOGEN
			J. VISCOELASTIC TESTS
		III. SPECIFIC BLOOD PRODUCTS
			A. WHOLE BLOOD
			B. PACKED RED BLOOD CELLS
			C. FRESH FROZEN PLASMA
			D. PLATELETS
			E. CRYOPRECIPITATE
		IV. MASSIVE TRANSFUSION AND DAMAGE CONTROL RESUSCITATION
			A. DEFINITION OF MASSIVE TRANSFUSION VARIES, BUT MOST COMMONLY USED IS 10 OR MORE UNITS OF BLOOD PRODUCTS IN THE FIRST 24 HOURS
			B. PREDICTORS OF NEED FOR MASSIVE TRANSFUSION
			C. PRESENCE AND IMPLEMENTATION OF STANDARDIZED PROTOCOLS IMPROVE SURVIVAL IN PATIENTS REQUIRING MASSIVE TRANSFUSION
			D. DAMAGE CONTROL RESUSCITATION IS A STRATEGY TO LIMIT ONGOING BLEEDING BY ADDRESSING HYPOTHERMIA, ACIDOSIS, AND COAGULOPATHY.
		V. TRANSFUSION REACTIONS
			A. IMMUNE MEDIATED
			B. NONIMMUNOLOGIC REACTIONS
		VI. SURGICAL COAGULOPATHY—GENERAL CONSIDERATIONS
			A. COAGULATION CASCADE (FIG. 11.2)
			B. MEDICAL HISTORY TO DETERMINE RISK FOR BLEEDING
		VII. CONGENITAL BLEEDING DISORDERS
			A. HEMOPHILIA A
			B. HEMOPHILIA B (CHRISTMAS DISEASE)
			C. VON WILLEBRAND DISEASE
		VIII. ACQUIRED BLEEDING DISORDERS
			A. VITAMIN K DEFICIENCY
			B. HYPOTHERMIA
			C. LIVER FAILURE
			D. END-STAGE RENAL DISEASE
			E. DISSEMINATED INTRAVASCULAR COAGULATION
			F. ACQUIRED THROMBOCYTOPENIA
			H. HYPERFIBRINOLYSIS
		IX. MEDICATIONS
			A. ANTIPLATELET AGENTS
			B. HEPARINS
			C. WARFARIN
			D. DIRECT THROMBIN INHIBITORS
			E. FACTOR XA INHIBITORS (FONDAPARINUX)
			F. NEW ORAL ANTICOAGULANTS
			G. ANTIFIBRINOLYTICS
	12 - Shock
		I. PATHOPHYSIOLOGY
		II. HEMODYNAMIC CONSIDERATIONS
			A. IMPORTANT RELATIONSHIPS
			B. PRELOAD
			C. AFTERLOAD
		III. ORGAN RESPONSE TO SHOCK
			A. NEUROENDOCRINE RESPONSE
			B. MICROVASCULAR DYSFUNCTION
			C. INFLAMMATORY RESPONSE
			D. PULMONARY
			E. RENAL
		IV. MULTIORGAN DYSFUNCTION SYNDROME
			A. DEFINITION
			B. CAUSES
			C. PREVENTIVE MEASURES
		V. SHOCK STATES
			A. HYPOVOLEMIC SHOCK
			B. SEPTIC SHOCK
			C. NEUROGENIC SHOCK
			D. CARDIOGENIC SHOCK
			E. HYPOADRENAL SHOCK/ADRENAL INSUFFICIENCY
		VI. VASOACTIVE AGENTS
	13 - Cardiopulmonary Monitoring
		I. CARDIAC MONITORING
			A. CARDIAC RHYTHMS
			B. BLOOD PRESSURE MONITORING
			C. HEMODYNAMIC MONITORING BASIC PRINCIPLES
			D. SPECIFIC DEVICES FOR CARDIAC MONITORING
		II. PULMONARY MONITORING
			A. PULSE OXIMETRY
			D. ARTERIAL OR VENOUS BLOOD GAS
		III. IMPORTANT FORMULAS
			A. CARDIAC OUTPUT
			B. ARTERIAL CONTENT OF OXYGEN
			C. OXYGEN DELIVERY
			D. OXYGEN CONSUMPTION
	14 - Mechanical Ventilation
		I. DETERMINING NEED FOR MECHANICAL VENTILATION
			A. AIRWAY INSTABILITY
			B. RESPIRATORY FAILURE
			C. GUIDELINES
		II. VENTILATION VERSUS OXYGENATION
			A. VENTILATION
			B. OXYGENATION
		III. NONINVASIVE POSITIVE PRESSURE VENTILATION
			A. POSITIVE PRESSURE VENTILATION
			B. INITIAL SETTINGS
			C. ADVANTAGES
			D. RESERVED
		IV. CONVENTIONAL MECHANICAL VENTILATION
			A. MODES OF VENTILATION
			B. VENTILATOR STRATEGIES
			C. LIBERATION FROM MECHANICAL VENTILATION
			D. FAILURE TO LIBERATE FROM MECHANICAL VENTILATION
		V. EFFECTS ON CARDIAC PERFORMANCE
			A. ENDOTRACHEAL INTUBATION AND MECHANICAL VENTILATION PLACE IMPORTANT PHYSIOLOGIC DEMANDS ON PATIENTS
			B. THE SHIFT FROM NEGATIVE PRESSURE TO POSITIVE PRESSURE VENTILATION CAN COMPROMISE PRELOAD BY
			C. POSITIVE PRESSURE VENTILATION
			D. THE EFFECTS OF POSITIVE PRESSURE VENTILATION ON CARDIAC PERFORMANCE
		VI. NEED FOR TRACHEOSTOMY
		VII. VENTILATOR CAUTIONS
			A. DEFINITION OF ACUTE RESPIRATORY DISTRESS SYNDROME
			B. ACUTE LUNG INJURY/ACUTE RESPIRATORY DISTRESS SYNDROME TREATED WITH PROTECTIVE LUNG STRATEGY
			C. VENTILATOR-ASSOCIATED PNEUMONIA
		VIII. PEARLS
			A. STANDARD INITIAL VENTILATOR SETTINGS
IV - Trauma Surgery
	15 - Primary and Secondary Survey
		I. EPIDEMIOLOGY
			A. MORTALITY
			B. MECHANISMS OF INJURY
		II. MANAGEMENT OF THE TRAUMA PATIENT
			A. PRIMARY SURVEY
			B. FURTHER EVALUATION AND TRANSFER
			C. SECONDARY SURVEY
		III. PEDIATRIC TRAUMA
			A. MECHANISMS OF INJURY
			B. PRIMARY SURVEY
		IV. TRAUMA AND PREGNANCY
			A. EPIDEMIOLOGY
			B. ANATOMIC AND PHYSIOLOGIC CHANGES DURING PREGNANCY
			C. MATERNAL EVALUATION
			D. FETAL ASSESSMENT
		V. PENETRATING NECK TRAUMA
			A. ZONE I
			B. ZONE II
			C. ZONE III
			D. NECK EXPLORATION
	16 - Abdominal Trauma
		I. PATHOPHYSIOLOGY
		II. DIAGNOSIS
		III. TREATMENT
		V. SPECIAL CIRCUMSTANCES
	17 - Thoracic Trauma
		I. EPIDEMIOLOGY OF THORACIC TRAUMA
			A. THORACIC TRAUMA
			B. AFRICAN-AMERICAN MALES
			C. MOTORCYCLE ACCIDENTS
		II. PHYSICAL EXAMINATION OF THE CHEST
			A. CHEST AUSCULTATION
			B. POINT TENDERNESS
			C. FLAIL CHEST
			D. SUBCUTANEOUS EMPHYSEMA
			E. DULLNESS VERSUS RESONANCE ON PERCUSSION
			F. SEAT BELT SIGNS
		III. ADJUNCTS TO THE PHYSICAL EXAMINATION
			A. CHEST RADIOGRAPHS
		IV. PATHOPHYSIOLOGY OF THORACIC TRAUMA
		V. BLUNT CHEST TRAUMA
		VI. PENETRATING CHEST TRAUMA
		VII. RESUSCITATIVE THORACOTOMY
		VIII. OTHER THORACIC PROCEDURES IN THE FACE OF TRAUMA
			A. FOCUSED ASSESSMENT WITH SONOGRAPHY FOR TRAUMA EXAMINATION
			B. PERICARDIOCENTESIS
			C. SUBXIPHOID PERICARDIOTOMY
			D. THORACOSCOPY
		IX. POSTOPERATIVE CARE OF THE PATIENT WITH A CHEST INJURY
			A. CHEST TUBE MANAGEMENT
		X. COMPLICATIONS OF THORACIC TRAUMA
	18 - Extremity Trauma
		I. EVALUATION OF THE INJURED LIMB
			A. GENERAL POINTS
			B. EVALUATION OF FRACTURES AND DISLOCATIONS
		II. OPEN FRACTURES
			A. DEFINITION
			B. COMPLICATIONS OF OPEN FRACTURES
			C. GUSTILO-ANDERSON CLASSIFICATION SYSTEM (TABLE 18.1)
			D. EMERGENCY DEPARTMENT MANAGEMENT OF OPEN FRACTURES
		III. COMPARTMENT SYNDROME
			A. DEFINITION
			B. CAUSES OF COMPARTMENT SYNDROME
			C. SIGNS AND SYMPTOMS
			D. DIAGNOSIS OF COMPARTMENT SYNDROME
			E. SURGICAL TREATMENT OF ACUTE COMPARTMENT SYNDROME
		IV. PELVIC FRACTURES
			A. EVALUATION OF PELVIC RING FRACTURES
		V. VASCULAR INJURY IN EXTREMITY TRAUMA
			A. HISTORY AND PHYSICAL
			B. MANAGEMENT OF EXTREMITY TRAUMA
			C. COMPLICATIONS OF VASCULAR INJURIES
		VI. AMPUTATION IN TRAUMA
	19 - Burn Care
		I. CAUSATIVE FACTORS
			A. SCALDS
			B. FLAME
			C. FLASH
			D. CONTACT
		II. INDICATIONS FOR HOSPITAL ADMISSION
			A. OUTPATIENT SETTING
			B. BURN UNIT SETTING
		III. INITIAL MANAGEMENT
			A. HISTORY
			B. AIRWAY/BREATHING
			C. BURN EVALUATION
			D. FLUID RESUSCITATION
			E. INITIAL PROCEDURES
			F. INITIAL TESTS
			G. MEDICATIONS
		IV. PATHOPHYSIOLOGIC CHANGES ASSOCIATED WITH BURN INJURIES
			A. EDEMA
			B. HEMODYNAMICS
		V. BURN WOUND CARE
			A. GOALS OF BURN WOUND CARE
			B. TOPICAL AGENTS
			C. LOCAL CARE
			D. EARLY EXCISION AND GRAFTING
			E. GRAFTING
		VI. SUPPORTIVE CARE
			A. NUTRITION
			B. PHYSICAL AND OCCUPATIONAL THERAPY
			C. ANALGESIA
		VII. MANAGEMENT OF INFECTION IN THE BURN PATIENT
			A. THE MOST COMMON INFECTION IN BURN PATIENTS IS PNEUMONIA
			B. PATHOGENESIS OF WOUND SEPSIS IN AN UNTREATED BURN WOUND
			C. CLINICAL SIGNS
			D. DIAGNOSIS OF INVASIVE BURN WOUND SEPSIS
			E. BACTERIOLOGY OF NOSOCOMIAL BURN INFECTION
			F. PREVENTION OF BURN INFECTION
			G. TREATMENT OF BURN INFECTION
			H. NONBACTERIAL INFECTION
		VIII. ELECTRICAL INJURIES
			A. TISSUE DESTRUCTION
			B. TREATMENT
			C. FLUID RESUSCITATION
			D. EARLY DEBRIDEMENT
			E. IMMEDIATE EXTREMITY FASCIOTOMY
		IX. CHEMICAL INJURIES
			A. MANAGEMENT
		X. OUTPATIENT AND CLINIC TREATMENT
			A. SELECTION
			B. TREATMENT
			C. FOLLOW-UP CARE
			D. WOUNDS
		XI. COMPLICATIONS OF BURN INJURIES
			A. GASTROINTESTINAL
			B. OCULAR
			C. CUTANEOUS
			D. MISCELLANEOUS
	20 - Neurosurgical Emergencies
		I. EVALUATION AND MANAGEMENT OF THE NEUROTRAUMA PATIENT
			A. INITIAL ASSESSMENT
			B. UNCONSCIOUS PATIENT
			C. PHYSICAL EXAMINATION
			D. RADIOLOGIC EVALUATION
		II. CRANIAL TRAUMA
			A. TRAUMATIC BRAIN INJURY
			B. ELEVATED INTRACRANIAL PRESSURE
			C. SPECIFIC TRAUMATIC CRANIAL INJURIES
			D. PENETRATING TRAUMATIC BRAIN INJURY
			E. TRAUMATIC BRAIN INJURY PROGNOSIS
		III. SPINAL TRAUMA
			A. GENERAL
			B. ASSESSMENT
			C. SPECIFIC SPINAL INJURIES
		IV. PERIPHERAL NERVE TRAUMA
			A. GENERAL
			B. EVALUATION
			C. TREATMENT
		V. TRAUMATIC CEREBROVASCULAR INJURIES
			B. BLUNT CEREBROVASCULAR INJURY
			C. EVALUATION
			D. TREATMENT
V - Gastrointestinal Surgery
	21 - Acute Abdomen
		I. PHYSIOLOGY OF ABDOMINAL PAIN
			A. VISCERAL PAIN
			B. SOMATIC PAIN
			C. REFERRED PAIN
		II. HISTORY
			A. PAIN
			B. VOMITING
			C. BOWEL FUNCTION
			D. MEDICAL HISTORY
			E. MEDICATION
		III. PHYSICAL EXAMINATION
			A. GENERAL APPEARANCE
			B. VITAL SIGNS
			C. ABDOMINAL EXAMINATION
			D. EXAMINATION OF PELVIC CAVITY
		IV. LABORATORY EXAMINATION
			A. WHITE BLOOD CELL COUNT
			B. HEMATOCRIT
			C. PLATELET COUNT
			D. ELECTROLYTES
			E. ARTERIAL BLOOD GAS
			F. LIVER FUNCTION TESTS
			G. AMYLASE LEVEL INCREASE
			H. URINE STUDIES
			I. TROPONINS
		V. RADIOGRAPHIC EVALUATION
			A. UPRIGHT CHEST RADIOGRAPH
			B. ABDOMINAL RADIOGRAPH
			C. ULTRASONOGRAPHY
			D. COMPUTED TOMOGRAPHY SCAN
		VI. INITIAL TREATMENT AND PREOPERATIVE PREPARATION
			A. ASSESSMENT
			B. DIET
			C. INTRAVENOUS FLUIDS
			D. HEMODYNAMIC MONITORING
			E. NASOGASTRIC TUBE
			F. FOLEY CATHETER
			G. TREATMENT
	22 - Abdominal Wall Hernias
		I. HISTORICAL PERSPECTIVE
			A. HENRY MARCY (1837–1924)
			B. EDOARDO BASSINI (1844–1924)
			C. SIR ASTLEY COOPER (1768–1841)
			D. CHESTER MCVAY (1911–1987)
			E. EDWARD EARLE SHOULDICE (1890–1965)
			F. IRVING LICHTENSTEIN AND PARVIZ AMID
		II. TERMINOLOGY
			A. HERNIA
			B. REDUCIBILITY
			C. INCARCERATION
			D. STRANGULATION
		III. NATURAL HISTORY
			A. INCIDENCE
		IV. ANATOMIC CONSIDERATIONS
			A. LAYERS OF THE ABDOMINAL WALL
			B. INGUINAL CANAL
			C. SPERMATIC CORD
			D. PROCESSUS VAGINALIS
			E. DEEP (INTERNAL) INGUINAL RING
			F. SUPERFICIAL (EXTERNAL) INGUINAL RING
			G. HESSELBACH TRIANGLE
			H. INGUINAL (POUPART) LIGAMENT
			I. ILIOPUBIC TRACT
			J. LACUNAR (GIMBERNAT) LIGAMENT
			K. PECTINEAL (COOPER) LIGAMENT
			L. FEMORAL CANAL
			M. INFERIOR LUMBAR (PETIT) TRIANGLE
			N. SUPERIOR LUMBAR (GRYNFELTT) TRIANGLE
		V. CLASSIFICATION OF HERNIAS
			A. GROIN HERNIAS (FIG. 22.1)
			B. VENTRAL HERNIAS
			C. MISCELLANEOUS HERNIAS
		VI. CAUSATIVE FACTORS
			A. INDIRECT INGUINAL HERNIA
			B. DIRECT INGUINAL HERNIA
			C. FEMORAL HERNIA
			D. CONTRIBUTING FACTORS
		VII. DIAGNOSIS
			A. HISTORY
			B. EXAMINATION
			C. SMALL BOWEL OBSTRUCTION
			D. DIFFERENTIAL DIAGNOSIS OF GROIN MASS
			E. REDUCTION OF INCARCERATED HERNIA
			F. REDUCTION EN MASSE
		VIII. PREOPERATIVE CONSIDERATIONS
			A. PATIENT COMORBIDITIES AND RISK FACTORS
			B. LAPAROSCOPIC VERSUS OPEN REPAIRS
		IX. INGUINAL/FEMORAL HERNIA REPAIR
			A. OPEN REPAIR
			B. FEMORAL HERNIAS
			C. LAPAROSCOPIC REPAIR
		X. VENTRAL/UMBILICAL/INCISIONAL HERNIA REPAIR
			A. OPEN REPAIR
			B. LAPAROSCOPIC REPAIR
		XI. POSTOPERATIVE COMPLICATIONS
			A. RECURRENT HERNIA
			B. INFECTION
			C. BLEEDING
			D. DYSEJACULATION
			E. TESTICULAR ATROPHY
			F. DIFFICULTY VOIDING
			G. NEUROMA/NEURITIS
			H. PAIN
			I. URINARY RETENTION
	23 - Gastrointestinal Bleeding
		I. HISTORY
			A. CHARACTERIZATION OF BLEEDING
			B. CAUSATIVE FACTORS
			C. ADDITIONAL MEDICAL HISTORY
		II. PHYSICAL EXAMINATION
			A. GENERAL APPEARANCE
			B. VITAL SIGNS
			C. SKIN
			D. HEAD AND NECK
			E. ABDOMEN
			F. DIGITAL RECTAL EXAMINATION
		III. INITIAL MANAGEMENT
			A. ASSESS THE MAGNITUDE OF HEMORRHAGE
			B. STABILIZE HEMODYNAMIC STATUS
			C. MONITOR FOR CONTINUED BLOOD LOSS
		IV. LABORATORY EVALUATION
			A. TYPE AND CROSSMATCH
			B. HEMOGLOBIN/HEMATOCRIT/RED BLOOD CELLS CHARACTERISTICS
			C. PLATELET COUNT
			D. PROTHROMBIN AND PARTIAL THROMBOPLASTIN TIMES
			E. THROMBOELASTOGRAPHY
			F. RENAL PROFILE
		V. INVESTIGATIVE AND DIAGNOSTIC PROCEDURES
			A. NASOGASTRIC TUBE
			B. ENDOSCOPY
			C. ANGIOGRAPHY
			E. COMPUTED TOMOGRAPHY
		VI. NONSURGICAL TREATMENT
			A. ENDOSCOPIC
			B. ELECTROCAUTERY
			C. VASOPRESSIN INFUSION
			D. EMBOLIZATION
		VII. DISEASE-SPECIFIC THERAPY
			A. ACUTE HEMORRHAGIC GASTRITIS
			B. PEPTIC ULCER DISEASE
			C. ESOPHAGOGASTRIC VARICES
			D. MALLORY-WEISS TEAR
			E. DIEULAFOY LESION (EXULCERATIO SIMPLEX)
			F. NEOPLASM
			G. DIVERTICULOSIS
			H. ARTERIOVENOUS MALFORMATIONS
			I. MECKEL DIVERTICULUM
			J. BENIGN ANORECTAL DISEASE
			K. AORTOENTERIC FISTULA
	24 - Intestinal Obstruction
		I. TERMINOLOGY
			A. ILEUS
			B. MECHANICAL OBSTRUCTION
			C. SIMPLE OBSTRUCTION
			D. CLOSED-LOOP OBSTRUCTION
			E. STRANGULATION
		II. CAUSATIVE FACTORS
			A. SMALL BOWEL OBSTRUCTION
			B. LARGE BOWEL OBSTRUCTION
			D. ILEUS
		III. PRESENTATION
			A. HISTORY
			B. PHYSICAL EXAMINATION
			C. LABORATORY TESTS
		IV. IMAGING
			A. PLAIN FILMS
			B. CONTRAST STUDIES
			C. COMPUTED TOMOGRAPHY
		V. MANAGEMENT
			A. EXPECTANT/PREOPERATIVE MANAGEMENT (FIG. 24.2)
			B. OPERATIVE MANAGEMENT
			C. POSTOPERATIVE CARE
			D. PARALYTIC ILEUS
		VI. OUTCOMES
			A. RECURRENCE
			B. OPERATIVE MORTALITY
	25 - Peptic Ulcer Disease
		I. OCCURRENCE
		II. PRESENTATION AND EVALUATION
			A. SYMPTOMS
			B. PHYSICAL EXAMINATION
			C. LABORATORY STUDIES
			D. DEFINITIVE DIAGNOSIS
			E. MODIFIED JOHNSON CLASSIFICATION
		III. PATHOGENESIS
		IV. HELICOBACTER PYLORI
		V. TREATMENT OF UNCOMPLICATED DISEASE
			A. PREVENTION
			B. EMPIRIC MEDICAL THERAPY
			C. CONCERN FOR GASTRIC CANCER
			D. SURGICAL THERAPY
		VI. TREATMENT OF COMPLICATED DISEASE
			A. CONCERN FOR GASTRIC CANCER
			B. BLEEDING PEPTIC ULCER
			C. PERFORATED PEPTIC ULCER
			D. OBSTRUCTION
			E. INTRACTABILITY—CURRENTLY RARE
		VII. DETAILS OF SURGICAL OPTIONS
			A. HIGHLY SELECTIVE VAGOTOMY (OR PROXIMAL GASTRIC OR PARIETAL CELL)
			B. OMENTAL (GRAHAM) PATCH
			C. VAGOTOMY AND DRAINAGE
			D. VAGOTOMY AND ANTRECTOMY
			E. DISTAL GASTRECTOMY
			F. POSTOPERATIVE COMPLICATIONS
	26 - Inflammatory Bowel Disease
		I. INFLAMMATORY BOWEL DISEASE
			A. ULCERATIVE COLITIS
			B. CROHN DISEASE
			C. INDETERMINATE COLITIS
			D. ETIOLOGY
		II. EXTRAINTESTINAL MANIFESTATIONS
			A. CUTANEOUS
			B. OCULAR
			C. MUSCULOSKELETAL
			D. HEPATOBILIARY
		III. ULCERATIVE COLITIS
			A. PATHOPHYSIOLOGY AND DISTRIBUTION
			B. EPIDEMIOLOGY
			C. CLINICAL MANIFESTATIONS
			D. DIAGNOSIS
			E. COMPLICATIONS
			F. MEDICAL MANAGEMENT
			G. SURGICAL MANAGEMENT
			H. PROGNOSIS
		IV. CROHN DISEASE
			A. EPIDEMIOLOGY
			B. PATHOPHYSIOLOGY AND DISTRIBUTION
			C. CLINICAL MANIFESTATIONS
			D. DIAGNOSIS
			E. COMPLICATIONS
			F. MEDICAL MANAGEMENT (SEE SECTION III.G)
			G. SURGICAL MANAGEMENT
			H. PROGNOSIS
		V. INDETERMINATE COLITIS
			A. TYPICALLY PRESENT WITH SYMPTOMS SIMILAR TO ULCERATIVE COLITIS
	27 - Benign Esophageal Disease
		I. ANATOMY
			A. GENERAL DESCRIPTION
			B. BLOOD SUPPLY AND NERVES
			C. HISTOLOGY
		II. PHYSIOLOGY
			A. SWALLOWING MECHANISM
			B. SPHINCTERS
		III. MOTILITY DISORDERS
			A. ACHALASIA
			B. DIFFUSE ESOPHAGEAL SPASM
			C. NUTCRACKER ESOPHAGUS
			D. HYPERTENSIVE LES
			E. SCLERODERMA
		IV. DIVERTICULA
			A. DEFINITION
			B. PHARYNGOESOPHAGEAL (ZENKER DIVERTICULUM)
			C. MIDESOPHAGEAL
			D. EPIPHRENIC
		V. GASTROESOPHAGEAL REFLUX
			A. ANATOMY
			B. PATHOPHYSIOLOGY
			C. DIAGNOSIS
			D. TREATMENT
			E. HIATAL HERNIA
			F. BARRETT ESOPHAGUS
		VI. BENIGN TUMORS OF THE ESOPHAGUS
			A. LEIOMYOMA
			B. OTHER BENIGN LESIONS
		VII. ESOPHAGEAL RUPTURE AND PERFORATION
			A. CAUSATIVE FACTORS
			B. CLINICAL PRESENTATION
			C. DIAGNOSIS
			D. TREATMENT
		VIII. CAUSTIC INJURY
			A. BACKGROUND
			B. CLINICAL PRESENTATION
			C. DIAGNOSIS
			D. TREATMENT
	28 - Benign Colorectal Disease
		I. ANATOMY
			A. RECTUM
			B. ANAL CANAL
			C. LEVATOR ANI MUSCLE
			D. BLOOD SUPPLY AND LYMPHATIC DRAINAGE
		II. HEMORRHOIDS
			A. SIGNS AND SYMPTOMS
			B. DIAGNOSIS
			C. MEDICAL TREATMENT
			D. OFFICE TREATMENT
			E. SURGICAL HEMORRHOIDECTOMY
		III. ANAL FISSURE
			A. OVERVIEW
			B. SIGNS AND SYMPTOMS
			C. TREATMENT
		IV. ANORECTAL ABSCESS
			A. CLASSIFICATION (BASED ON LOCATION)
			B. SIGNS AND SYMPTOMS
			C. TREATMENT
		V. FISTULA IN ANO
			A. GENERAL
			B. CLASSIFICATION
			C. GOODSALL RULE
			D. SIGNS AND SYMPTOMS
			E. TREATMENT
		VI. PILONIDAL DISEASE
			A. GENERAL
			B. TREATMENT
		VII. ANAL AND PERIANAL INFECTIONS
			A. CONDYLOMATA ACUMINATA
			B. ANORECTAL HERPES
			C. GONOCOCCAL PROCTITIS
		VIII. PRURITUS ANI
			A. ETIOLOGY
			B. DIAGNOSIS
			C. TREATMENT
		IX. ANAL NEOPLASM
			A. TUMORS OF THE ANAL CANAL
		X. RECTAL PROLAPSE
			A. CLASSIFICATION
			B. CLINICAL FEATURES
			C. EVALUATION
			D. TREATMENT OPTIONS
		XI. ANOSCOPY
			A. GENERAL
			B. TECHNIQUE
		XII. RIGID SIGMOIDOSCOPY
			A. GENERAL
			B. TECHNIQUE
	29 - Appendix
		I. OVERVIEW
			A. ANATOMY
			B. FUNCTION
		II. EPIDEMIOLOGY
			A. GENERAL
			B. MORBIDITY AND MORTALITY
		III. PATHOPHYSIOLOGY
			A. GENERAL
			B. COMPLICATIONS
		IV. PRESENTATION
			A. HISTORY
			B. PHYSICAL EXAMINATION
			C. LABORATORY AND RADIOLOGIC FINDINGS
		V. DIFFERENTIAL DIAGNOSIS
		VI. COMPLICATIONS
			A. PERFORATION
			B. PERITONITIS
			C. ABSCESS
		VII. TREATMENT
			A. GENERAL
			B. TECHNIQUE
			C. LAPAROSCOPY
			D. FUTURE RESEARCH
		VIII. SPECIAL CIRCUMSTANCES
			A. OLDER ADULTS
			B. INFANTS
			C. PREGNANCY
		IX. APPENDICEAL TUMORS
			A. CARCINOID
			B. ADENOCARCINOMA
			C. PSEUDOMYXOMA
	30 - Benign Pancreatic Disease
		I. ANATOMY
			A. EMBRYOLOGY
			B. HISTOLOGY
			C. GROSS ANATOMY
			D. VASCULAR/LYMPHATIC ANATOMY
			E. DUCT SYSTEM
		II. ACUTE PANCREATITIS
			A. BASICS
			B. PATHOGENESIS
			C. ETIOLOGY/RISK FACTORS
			D. DIAGNOSIS
			E. TREATMENT
			F. PROGNOSIS
			G. COMPLICATIONS
		III. CHRONIC PANCREATITIS
			A. BASICS
			B. ETIOLOGY
			C. DIAGNOSIS
			D. TREATMENT
			E. COMPLICATIONS
	31 - Surgical Diseases of the Spleen
		I. ANATOMY
			A. AVERAGE ADULT SPLEEN
			B. ENCAPSULATED
			C. SPLENOMEGALY DEFINITION
			D. BLOOD SUPPLY
			E. STRUCTURAL SUPPORT
			F. MICROANATOMY
			G. ACCESSORY SPLEENS
		II. FUNCTION
			A. HEMATOLOGIC
			B. IMMUNOLOGIC
		III. GENERAL INDICATIONS FOR SPLENECTOMY
			A. TRAUMA
			B. RED BLOOD CELL DISORDERS
			C. MYELOPROLIFERATIVE DISORDERS
			D. WHITE BLOOD CELLS DISORDERS
			E. PLATELET DISORDERS
			F. OTHER SPLENIC DISORDERS
		IV. SURGICAL TECHNIQUES
			A. OPEN SPLENECTOMY
			B. LAPAROSCOPIC SPLENECTOMY
			C. HAND-ASSISTED TECHNIQUE
		V. POSTSPLENECTOMY CONSIDERATIONS
			A. OVERWHELMING POSTSPLENECTOMY INFECTION
			B. POSTSPLENECTOMY HEMATOLOGIC CHANGES
			C. HEMORRHAGE
			D. INFECTION
			E. PORTAL VEIN THROMBOSIS
			F. PANCREATITIS, PSEUDOCYST, FISTULA
	32 - Bariatric Surgery
		I. EPIDEMIOLOGY OF MORBID OBESITY
			A. DEFINITIONS
			B. CAUSES OF OBESITY
			C. EPIDEMIOLOGY
		II. COMORBIDITY ASSOCIATED WITH MORBID OBESITY
			A. NEOPLASIA
			B. CARDIOVASCULAR DISEASE
			C. PULMONARY DISEASE
			D. ENDOCRINE DISEASE
			E. GASTROINTESTINAL DISEASE
			F. OTHER COMORBIDITIES ASSOCIATED WITH MORBID OBESITY
		III. MEDICAL THERAPY FOR MORBID OBESITY
		IV. TYPES OF PROCEDURES
			A. MALABSORPTIVE OPERATIONS
			B. RESTRICTIVE OPERATIONS
			C. COMBINED OPERATIONS ARE RESTRICTIVE AND MALABSORPTIVE
		V. PREOPERATIVE WORK-UP
			A. PATIENT SELECTION CRITERIA
			B. PREOPERATIVE ASSESSMENT—MULTIDISCIPLINARY APPROACH
			C. CONTRAINDICATIONS
		VI. SURGICAL PROCEDURES FOR THE BARIATRIC PATIENT
			A. LAPAROSCOPIC SLEEVE GASTRECTOMY
			B. LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS
			C. LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING
			D. JEJUNOILEAL BYPASS
			E. VERTICAL BANDED GASTROPLASTY
			F. BILIOPANCREATIC DIVERSION
		VII. RESULTS OF BARIATRIC SURGERY
			A. SURGICAL THERAPY
			B. RISK REDUCTION
			E. WEIGHT LOSS
VI - Surgical Oncology
	33 - Tumor Biology, Syndromes, and Genetic Mutations
		I. SELF-SUFFICIENCY IN GROWTH SIGNALS
			A. GROWTH FACTORS
			B. ALTERATION OF GROWTH SIGNALING PATHWAYS
			C. SOS/RAS/RAF/MITOGEN-ACTIVATED PROTEIN KINASE PATHWAY
			D. TUMOR GROWTH IS DEPENDENT ON MANY FACTORS
		II. INSENSITIVITY TO GROWTH-INHIBITORY SIGNALS
			A. RETINOBLASTOMA PROTEIN
		III. EVASION OF PROGRAMMED CELL DEATH
			A. P53 TUMOR-SUPPRESSOR PROTEIN
			B. EXTRINSIC APOPTOSIS INDUCTION
		IV. LIMITLESS REPLICATIVE POTENTIAL
		V. SUSTAINED ANGIOGENESIS
		VI. TISSUE INVASION AND METASTASIS
			A. TETHERING MOLECULES ARE ALTERED
			B. PROTEASES DEGRADE EXTRACELLULAR MATRICES
		VII. GENETIC INSTABILITY
			A. THE PREVIOUS SIX (I–VI) CHARACTERISTICS MUST BE OBTAINED THROUGH GENETIC ALTERATION
			B. MALFUNCTION OF THE “CARETAKER” SYSTEM
		VIII. FAMILIAL CANCER SYNDROMES
			A. FAMILIAL ADENOMATOUS POLYPOSIS
			B. HEREDITARY BREAST-OVARIAN CANCER SYNDROMES
			D. LI-FRAUMENI SYNDROME
			E. MULTIPLE ENDOCRINE NEOPLASIA
			F. VON HIPPEL-LINDAU DISEASE
			G. COWDEN SYNDROME
			H. HEREDITARY DIFFUSE GASTRIC CANCER
			I. PEUTZ-JEGHERS SYNDROME
		IX. PHARMACOTHERAPY
			A. TUMOR GROWTH AND KINETICS
			B. DRUG MECHANISMS AND THERAPEUTICS
		X. CHEMOTHERAPEUTIC AGENTS: MECHANISMS, USES, AND IMPORTANT TOXICITIES
			A. ALKYLATING AGENTS
			B. ANTIMETABOLITES
			C. ANTITUMOR ANTIBIOTICS
			D. MITOTIC INHIBITORS
			E. HORMONAL AGENTS
			F. IMMUNOTHERAPY
			G. MISCELLANEOUS
		RECOMMENDED READINGS
	34 - Head and Neck Malignancy
		I. EPIDEMIOLOGY
		II. WORK-UP OF A NECK MASS
		III. NECK DISSECTION
		IV. TREATMENT OF CANCER BY SITE
			A. CARCINOMA OF THE ORAL CAVITY AND LIP
			B. OROPHARYNGEAL CARCINOMA
			C. LARYNGEAL CANCER
			D. HYPOPHARYNGEAL
			E. NASOPHARYNGEAL CARCINOMA
			F. SALIVARY GLAND TUMORS
		V. NECK DISSECTION INDICATIONS FOR SALIVARY GLAND MALIGNANCY
			A. RARER SITES OF CARCINOMA
	35 - Esophageal Malignancy
		I. ESOPHAGEAL ANATOMY
		II. EPIDEMIOLOGY
		III. HISTOLOGY AND RISK FACTORS
		IV. DIAGNOSIS AND STAGING
		V. TNM STAGING SYSTEM
		VI. TREATMENT PLANNING
			A. IMPLICATIONS FOR THERAPY
		VII. ESOPHAGECTOMY
		VIII. ESOPHAGECTOMY APPROACHES
		IX. ENDOSCOPIC THERAPIES
		X. CHEMOTHERAPY AND RADIOTHERAPY
		XI. PALLIATIVE CARE
			A. DYSPHAGIA AND OBSTRUCTION
			B. ESOPHAGEAL-AIRWAY FISTULA
	36 - Gastric Malignancy
		I. ADENOCARCINOMA OF THE STOMACH
			A. EPIDEMIOLOGY
			B. RISK FACTORS
			C. PATHOLOGIC CLASSIFICATIONS
			D. CLINICAL MANIFESTATIONS
			E. SCREENING
			F. DIAGNOSIS/STAGING
			I. SURGICAL TREATMENT
			J. NEOADJUVANT/ADJUVANT THERAPY
			K. PROGNOSIS (5-YEAR SURVIVAL)
		II. GASTRIC LYMPHOMA
			A. GENERAL CONSIDERATIONS
			B. CLINICAL PRESENTATION
			C. PATHOLOGY
			D. DIAGNOSIS
			E. TREATMENT
		III. GASTROINTESTINAL STROMAL TUMORS
			A. GENERAL CONSIDERATIONS
			B. OTHER CHARACTERISTICS
			C. DIAGNOSIS
			D. PATHOLOGIC LESIONS
			E. TREATMENT
	37 - Small Bowel Malignancy
		I. EPIDEMIOLOGY
			A. INCIDENCE
			B. TUMOR CHARACTERISTICS
			C. GENETIC PREDISPOSITION AND PATHOGENESIS
		II. DIAGNOSIS
		III. STAGING
			A. ADENOCARCINOMA
			B. LYMPHOMA
			C. SARCOMA AND CARCINOID TUMORS
		IV. MANAGEMENT
			A. SURGERY
			B. CHEMOTHERAPY
	38 - Malignant Colorectal and Perianal Disease
		I. COLORECTAL CANCER: EPIDEMIOLOGY
			A. EACH YEAR IN THE UNITED STATES, 135,000 CASES OF COLORECTAL CANCER WILL BE DIAGNOSED
			B. ALMOST 50,000 PEOPLE DIE OF COLORECTAL CANCER ANNUALLY IN THE UNITED STATES.
		II. RISK FACTORS
		III. SIGNS AND SYMPTOMS
		IV. SCREENING GUIDELINES FOR COLORECTAL CANCER
			A. AVERAGE-RISK PATIENT, STARTING AT AGE 50–75 YEARS—ANY OF THE FOLLOWING SCREENING MODALITIES ARE ACCEPTED
			C. FAMILIAL ADENOMATOUS POLYPOSIS
			D. HEREDITARY NONPOLYPOSIS COLORECTAL CANCER
			E. FAMILY HISTORY
		V. POLYPS
		VI. PATHOGENESIS
			A. LOSS OF HETEROZYGOSITY PATHWAY—80% OF CASES
			B. REPLICATION ERROR REPAIR PATHWAY—20% OF CASES
			C. ADENOMATOUS POLYPOSIS SYNDROMES
			D. NONADENOMATOUS POLYPOSIS SYNDROMES
			E. NONPOLYPOSIS SYNDROMES
		VII. PREOPERATIVE EVALUATION
			A. COMPLETE HISTORY
			B. COLONOSCOPY
			C. RECTAL CANCER
			D. CARCINOEMBRYONIC ANTIGEN
		VIII. TREATMENT OF COLON CANCER
			A. GENERAL PRINCIPLES
			B. SURGICAL THERAPY FOR RESECTABLE MASSES
			C. CHEMOTHERAPEUTIC REGIMENS
			D. STAGE-SPECIFIC THERAPY
		IX. RECTAL CANCER
			A. STAGE-SPECIFIC THERAPY
			B. OPERATIVE APPROACH
			C. CHEMOTHERAPEUTIC REGIMENS
		X. POSTOPERATIVE FOLLOW-UP
			A. DIAGNOSIS AND TREATMENT
			B. TREATMENT OF LOCAL RECURRENT DISEASE
		XI. ANAL CANCER
		XII. TUMORS OF THE ANAL CANAL
		XIII. SIGNS AND SYMPTOMS
		XIV. SCREENING
		XV. ANATOMY AND CHARACTERIZATION
			A. ANAL TUMORS ARE CLASSIFIED INTO TWO GROUPS
			B. ANATOMY
		XVI. TUMORS OF THE ANAL CANAL
			A. ANAL INTRAEPITHELIAL NEOPLASIA
			C. DIAGNOSIS
			D. STAGING
			E. TREATMENT
			F. ADENOCARCINOMA OF THE ANAL CANAL
		XVII. TUMORS OF THE ANAL MARGIN
			A. SQUAMOUS CELL CARCINOMA
			B. DIAGNOSIS AND STAGING
			C. TREATMENT
		XVIII. MALIGNANT MELANOMA OF THE ANAL MARGIN/CANAL
			A. DIAGNOSIS AND STAGING
			B. TREATMENT
	39 - Malignant Pancreas Disease
		I. PANCREATIC ADENOCARCINOMA
			A. EPIDEMIOLOGY
			B. CAUSATIVE FACTORS
			C. PATHOLOGY
			D. PRESENTATION
			E. DIAGNOSTIC EVALUATION/STAGING
			F. SURGICAL THERAPY/RESECTABILITY
			G. NEOADJUVANT THERAPY
			H. ADJUVANT THERAPY
			I. SURVEILLANCE
			J. SURVIVAL
		II. PREMALIGNANT CYSTIC NEOPLASMS OF THE PANCREAS
			A. MUCINOUS CYSTIC NEOPLASMS (MCNS)
			B. INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS
	40 - Diseases of the Breast
		I. ANATOMY AND PHYSIOLOGY
			A. ANATOMY BASICS
			B. LYMPHATIC DRAINAGE
			C. NERVES
			D. BLOOD SUPPLY
			E. PHYSIOLOGY
		II. HISTORY
			A. AGE
			B. MASS
			C. NIPPLE DISCHARGE (TABLE 40.1)
			D. BREAST PAIN (MASTODYNIA)
			E. GYNECOLOGIC HISTORY
			F. MEDICAL HISTORY
			G. SURGICAL HISTORY
			H. FAMILY HISTORY
			I. CONSTITUTIONAL SYMPTOMS
		III. PHYSICAL EXAMINATION
			A. INSPECTION
			B. PALPATION
			C. SCREENING
		IV. RADIOGRAPHIC STUDIES
			A. MAMMOGRAPHY
			B. MAMMOGRAPHIC FINDINGS SUGGESTIVE OF MALIGNANCY
			C. ULTRASONOGRAPHY
			D. MAGNETIC RESONANCE IMAGING
			E. DIGITAL BREAST TOMOSYNTHESIS
		V. EVALUATION OF BREAST MASS
			A. NIPPLE DISCHARGE
			B. PALPABLE LESIONS
			C. FINE-NEEDLE ASPIRATION BIOPSY
			D. CORE NEEDLE BIOPSY (PERCUTANEOUS)
			E. EXCISIONAL BIOPSY
		VI. BENIGN BREAST DISEASE
			A. GALACTORRHEA
			B. FIBROCYSTIC CHANGES
			C. FIBROADENOMA
			D. PHYLLODES TUMOR AND CYSTOSARCOMA PHYLLODES
			E. INTRADUCTAL PAPILLOMA
			F. FAT NECROSIS
			G. PLASMA CELL MASTITIS AND PERIDUCTAL MASTITIS
			H. GALACTOCELE
			I. MASTITIS AND BREAST ABSCESS
			J. MONDOR DISEASE
			K. GYNECOMASTIA
			L. POLAND SYNDROME
		VII. BREAST CANCER
			A. EPIDEMIOLOGY
			B. RISK FACTORS
			C. CLINICAL PRESENTATION
			D. TNM CLASSIFICATION
			E. STAGING
			F. PATHOLOGIC LESIONS
			G. SURGICAL TREATMENT OPTIONS
			H. SURGICAL TREATMENT BY STAGE
			I. RADIOTHERAPY TO CHEST AND BREAST
			J. CHEMOTHERAPY AND HORMONAL THERAPY
			K. BREAST CANCER AND PREGNANCY
			L. MALE BREAST CANCER
	41 - Malignant Skin Lesions
		I. BASAL CELL CARCINOMA
			A. GENERAL
			B. DIAGNOSIS
			C. TREATMENT
		II. SQUAMOUS CELL CARCINOMA
			A. GENERAL
			B. DIAGNOSIS
			C. TREATMENT
		III. MALIGNANT MELANOMA
			A. GENERAL
			B. CLINICAL PRESENTATION
			C. TYPES OF MELANOMA
			D. PROGNOSTIC FACTORS
			E. STAGING
			F. DIAGNOSIS
			G. TREATMENT
		IV. MERKEL CELL CARCINOMA
			A. GENERAL
			B. TREATMENT
VII - Hepatobiliary Surgery
	42 - Benign Gallbladder and Biliary Tree
		I. ANATOMY
			A. GALLBLADDER
			B. BILE DUCTS
			C. ANOMALIES
		II. CHOLELITHIASIS
			A. INCIDENCE
			B. CAUSATIVE FACTORS
			C. TYPES OF GALLSTONES
			D. TREATMENT OF ASYMPTOMATIC CHOLELITHIASIS
		III. SYMPTOMATIC CHOLELITHIASIS
			A. BILIARY COLIC
			B. ACUTE CALCULOUS CHOLECYSTITIS
		IV. CHOLEDOCHOLITHIASIS
			A. CAUSATIVE FACTORS AND NATURAL HISTORY
			B. TREATMENT
		V. CHOLANGITIS
			A. CAUSATIVE FACTORS AND PATHOPHYSIOLOGY
			B. CLINICAL FEATURES AND DIAGNOSIS
			C. TREATMENT
		VI. ACALCULOUS CHOLECYSTITIS
			A. EPIDEMIOLOGY AND PATHOGENESIS
			B. NATURAL HISTORY
			C. CLINICAL MANIFESTATION AND DIAGNOSIS
			D. TREATMENT
		VII. OTHER DISORDERS OF THE GALLBLADDER
			A. GALLSTONE DISEASE IN PREGNANCY
			B. BILIARY DYSKINESIA
			C. BILIARY SLUDGE
			D. MIRIZZI SYNDROME
			E. GALLSTONE ILEUS
			F. EMPHYSEMATOUS CHOLECYSTITIS
			G. CALCIFIED “PORCELAIN” GALLBLADDER
		VIII. MEDICAL TREATMENTS
			A. ORAL DISSOLUTION THERAPY
			B. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
		IX. LAPAROSCOPIC CHOLECYSTECTOMY
			A. SETUP
			B. TECHNIQUE (FIGS. 42.1 AND 42.2)
			C. POSTOPERATIVE CARE
			D. COMPLICATIONS
	43 - Malignant Gallbladder and Biliary Tree
		I. GALLBLADDER CANCER
			A. GENERAL CONSIDERATIONS
			B. PRESENTATION
			C. TREATMENT
		II. BILE DUCT CANCER (CHOLANGIOCARCINOMA)
			A. GENERAL CONSIDERATIONS
			B. INTRAHEPATIC CHOLANGIOCARCINOMA
			C. EXTRAHEPATIC CHOLANGIOCARCINOMA
	44 - Benign Liver Disease, Cirrhosis, and Portal Hypertension
		I. PATHOPHYSIOLOGY
		II. MORPHOLOGY
		III. ETIOLOGY
		IV. DIAGNOSIS
		V. CLASSIFICATION
		VI. CONSEQUENCES OF CIRRHOSIS
		VII. HEPATIC SYNDROMES
	45 - Liver Tumors
VIII - Transplant Surgery
	46 - Renal Transplantation
		I. GENERAL CONSIDERATIONS
			A. HISTORY AND EPIDEMIOLOGY
			B. IMMUNOLOGY OF RENAL TRANSPLANTATION
			C. IMMUNOSUPPRESSION
		II. EVALUATION OF CANDIDATES FOR TRANSPLANTATION
			A. INDICATIONS
			C. RELATIVE CONTRAINDICATIONS
			D. PATIENT EVALUATION
			E. INDICATION FOR PRETRANSPLANT NATIVE NEPHRECTOMY
		III. KIDNEY DONATION
			A. LIVING DONOR KIDNEY TRANSPLANTATION
			B. CLASSICALLY DEFINED DONOR CATEGORIES
		IV. SPECIFIC OPERATIVE CONSIDERATIONS
			A. LIVING DONOR NEPHRECTOMY
			B. TRANSPLANT PROCEDURE
		V. POSTOPERATIVE CONSIDERATIONS
			A. POSTOPERATIVE CARE
			B. ASSESSMENT OF GRAFT FUNCTION
			C. COMPLICATIONS
		VI. OUTCOMES
			A. SURVIVAL BENEFIT OF RENAL TRANSPLANTATION
			B. SURVIVAL
	47 - Liver Transplantation
		I. GENERAL CONSIDERATIONS
			A. HISTORY
			B. INDICATIONS AND LISTING PROCESS FOR TRANSPLANTATION
			C. SPECIFIC INDICATIONS
			D. CONTRAINDICATIONS
			E. ORGAN SELECTION
		II. SPECIFIC OPERATIVE CONSIDERATIONS
			A. TRADITIONAL OPERATIVE TECHNIQUE
			B. PIGGYBACK TECHNIQUE
			C. LIVING DONOR HEPATECTOMY
		III. POSTOPERATIVE CONSIDERATIONS
			A. POSTOPERATIVE CARE
			B. IMMUNOSUPPRESSION (PROTOCOLS VARY BY INSTITUTION)
			C. ASSESSMENT OF GRAFT FUNCTION
			D. COMPLICATIONS
	48 - Pancreas Transplantation
		I. GENERAL CONSIDERATIONS
			A. HISTORY AND EPIDEMIOLOGY
			B. INDICATIONS FOR PANCREAS TRANSPLANTATION
			C. TYPES OF PANCREAS TRANSPLANTS
			D. ORGAN SELECTION
		II. SPECIFIC OPERATIVE CONSIDERATIONS
			A. TRANSPLANT ANATOMY
			B. MANAGEMENT OF EXOCRINE SECRETIONS
		III. POSTOPERATIVE CONSIDERATIONS
			A. POSTOPERATIVE CARE
			B. COMPLICATIONS
			C. OUTCOMES
		IV. ISLET CELL TRANSPLANTATION
			A. BACKGROUND
			B. INDICATIONS
			C. TECHNIQUE
			D. OUTCOMES
		V. PANCREAS VERSUS ISLET CELL TRANSPLANTATION
IX - Endocrine Surgery
	49 - Thyroid
		I. EMBRYOLOGY
			A. THYROID DEVELOPMENT
			B. DEVELOPMENTAL ANOMALIES
		II. ANATOMY
			A. OVERVIEW
			B. ARTERIAL SUPPLY
			C. VENOUS DRAINAGE
			D. NERVES
			E. LYMPHATICS
			F. HISTOLOGY
		III. PHYSIOLOGY
			A. IODINE METABOLISM
			B. THYROID HORMONE SYNTHESIS
			C. THYROID HORMONE FUNCTION
			D. THYROID HORMONE REGULATION
			E. CALCITONIN
		IV. WORK-UP OF THYROID DISEASE
			A. CLINICAL PRESENTATION
			B. LABORATORY DATA
			C. IMAGING
			D. BIOPSY
		V. HYPERTHYROIDISM
			A. DIFFUSE TOXIC GOITER—GRAVES DISEASE
			B. TOXIC ADENOMA—PLUMMER DISEASE
			C. TOXIC MULTINODULAR GOITER
			D. THYROID STORM
		VI. HYPOTHYROIDISM
			A. CHRONIC LYMPHOCYTIC THYROIDITIS—HASHIMOTO THYROIDITIS
		VII. THYROIDITIS AND NONTOXIC GOITERS
			A. ACUTE SUPPURATIVE THYROIDITIS
			B. SUBACUTE THYROIDITIS
			C. RIEDELS THYROIDITIS (INVASIVE FIBROUS THYROIDITIS)
			D. NONTOXIC GOITER
		VIII. THYROID NODULES
			A. CLINICAL PRESENTATION
			B. CLINICAL EVALUATION
			C. MANAGEMENT BASED ON FINE-NEEDLE ASPIRATION RESULTS
			D. CYSTIC NODULES
			E. INCIDENTALOMA
		IX. THYROID NEOPLASMS
			A. EPIDEMIOLOGY
			B. PAPILLARY THYROID CARCINOMA
			C. FOLLICULAR THYROID CARCINOMA
			D. HÜRTHLE CELL CARCINOMA
			E. MEDULLARY THYROID CANCER
			F. ANAPLASTIC THYROID CANCER
			G. THYROID LYMPHOMA
			H. ADJUVANT THERAPY
	50 - Parathyroid
		I. PARATHYROID EMBRYOLOGY AND ANATOMY
			A. EMBRYOLOGY
			B. ANATOMY
			C. PHYSIOLOGY
		II. PRIMARY HYPERPARATHYROIDISM
			A. GENERAL
			B. CAUSATIVE FACTORS
			C. PRESENTATION
			D. DIAGNOSIS
			E. MANAGEMENT
		III. SECONDARY HYPERPARATHYROIDISM
			A. CAUSATIVE FACTORS
			B. SYMPTOMS
			C. TREATMENT
		IV. TERTIARY HYPERPARATHYROIDISM
			A. CAUSATIVE FACTOR
			B. SYMPTOMS
			C. TREATMENT
		V. PARATHYROID CARCINOMA
	51 - Adrenal Gland
		I. EMBRYOLOGY AND ANATOMY
			A. GENERAL
			B. ARTERIAL SUPPLY
			C. VENOUS DRAINAGE
			D. CORTEX
			E. MEDULLA
		II. ZONA GLOMERULOSA—MINERALOCORTICOIDS
			A. PHYSIOLOGY
			B. PRIMARY ALDOSTERONISM/CONN SYNDROME
		III. ZONA FASICULATA—GLUCOCORTICOIDS
			A. PHYSIOLOGY
			B. CUSHING SYNDROME
		IV. ZONA RETICULARIS—ANDROGENS
			A. PHYSIOLOGY
			B. ANDROGEN-BASED TUMORS
		V. ADRENOCORTICAL CANCER
			A. PHYSIOLOGY
			B. PHEOCHROMOCYTOMA—CATECHOLAMINE-SECRETING TUMOR
		VI. ADRENAL MEDULLA
			A. PHYSIOLOGY
			B. PHEOCHROMOCYTOMA—CATECHOLAMINE-SECRETING TUMOR
		VII. INCIDENTALOMA
			A. EPIDEMIOLOGY
			B. CLINICAL EVALUATION
			C. MANAGEMENT
		VIII. ADRENAL INSUFFICIENCY
			A. PATHOPHYSIOLOGY AND CLINICAL PRESENTATION
			B. DIAGNOSIS
			C. TREATMENT
		IX. ADRENAL SURGERY
			A. ADRENLAECTOMY
			B. OPEN ADRENALECTOMY
			C. LAPAROSCOPIC ADRENALECTOMY
	52 - Neuroendocrine Tumors
		I. NEUROENDOCRINE TUMORS
			A. DEMOGRAPHICS
			C. LOCATION
			D. PRESENTATION
			E. STAGING AND LOCALIZATION
			F. MANAGEMENT
		II. GASTRINOMA
			A. DEMOGRAPHICS
			B. LOCATION
			C. PRESENTATION
			D. DIAGNOSIS
			E. MANAGEMENT
		III. INSULINOMA
			A. DEMOGRAPHICS
			B. PRESENTATION
			C. DIAGNOSIS
			D. MANAGEMENT
		IV. GLUCAGONOMA
			A. DEMOGRAPHICS
			B. PRESENTATION
			C. DIAGNOSIS
			D. MANAGEMENT
		V. VASOACTIVE INTESTINAL POLYPEPTIDOMA, VIPOMA
			A. DEMOGRAPHICS
			B. PRESENTATION
			C. DIAGNOSIS
			D. MANAGEMENT
		VI. SOMATOSTATINOMA
			A. DEMOGRAPHICS
			B. PRESENTATION
			C. DIAGNOSIS
			D. MANAGEMENT
		VII. PANCREATIC POLYPEPTIDOMAS
			A. DEMOGRAPHICS
			B. PRESENTATION
			C. DIAGNOSIS
			D. MANAGEMENT
X - Vascular Surgery
	53 - Thromboembolic Disease
		I. INTRODUCTION
			A. EPIDEMIOLOGY
			B. CAUSATIVE FACTORS
			D. CLINICAL PRESENTATION
			E. DIFFERENTIAL DIAGNOSES
			F. DIAGNOSIS
			G. SEQUELAE
		II. METHODS OF PROPHYLAXIS AND TREATMENT OF DEEP VENOUS THROMBOSES AND PULMONARY EMBOLI
			A. DEEP VEIN THROMBOSIS PROPHYLAXIS
			B. TREATMENT OF DEEP VEIN THROMBOSIS AND PULMONARY EMBOLI
			C. PROPHYLACTIC INFERIOR VENA CAVA FILTER PLACEMENT
		III. AN APPROACH TO PROPHYLAXIS
			A. DETERMINE THE PATIENT’S RISK FACTORS
			B. PROPHYLAXIS OF CHOICE
		IV. APPROACH TO THE PATIENT WITH PULMONARY EMBOLUS
			A. PHYSIOLOGY
			D. SURGICAL TREATMENT OPTIONS
	54 - Aneurysms
		I. EPIDEMIOLOGY
			A. GENERAL
			B. CASE REPORT
			C. RISK FACTORS
			D. CAUSATIVE FACTORS
		II. PATHOLOGY
			A. LOCATION
			B. CHARACTERISTICS
			C. ASSOCIATED MANIFESTATIONS OF DIFFUSE ATHEROSCLEROSIS
		III. NATURAL HISTORY
			A. GENERAL CONSIDERATIONS
			B. STATISTICS
		IV. CLINICAL PRESENTATION
			A. SYMPTOMS
			B. PHYSICAL EXAMINATION
		V. DIAGNOSTIC STUDIES
			A. PLAIN FILMS
			B. B-MODE ULTRASOUND
			C. COMPUTED TOMOGRAPHY SCAN
			D. MAGNETIC RESONANCE IMAGING
			E. AORTOGRAPHY
		VI. ELECTIVE MANAGEMENT OF ABDOMINAL AORTIC ANEURYSM
			A. OPERATIVE INDICATIONS
			B. PREOPERATIVE WORK-UP
			C. PREOPERATIVE PREPARATION
		VII. OPEN ABDOMINAL AORTIC ANEURYSM REPAIR
			A. APPROACH
			B. OPERATIVE STEPS
			C. INTRAOPERATIVE PROBLEMS
			D. PROSTHETIC GRAFT
			E. POSTOPERATIVE COURSE
		VIII. COMPLICATIONS
			A. LOWER EXTREMITY ISCHEMIA
			B. CARDIAC EVENTS
			C. RENAL INSUFFICIENCY
			D. STROKE
			E. COLONIC ISCHEMIA
			F. SPINAL CORD ISCHEMIA
			G. SEXUAL DYSFUNCTION
			H. LATE COMPLICATIONS
		IX. ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR
			A. INDICATIONS
			B. PROCEDURE
			C. LONG-TERM CARE
			D. COMPLICATIONS
			E. OUTCOMES
		X. OPERATIVE MORTALITY
			A. OPEN REPAIR
			B. ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR
		XI. RUPTURED ABDOMINAL AORTIC ANEURYSM
			A. SYMPTOMS
			B. PRINCIPLES OF MANAGEMENT
		XII. ABDOMINAL AORTIC ANEURYSM SCREENING (TABLE 54.3)
			A. ULTRASOUND
	55 - Peripheral Vascular Disease
		I. DEFINITIONS
		II. PERIPHERAL ARTERIAL DISEASE
			A. EPIDEMIOLOGY
			B. RISK FACTORS
			C. NATURAL HISTORY
			D. PATHOPHYSIOLOGY
			E. SYMPTOMS
			F. PHYSICAL EXAMINATION FINDINGS
			G. LAB WORK
			H. DIAGNOSTIC STUDIES
		III. MANAGEMENT OF ATHEROSCLEROTIC PERIPHERAL ARTERIAL DISEASE
			A. MEDICAL MANAGEMENT
			B. REVASCULARIZATION THERAPY
			C. CRITICAL LIMB ISCHEMIA
			D. ACUTE LIMB ISCHEMIA
		IV. RENAL ARTERY DISEASE
			A. EPIDEMIOLOGY
			B. NATURAL HISTORY
			C. CLINICAL CONSEQUENCE
			D. PATHOPHYSIOLOGY
			E. DIAGNOSIS
			F. RENAL ARTERY ANEURYSMS
		V. LOWER EXTREMITY ANEURYSM DISEASE
			A. EPIDEMIOLOGY
			B. NATURAL HISTORY
			C. FEMORAL ARTERY ANEURYSMS
			D. POPLITEAL ARTERY ANEURYSMS
			E. FEMORAL ARTERY PSEUDOANEURYSM
			F. MYCOTIC ANEURYSMS
		VI. CHRONIC VENOUS INSUFFICIENCY
			A. OVERVIEW
			B. DIAGNOSIS
			C. MANAGEMENT
	56 - Carotid Disease
		I. BACKGROUND: STROKE
		II. DIAGNOSIS
			A. HISTORY
			B. PHYSICAL EXAMINATION
			C. IMAGING
		III. DIFFERENTIAL DIAGNOSIS OF STROKE/TRANSIENT ISCHEMIC ATTACKS
			A. ATHEROSCLEROTIC DISEASE
			B. FIBROMUSCULAR DYSPLASIA
			C. COILS AND KINKS BECAUSE OF ANATOMIC VARIATION
			D. CAROTID ANEURYSMS
			E. CAROTID DISSECTION
			F. RADIATION ARTERITIS
			G. TAKAYASU ARTERITIS
			H. GIANT CELL ARTERITIS
		IV. MANAGEMENT
			A. MEDICAL
			B. SURGICAL—CAROTID ENDARTERECTOMY
			C. ENDOVASCULAR—CAROTID ARTERY STENTING
		V. POSTOPERATIVE COMPLICATIONS
			A. CARDIOVASCULAR
			B. NEUROLOGIC
		VI. POSTOPERATIVE CARE
	57 - Mesenteric Ischemia
		I. ANATOMY AND PHYSIOLOGY
			A. VASCULAR SUPPLY
			B. COLLATERAL VESSELS
			C. PHYSIOLOGY
		II. EPIDEMIOLOGY
		III. ACUTE MESENTERIC ISCHEMIA
			A. RISK FACTORS
			B. CLINICAL PRESENTATION
			C. CAUSATIVE FACTORS
			D. DIAGNOSIS
			E. MANAGEMENT
		IV. CHRONIC MESENTERIC ISCHEMIA
			A. CAUSATIVE FACTORS
			B. DIAGNOSIS
			C. TREATMENT
			D. PROGNOSIS
		V. MESENTERIC VENOUS THROMBOSIS
			A. CAUSATIVE FACTORS—VENOUS THROMBOSIS PREDOMINANTLY A RESULT OF STAGNATION OF BLOOD FLOW, HYPERCOAGULABILITY, AND VASCULAR INJU...
			B. CLINICAL PRESENTATION
			C. DIAGNOSIS
			D. TREATMENT
			E. PROGNOSIS
		VI. MEDIAN ARCUATE LIGAMENT SYNDROME (CELIAC ARTERY COMPRESSION SYNDROME)
			A. CAUSATIVE FACTORS
			B. PRESENTATION
			C. DIAGNOSIS
			D. TREATMENT
	58 - Dialysis Access
		I. INTRODUCTION
		II. GENERAL OVERVIEW OF DIALYSIS ACCESS TYPES
			A. SHORT-TERM/EMERGENT ACCESS
			B. LONG-TERM ACCESS
		III. DIALYSIS CATHETERS
			A. NONTUNNELED (NONCUFFED CATHETERS)
			B. TUNNELED CATHETERS (CUFFED)
		IV. ARTERIOVENOUS FISTULAS AND GRAFTS
			A. ARTERIOVENOUS FISTULA
			B. ARTERIOVENOUS GRAFT
		V. ARTERIOVENOUS FISTULA MATURATION
		VI. COMPLICATIONS OF ARTERIOVENOUS FISTULAS AND GRAFTS
		VII. PERITONEAL DIALYSIS
	59 - The Diabetic Patient
		I. DEFINITIONS
			A. DIABETES
			B. METABOLIC SYNDROME
		II. MEDICAL THERAPIES
			A. ORAL ANTIHYPERGLYCEMICS
			B. INSULIN
			D. ADJUSTING MEDICATIONS FOR SURGERY
			E. HYPOGLYCEMIA (BLOOD GLUCOSE LEVEL LESS THAN 70 MG/DL)
			F. DIABETIC KETOACIDOSIS
			G. NONKETOTIC HYPEROSMOLAR HYPERGLYCEMIA
		III. GLYCEMIC CONTROL IN THE CRITICALLY ILL PATIENT
			A. HYPERGLYCEMIC RESPONSE TO SURGERY AND ANESTHESIA
			B. IATROGENIC HYPERGLYCEMIA
			C. GLYCEMIC CONTROL
			D. SPECIAL POPULATIONS
		IV. COMPLICATIONS OF DIABETES
			A. TISSUE HYPOXIA CAUSED BY MICROVASCULAR DISEASE
		V. DIABETIC FOOT ULCERS
XI - Cardiothoracic Surgery
	60 - Benign Tumors of the Lung
		I. OVERVIEW
		II. HISTORY
		III. PHYSICAL EXAMINATION
		IV. INITIAL EVALUATION
		V. IMAGING
		VI. BIOPSY OPTIONS
		VII. EPITHELIAL TUMORS
			A. POLYPS
			B. PAPILLOMA
			C. MUCOUS GLAND ADENOMA
		VIII. MESENCHYMAL TUMORS
			A. VESSEL ORIGIN
		IX. MISCELLANEOUS TUMORS
			A. FIBROMA
			B. HAMARTOMA
			C. TERATOMA
		X. OTHER TUMORS
			A. LIPOMA
			B. CHONDROMA
		XI. INFLAMMATORY PSEUDOTUMORS
			A. PLASMA CELL GRANULOMA
			B. PULMONARY HYALINIZING GRANULOMA
		XII. OTHER BENIGN TUMORS
			A. MUCINOUS CYSTADENOMA
			B. NODULAR AMYLOID
	61 - Malignant Tumors of the Lung
		I. EPIDEMIOLOGY
			A. GENERAL
			B. MORTALITY
		II. ETIOLOGY
			A. CIGARETTE SMOKING
			B. EXPOSURE
		III. SCREENING
			A. GENERAL
			B. SCREENING MODALITIES
		IV. SOLITARY PULMONARY NODULE
			A. GENERAL
			B. DIFFERENTIAL DIAGNOSIS
			C. RADIOGRAPHIC CHARACTERISTICS OF BENIGN NODULE
			D. MANAGEMENT OF SOLITARY PULMONARY NODULE
		V. CLINICAL FEATURES
			A. RESPIRATORY
			B. ASSOCIATED SYNDROMES
			C. EVIDENCE OF METASTATIC OR LOCALLY ADVANCED DISEASE
			D. METHOD OF SPREAD
		VI. PATHOLOGY
			A. HISTOLOGIC CLASSIFICATION
			B. LOCATION OF PRIMARY TUMORS
		VII. ADENOCARCINOMA—40%
			A. GENERAL
			B. PATHOLOGIC FEATURES
		VIII. SQUAMOUS CELL CARCINOMA—20%
			A. GENERAL
			B. PATHOLOGIC FEATURES
		IX. LARGE CELL CARCINOMA—10%
			A. GENERAL
			B. PATHOLOGIC FEATURES
		X. NEUROENDOCRINE CARCINOMA—20%–25%
			A. GENERAL
		XI. OTHER—5%–10%
			A. GENERAL
		XII. DIAGNOSIS
			A. CHEST RADIOGRAPH
			B. CHEST COMPUTED TOMOGRAPHY SCAN
			C. POSITRON EMISSION TOMOGRAPHY SCAN
			D. CLINICAL STAGING
			E. TISSUE BIOPSY
			F. CLASSIFICATION AND STAGING
		XIII. TREATMENT
		XIV. THE FUTURE
	62 - Thymus and Mediastinal Tumors
		I. ANATOMY AND EMBRYOLOGY
		II. ASSESSMENT OF MEDIASTINAL MASSES
		III. ANTERIOR MEDIASTINAL MASSES
			A. THYMOMAS
			B. THYMIC CARCINOMA
			C. GERM CELL TUMORS
			D. LYMPHOMAS
		IV. VISCERAL MEDIASTINAL COMPARTMENT MASSES
			A. BRONCHOGENIC CYSTS
			B. ENTERIC (DUPLICATION) CYSTS
			C. NEUROENTERIC CYSTS
			D. PERICARDIAL CYSTS
		V. POSTERIOR MEDIASTINAL MASSES
			A. NERVE SHEATH TUMORS
	63 - Cardiac Surgery
		I. PREOPERATIVE EVALUATION
			A. HISTORY
			B. PHYSICAL EXAMINATION—COMPLETE AND SYSTEMS BASED
			C. PREOPERATIVE TESTING
			D. PREOPERATIVE ORDERS
		II. OPERATIVE PROCEDURES
			A. CORONARY ARTERY BYPASS GRAFTING
			B. VALVE REPLACEMENT OR REPAIR
			C. INFECTIVE ENDOCARDITIS
			D. AORTIC DISSECTION
			E. TRAUMATIC AORTIC DISRUPTION
			F. AORTIC ANEURYSMS
			G. CONGENITAL HEART SURGERY
		III. POSTOPERATIVE CARE
			A. HEMODYNAMICS
			B. ARRHYTHMIAS
			C. ANTIARRHYTHMICS
			D. ANTICOAGULATION
			E. HARDWARE
		IV. POSTOPERATIVE COMPLICATIONS
			A. ARRHYTHMIAS
			B. BLEEDING
			C. CARDIAC TAMPONADE
			D. RENAL FAILURE
			E. RESPIRATORY FAILURE
			F. LOW CARDIAC OUTPUT SYNDROME
			G. CARDIAC TAMPONADE
		V. PHARMACOLOGY
			A. INOTROPES
			B. VASOPRESSORS
			C. VASODILATORS
			D. POSTOPERATIVE FEVER
			E. CENTRAL NERVOUS SYSTEM COMPLICATIONS
	64 - Cardiac Transplantation
		I. HISTORY
		II. INDICATIONS
		III. CONTRAINDICATIONS
			A. ABSOLUTE CONTRAINDICATIONS
			B. RELATIVE CONTRAINDICATIONS
		IV. PREOPERATIVE EVALUATION
		V. LISTING CRITERIA
		VI. LISTING STATUS ACCORDING TO WHOM IT MAY CONCERN: ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK POLICIES
		VII. MEDICAL AND MECHANICAL BRIDGES TO TRANSPLANT
		VIII. DONOR SELECTION, EVALUATION, AND MANAGEMENT
			A. DONOR SELECTION
			B. DONOR EVALUATION
		IX. DONOR HEART PROCUREMENT
		X. OPERATIVE TECHNIQUE FOR CARDIAC TRANSPLANTATION
		XI. POSTOPERATIVE MANAGEMENT
		XII. IMMUNOSUPPRESSION AND LONG-TERM MANAGEMENT
		XIII. PREVENTION OF OPPORTUNISTIC INFECTION
		XIV. SURVIVAL
XII - Surgical Subspecialties
	65 - General Pediatric Surgery
		I. FLUIDS AND NUTRITION
			A. MAINTENANCE FLUIDS
			B. RESUSCITATION FLUIDS
			C. FLUID BALANCE
			D. ACID-BASE ANOMALIES
			E. TOTAL PARENTERAL NUTRITION
		II. LESIONS OF THE HEAD AND NECK
			A. THRYOGLOSSAL DUCT CYST
			B. BRANCHIAL CLEFT ANOMALIES
		III. THORACIC DISORDERS
			A. PULMONARY SEQUESTRATION
			B. CONGENITAL CYSTIC ADENOMATOID MALFORMATION
			C. CONGENITAL DIAPHRAGMATIC HERNIA
		IV. ESOPHAGEAL ANOMALIES
			A. TRACHEOESOPHAGEAL FISTULA
			B. ISOLATED ESOPHAGEAL ATRESIA—TYPE A (6%)
			C. SURVIVAL
		V. GASTROINTESTINAL TRACT
			A. HYPERTROPHIC PYLORIC STENOSIS
			B. INTESTINAL OBSTRUCTION IN THE NEONATE
			D. NECROTIZING ENTEROCOLITIS
			E. MECKEL DIVERTICULUM
			F. APPENDICITIS
			G. GASTROESOPHAGEAL REFLUX
		VI. ABDOMINAL WALL DEFECTS
			A. OMPHALOCELE
			B. GASTROSCHISIS
			C. UMBILICAL HERNIA
			D. INGUINAL HERNIA
			E. SHORT BOWEL SYNDROME
		VII. ANORECTAL MALFORMATIONS
		VIII. NEOPLASMS
			A. NEUROBLASTOMA
			B. WILMS TUMOR
	66 - Neurosurgery
		I. CRANIAL URGENCIES AND EMERGENCIES
			A. SPONTANEOUS SUBARACHNOID HEMORRHAGE
			C. MALIGNANT STROKE (FIG. 66.3)
			D. HYDROCEPHALUS
		II. SPINAL URGENCIES AND EMERGENCIES
			A. DEGENERATIVE SPINAL DISEASE
		III. CNS TUMORS
			A. BRAIN TUMORS (FIG. 66.5)
			B. SPINAL TUMORS (FIG. 66.7)
		IV. CNS INFECTIOUS URGENCIES AND EMERGENCIES (FIG. 66.8)
			A. EPIDURAL ABSCESS
			B. SUBDURAL EMPYEMA
			C. PARENCHYMAL ABSCESS
		V. OTHER NEUROSURGICAL URGENCIES/EMERGENCIES
			A. SEIZURES AND STATUS EPILEPTICUS
			B. BACLOFEN TOXICITY AND WITHDRAWAL
		VI. HERNIATION SYNDROMES AND BRAIN DEATH
			A. HERNIATION SYNDROMES CAN RESULT FROM A VARIETY OF BOTH TRAUMATIC AND NONTRAUMATIC CRANIAL PATHOLOGIES; THERE ARE FOUR COMMON ...
			B. BRAIN DEATH
	67 - Orthopedic Surgery
		I. ASSESSMENT OF THE ORTHOPEDIC PATIENT
			A. BASIC ADVANCED TRAUMA LIFE SUPPORT PRINCIPLES
		II. ORTHOPEDIC EMERGENCIES
			A. HEMODYNAMICALLY UNSTABLE PELVIC FRACTURES
			B. OPEN FRACTURES
			C. COMPARTMENT SYNDROME
			D. VASCULAR INJURY ASSOCIATED WITH EXTREMITY TRAUMA
			E. TRAUMATIC ARTHROTOMIES
			F. GUNSHOT WOUNDS
			G. BITE INJURIES
	68 - Plastic Surgery: Breast Reconstruction
		I. INTRODUCTION
		II. RELEVANT ANATOMY FOR RECONSTRUCTION
			A. VASCULAR SUPPLY (FIG. 68.1)
			B. INNERVATION
		III. PREOPERATIVE EVALUATION
			A. GOALS OF RECONSTRUCTION
			B. TIMING
			C. CURRENT TECHNIQUES
			D. TECHNIQUE SELECTION CRITERIA
		IV. TECHNIQUES
			A. PROSTHETIC RECONSTRUCTION USING IMPLANTS AND EXPANDERS
			B. AUTOLOGOUS TISSUE TRANSFER
			C. NIPPLE AREOLAR COMPLEX RECONSTRUCTION (FIG. 68.4)
		V. ONCOPLASTIC SURGERY
			A. DEFINITION
			B. CONSIDERATIONS
			C. TECHNIQUES
		VI. POSTRECONSTRUCTION FOLLOW-UP
XIII - Future of Surgery
	69 - Robotics and Newer Surgical Technologies
		I. SINGLE-INCISION LAPAROSCOPIC SURGERY
		II. ROBOTIC SURGERY
		III. NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY
		IV. ENDOLUMINAL AND ENDOVASCULAR SURGERY
XIV - Procedures
	70 - Procedures
		I. INDICATIONS FOR AN ARTIFICIAL AIRWAY
			A. ABSOLUTE
			B. RELATIVE
		II. NONSURGICAL TECHNIQUES
			A. INITIAL/TEMPORIZING MANEUVERS
			B. OROTRACHEAL INTUBATION
			C. NASOTRACHEAL INTUBATION
			D. COMPLICATIONS
		III. SURGICAL AIRWAY OPTIONS AND METHODS
			A. CRICOTHYROIDOTOMY
			B. TRACHEOSTOMY
			C. PERCUTANEOUS TRACHEOSTOMY
			D. COMPLICATIONS
		IV. ALTERNATE AIRWAY METHODS
			A. COMBITUBE
			B. FIBEROPTIC BRONCHOSCOPY
			C. LARYNGEAL MASK AIRWAY
		V. ARTERIAL CATHETERIZATION
			A. INDICATIONS
			B. TECHNIQUES
			C. COMPLICATIONS
		VI. BLADDER CATHETERIZATION
			A. INDICATIONS FOR INDWELLING URETHRAL CATHETER
			B. COMPLICATIONS OF INDWELLING URINARY CATHETER
			C. CONTRAINDICATIONS OF BLADDER CATHETERIZATION
			D. TECHNIQUES
			E. ALTERNATIVES
		VII. CENTRAL VENOUS LINES
			A. INDICATIONS
			C. TECHNIQUES
			D. COMPLICATIONS
		VIII. ENTERAL ACCESS
			A. NASOGASTRIC TUBES
			B. OROGASTRIC TUBES
			C. FEEDING TUBES
		X. PULMONARY ARTERY (SWAN-GANZ) CATHETERIZATION
			A. INDICATIONS
			B. DESIGN
			C. MEASUREMENT
			D. PITFALLS
		XI. ABSCESS DRAINAGE
			A. TECHNIQUE
		XII. THORACENTESIS
			A. INDICATIONS
			B. TECHNIQUE
			C. POSITIONING
			D. PROCEDURE
			E. INTERPRETATION OF RESULTS (TABLE 70.3)
			F. COMPLICATIONS
XV - Rapid References
	71 - Rapid References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Y
	Z