Ellis and Calne's Lecture Notes in General Surgery, 14e

Cover
Title Page
Copyright Page
Contents
Author affiliations
Preface
Acknowledgements
Abbreviations
About the companion website
Chapter 1 Surgical strategy
History and examination
The history
The examination
Documenting medical notes
Case presentation
Chapter 2 Human factors in surgery
What are human factors?
Error in healthcare
What are the different types of error and failure?
What human factors in surgery should we be thinking about?
Tiredness and fatigue
Hydration and nutritional status
Emotion and stress
Situational awareness
The team brief, lowering authority gradients and ensuring good communication
Chapter 3 Fluid and nutrition management
Body fluid compartments
Fluid and electrolyte losses
Normal fluid losses
The kidney
The gastrointestinal tract
Insensible losses
Abnormal fluid losses
Effects of surgery
Prescribing fluids for the surgical patient
Nutrition
Chapter 4 Preoperative assessment
Patient assessment
History of presenting complaint
Past medical history
Perioperative care of the elderly
Frailty
Past surgical history
Past anaesthetic history
Social history
Medication
Allergies
Management of pre-existing medical conditions
Diabetes
Respiratory disease
Operative factors influencing preoperative management
Nature of the surgery
Urgency of the surgery
Objective operative risk assessment
Surgical risk assessment
Anaesthetic risk assessment
Chapter 5 Postoperative complications
Classification
Time of occurrence
Aetiology
Grading the severity of complications
Predisposing factors
Surgical site infection (SSI)
Preoperative risk factors
Operative factors
Operation sites and risk of SSI
Antibiotic prophylaxis
Postoperative factors
Causative organisms
Clinical features
Treatment
Complications of antibiotic therapy
Antibiotic-associated colitis: Clostridium difficile
Clinical features
Treatment
Methicillin-resistant Staphylococcus aureus, MRSA
Clinical features
Treatment
Other multi-resistant organisms of significance
Venous thromboembolism
Risk factors
Thromboprophylaxis
Monitoring heparin therapy in renal failure
Deep vein thrombosis
Clinical features
Special investigations
Management
Pulmonary embolism
Clinical features
Risk prediction of a pulmonary embolus
Special investigations
Treatment
Management of the unwell postoperative patient
Initial assessment
ABCDE assessment
Postoperative haemorrhage
Reactionary bleeding
Secondary haemorrhage
Clinical features
Management
Postoperative fever
Assessment
Postoperative respiratory problems
Aetiology
Opiates, renal failure, and respiratory depression
Pulmonary collapse and infection
Aetiology
Clinical features
Treatment
Postoperative ileus
Abdominal wound dehiscence
Risk factors
Preoperative
Operative
Postoperative
Clinical features
Management
Anastomotic leak
Risk factors
Clinical features
Special investigations
Management
Contained leaks
Uncontained (‘free’) leaks
Postoperative fistula
Clinical features
Classification
Treatment
Localized intraperitoneal collections
Risk factors
Clinical features
Special investigations
Subphrenic abscess
Anatomy
Aetiology
Clinical features
Special investigations
Treatment
Pelvic abscess
Clinical features
Treatment
Delirium
Risk factors
Management
Complications of minimally invasive surgery
Radiological intervention
Endoluminal surgery
Laparoscopic surgery
Additional resources
Chapter 6 Acute infections
Cellulitis
Treatment
Erysipelas
Abscess
Treatment
Boil
Differential diagnosis
Treatment
Carbuncle
Treatment
Specific infections
Tetanus
Pathology
Clinical features
Differential diagnosis
Treatment
Necrotizing soft tissue infections
Clinical features
Risk factors
Investigation
Treatment
Polymicrobial infection: ‘Synergistic gangrene’
Group A streptococcal infection
Gas gangrene
Treatment
Anthrax
Botulism
Actinomycosis
Additional resources
Chapter 7 Tumours
Pathology
Clinical features and diagnosis
History
Examination
Special investigations
Tumour markers
Prognosis
Extent of spread (staging)
The TNM classification
Microscopic appearance (histological differentiation)
Anatomical situation
General condition of the patient
Treatment
Curative treatment
Best Supportive/Palliative treatment
Anti-neoplastic agents
Cell cycle chemotherapy classification
Immunotherapy
Combination chemotherapy
Radiotherapy
Cancer screening
Population screening
Screening for high-risk individuals
Inherited cancer syndromes
Familial clustering
Chapter 8 Shock
Aetiology
Normal regulation of tissue perfusion
Abnormal regulation of tissue perfusion
Special causes of shock
Adrenocortical failure
Sympathetic interruption
The vasovagal syndrome (faint)
Septic shock
Sequelae of shock
Principles in the management of patients in shock
Assessment
Immediate measures
Ventilatory support
Fluid resuscitation
Bleeding
Anaphylaxis
Monitoring and subsequent management
Cardiac output measurement
Prevention of hypothermia
Pharmacological agents
Noradrenaline (norepinephrine)
Metaraminol
Dopamine
Adrenaline (epinephrine)
Vasopressin
Dobutamine
Dopexamine
Chapter 9 Trauma surgery
Trauma types
Mechanisms of injury
Principles of trauma management
The triad of death in trauma
Phase 1: Pre-hospital trauma care and initial assessment
Phase 2: Initial assessment with ongoing resuscitation
Assessment of trauma patients
Advanced Trauma Life Support (ATLS)
Catastrophic haemorrhage control
The AMPLE history
Special investigations
Monitoring
Secondary survey
Head and neck
Chest
Transfer to the next phase of care
Damage control ethos
Permissive hypotension
Damage control surgery
Resuscitative or emergent thoracotomy
Emergency laparotomy
Individual organ management
Phases 3 to 5
Chapter 10 Burns
Causes
Severity
Depth of burn
Area of the burn
The initial management of the severe burn injury patient
Airway management
Breathing and ventilation
Fluid resuscitation
Pain
Anaemia
Stress reaction
Treatment
Local treatment
General treatment
Antimicrobial therapy
Nutrition
Complications
Local
General
Prognosis
Additional resources
Chapter 11 The skin and its adnexae
General functions of the skin
Skin anatomy and embryology
Epidermoid cyst
Complications
Treatment
Dermoid cyst
Verruca vulgaris (wart)
Treatment
Plantar warts
Ganglion
Treatment
Pilonidal sinus
Aetiology
Clinical features
Treatment
Hidradenitis suppurativa
Treatment
Conditions affecting the nails
Paronychia
Ingrowing toenail
Onychogryphosis
Lesions of the nail bed
Tumours of the skin and subcutaneous tissues
Classification
Marjolin’s ulcer
Basal cell carcinoma (rodent ulcer)
Pigmented skin lesions and malignant melanoma
Benign pigmented skin lesions
Tumours of sweat glands and sebaceous glands
Sebaceous adenoma
Adnexal-derived skin cancers
Sebaceous carcinoma
Vascular anomalies
Vascular tumours
Campbell de Morgan spots
Spider naevus
Infantile haemangioma (strawberry naevus)
Cavernous haemangioma
Glomus tumour
Kaposi’s sarcoma
Telangiectasia
Vascular malformations
Lymph vessel tumours
Cystic hygroma
Nerve tumours
Clinical features
Treatment
Fatty tumours
Lipoma
Liposarcoma
Additional resources
Chapter 12 Arterial disease
Arterial trauma
Closed injuries
Penetrating injuries
Types of arterial injury
Consequences of injury
Clinical features
Treatment
Aneurysm
Aneurysm types (Figure 12.1)
Aetiology
Mycotic
Aortopathies
Abdominal aortic aneurysm
Management
Operative management (Figure 12.2)
Complications of surgery
Ruptured abdominal aortic aneurysm
Popliteal aneurysm
Clinical features
Special investigations
Treatment
Assessing the patient with arterial disease
Risk factors for atherosclerosis (Box 12.1)
Lower limb peripheral arterial disease
Intermittent claudication
Critical limb-threatening ischaemia
Rest pain
Gangrene
Diabetic foot ulceration
Examination
Management
Critical limb-threatening ischaemia.
Acute limb ischaemia (Box 12.3)
Embolism
Treatment
In situ thrombosis
Atherosclerotic occlusive arterial disease
Coronary occlusive disease
Mesenteric occlusive disease
Carotid artery disease (Figure 12.6)
Clinical features
Differential diagnosis
Special investigations
Treatment
Complications of carotid endarterectomy
Raynaud’s disease and Raynaud’s phenomenon9
Aetiology
Clinical features
Treatment
Buerger’s disease
Cold injury
Additional resources
Chapter 13 The heart and thoracic aorta
Introduction
Cardiopulmonary bypass
Background
Technique
Cardiac intensive care
Complications of cardiopulmonary bypass and cardiac surgery in general
Valvular disease
Valve repair and replacement
Mechanical valves
Bioprosthetic valves
Complications of valve replacement
Aortic stenosis
Clinical features
Treatment
Mitral regurgitation
Pathology
Clinical features
Treatment
Mitral stenosis
Ischaemic heart disease
Aetiology
Special investigations
Treatment
Surgery for the complications of myocardial infarction
Heart transplantation
Thoracic aortic disease
Persistent ductus arteriosus
Coarctation of the aorta
Thoracic aortic aneurysms
Special investigations
Treatment
Complications
Aortic dissection
Chapter 14 The chest and lungs
Injury to the chest
Sternal fracture
Clinical features
Fractures of the ribs
Clinical features
Special investigations
Complications
Flail chest
Pneumothorax
Subcutaneous emphysema (surgical emphysema)
Sucking wound of the chest
Haemothorax
Traumatic asphyxia
Other visceral injury
Treatment
Simple rib fracture
Flail chest
Pneumothorax
Tension pneumothorax
Penetrating wounds of the chest
Cardiac tamponade
Lung abscess
Empyema
Aetiology
Complications
Clinical features
Special investigations
Treatment
Lung tumours
Classification
Carcinoid tumours
Typical carcinoid tumours
Investigations
Treatment
Lung cancer
Aetiology
Pathology
Spread
Clinical features
Special investigations
Treatment
Secondary tumours
Additional resources
Chapter 15 Venous disorders of the lower limb
Normal venous function
Anatomy of the venous drainage of the lower limb
The deep venous system
The superficial venous system
Perforating veins
Aetiology of venous disease
Primary venous disease
Congenital venous disease
Secondary (post-thrombotic) venous disease
Clinical presentation
Thread veins / reticular veins
Leg swelling and skin changes
Venous ulceration
Other complications of varicose veins
Assessment of the patient with venous disease
History
Clinical examination
Special investigations
Treatment of venous disease
Compression therapy
Compression therapy in venous ulceration
Treatment of superficial vein reflux
Traditional surgical ‘stripping’
Endovenous thermal ablation
Ultrasound-guided sclerotherapy
Non-thermal closure procedures
Treatment of deep venous disease
Deep vein thrombosis
Additional resources
Chapter 16 The brain and meninges
Space-occupying intracranial lesions
Clinical features
Localizing signs
Special investigations
Intracranial tumours
Classification
Gliomas
Cerebral lymphoma
Meningioma
Vestibular schwannomas
Pituitary tumours
Secondary tumours
Intracranial abscess
Aetiology
Clinical features
Special investigations
Treatment
Intracranial vascular lesions
Intracranial aneurysms
Arteriovenous malformations
Hydrocephalus
The circulation of cerebrospinal fluid
Non-communicating or obstructive hydrocephalus
Communicating hydrocephalus
Clinical features
Special investigations
Treatment
Normal pressure hydrocephalus
Additional resources
Chapter 17 Head injury
Types of injury
Scalp injuries
Skull injuries
Brain injuries
Diffuse brain injury
Localized brain injury
Coup and contre-coup (Figure 17.1)
Laceration within the skull
Cerebral perfusion
Systemic arterial pressure
Intracranial pressure
Management of the patient with a head injury
Initial assessment
Immediate management
Delayed management
Indications for surgery in head injuries
Early
Delayed
Traumatic intracranial bleeding
Classification
Other complications
Meningitis
Hyperpyrexia
Brain death
Additional resources
Chapter 18 The spine
Spina bifida (Figure 18.1)
Clinical features
Treatment
Spinal injuries
The bony-ligamentous injury
Initial management
Types of fracture
Clinical features
Special investigations
The neurological injury
Types of neurological injury
Treatment of spinal injuries
Immediate management
Treatment with no neurological injury
Treatment of paraplegia or tetraplegia
Age-related (degenerative) spinal disorders
Clinical presentations associated with age-related changes
Prolapsed intervertebral disc
Lumbar disc herniation
Spinal stenosis
Cervical spondylosis
Clinical features
Differential diagnosis
Treatment
Spinal infection
Clinical features
Treatment
Spinal tumours
Clinical features
Differential diagnosis
Special investigations
Treatment
Additional resources
Chapter 19 Peripheral nerve injuries
Classification
Acute peripheral nerve injuries
Chronic peripheral nerve injuries
Special investigations
Neurapraxia and axonotmesis
Neurotmesis
Nerve transfers
Tendon transfers
Brachial plexus injuries
Upper trunk lesions (Erb’s paralysis)
T1 injury (Klumpke’s paralysis)
Radial nerve injuries (Figure 19.1a)
Median nerve injuries (Figure 19.1b)
Median nerve compression at the wrist (carpal tunnel syndrome)
Ulnar nerve injuries (Figure 19.2)
Ulnar nerve compression at the elbow (cubital tunnel syndrome)
Differential diagnosis of flexion deformities of the fingers
Ulnar nerve lesion
Dupuytren’s contracture
Volkmann’s contracture due to ischaemic fibrosis of flexors of the fingers
Congenital contracture
Mallet finger
Trauma
Sciatic nerve injuries
Common peroneal nerve injuries
Lateral cutaneous nerve of the thigh compression: meralgia paraesthetica
Cervical sympathetic nerve injuries: Horner’s syndrome
Additional resources
Chapter 20 The oral cavity
The oral cavity
Embryology
Facial prominences
Development of the tongue
Embryology of teeth
Congenital disease of the oral cavity and lips
Cleft lip and palate
Aetiology
Manifestations
Embryology and anatomy
Cleft lip
Cleft palate
Management of clefts
Acquired disease of the oral cavity and lips
Dental disease
Dental caries
Dental abscess
Cysts and tumours of dental origin
Non-malignant disease of oral mucosa and oral cavity
Lesions of the cutaneous lip
Infective lesions
Non-infective lesions
Lesions of the oral mucosa including lip mucosa
Infective oral ulceration
Non-infective oral ulceration
Potential malignant disorders of the mouth
Lichen planus
Candidiasis
Leukoplakia
Intraoral pigmented lesions
Haemangioma
Intraoral lumps
Mucocele
Ranula
Trauma-induced hyperplasia
Fibroepithelial polyp
Malignant disease of the cutaneous lip
Surgical excision of lesions of the lip
Malignant disease of oral mucosa and oral cavity
Squamous cell carcinoma of the oral cavity
Other cancers of the oral cavity
Tumours adjacent to the oral cavity
Reconstructive surgery in head and neck cancer
Reconstructive ladder
Complications of surgery
Adjunctive therapy for oral SCC
Additional resources
Chapter 21 The salivary glands
Inflammation
Aetiology
Viral infections
Mumps
Acute bacterial parotitis
Clinical features
Treatment
Chronic recurrent parotid sialadenitis
Treatment
Sjögren’s syndrome
Calculi
Clinical features
Special investigations
Treatment
Salivary tumours
Benign
Malignant
Pleomorphic adenoma
Pathology
Adenolymphoma
Carcinoma
Clinical features
Treatment
Additional resources
Chapter 22 The oesophagus
Dysphagia
Local causes
Investigations
Perforations of the oesophagus
Classification
Clinical features
Special investigations
Treatment
Caustic stricture of the oesophagus
Treatment
Achalasia of the cardia
Clinical features
Special investigations
Treatment
Plummer–Vinson syndrome
Treatment
Oesophageal diverticula
Other oesophageal diverticula
Pharyngeal pouch
Clinical features
Treatment
Reflux oesophagitis
Special investigations
Differential diagnosis
Treatment
Tumours of the oesophagus
Classification
Carcinoma
Pathology
Spread
Clinical features
Special investigations
Differential diagnosis
Treatment
Barrett’s oesophagus and adenocarcinoma
Additional resources
Chapter 23 The stomach and duodenum
Congenital hypertrophic pyloric stenosis
Aetiology
Clinical features
Differential diagnosis
Management
Surgical treatment (Ramstedt’s pyloromyotomy)1
Duodenal atresia
Aetiology
Epidemiology
Differential diagnosis
Treatment
Peptic ulcer
Pathology
The acute peptic ulcer
The chronic peptic ulcer
Clinical features
Special investigations
Treatment
Complications of peptic ulceration
Perforated peptic ulcer
Pathology
Clinical features
Special investigations
Differential diagnosis
Treatment
Prognosis
Pyloric stenosis
Pathology
Clinical features
Special investigations
Biochemical disturbances
Differential diagnosis
Treatment
Gastrointestinal haemorrhage
Management
Assessment of the patient
Aetiology
Bleeding peptic ulcer
Overview
Management (Table 23.1)
Indications for surgery
Gastroparesis
Symptoms
Causes
Special investigations
Treatment
Gastric volvulus
Classification of gastric volvulus
Epidemiology
Symptoms
Acute gastric volvulus
Chronic gastric volvulus
Complications
Special investigations
Management
Gastric tumours
Classification
Epidemiology
Gastric polyps
Symptoms
Special investigation
Treatment
Gastrointestinal stromal tumours
Pathology
Aetiology
Clinical features
Special investigations
Treatment
Gastric lymphoma
Gastroenteropancreatic neuroendocrine tumours (GEP-NETs)
Gastric carcinoma
Aetiology and risk factors
Pathology
Early and advanced gastric carcinoma
Endoscopic gastric cancer screening
Treatment of gastric cancer
Additional resources
Chapter 24 The surgery of obesity
Obesity
Prevalence
Aetiology
Consequences of obesity
Treatments for obesity
Chapter 25 The small intestine
Meckel’s diverticulum
Clinical features
Special investigations
Crohn’s disease
Aetiology
Pathology
Clinical features
Special investigations
Complications outside the gastrointestinal tract
Treatment
Medical management
Surgical management
Prognosis
Tumours of the small intestine
Classification
Neuroendocrine tumours
Pathology
Clinical features
Special investigations
Treatment
Additional resources
Chapter 26 The appendix
Embryology and anatomy
Histology
Acute appendicitis
Aetiology and pathology
Clinical features
History
Examination
Atypical presentation
Special investigations
Differential diagnosis of RIF pain
Management of acute appendicitis
Appendicectomy
Conservative treatment
Appendiceal abscess
Appendix mass (Box 26.2)
Interval appendicectomy
Appendiceal neoplasms
Appendiceal neuroendocrine neoplasms
Mucinous neoplasms of the appendix
Pseudomyxoma peritonei
Goblet cell adenocarcinomas
Appendiceal adenocarcinoma
Additional resources
Chapter 27 The colon
Constipation and diarrhoea
Constipation
Diarrhoea
Diverticular disease
Background (Table 27.1)
Pathogenesis
Complications of diverticula
Clinical features
Treatment
Angiodysplasia
Clinical features
Special investigations
Treatment
Colitis
Ulcerative colitis
Crohn’s colitis
Tumours
Classification
Familial adenomatous polyposis
Hereditary non-polyposis colon cancer (HNPCC)
Differential diagnosis
Colostomy
Indications for colostomy formation
Types of colostomy
Complications of colostomy formation
Stoma appliances: principles
Management of a colostomy
Additional resources
Chapter 28 The rectum and anal canal
Bright red rectal bleeding ( Table 28.1)
General causes
Local causes
Haemorrhoids
Functional anatomy
Classification
Pathology
Grading haemorrhoids
Predisposing factors
Clinical features
Complications
Treatment
Thrombosed strangulated haemorrhoids
Specific complications of haemorrhoid surgery
Anal fissure
Clinical features
Treatment
Anorectal abscesses
Classification (Figure 28.2)
Treatment
Anal fistula
Definitions
Aetiology
Anatomical classification (Figure 28.3)
Clinical features
Treatment
Stricture of the anal canal
Classification
Treatment
Prolapse of the rectum
Treatment
Pruritus ani
Treatment
Faecal incontinence
Treatment
Tumours
Pathology
Rectal polyps
Carcinoma of the rectum
Pathology
Spread
Staging
Prognosis
Clinical features
Local symptoms
Examination
Special investigations
Differential diagnosis of a rectal cancer
Treatment
Surveillance
Palliative procedures
Anal cancer
Pathology
Clinical features
Special investigations
Treatment
Additional resources
Chapter 29 The acute abdomen
Aetiology
Clinical assessment
Special investigations
Principles of treatment
Non-surgical treatment
Surgery
Peritonitis
Aetiology
Pathology
Clinical features
Primary peritonitis
Secondary peritonitis
Tertiary peritonitis
Special causes of peritonitis
Peritoneal dialysis peritonitis
Pneumococcal peritonitis
Haemolytic streptococcal peritonitis
Staphylococcal peritonitis
Tuberculous peritonitis
Biliary peritonitis
Mesenteric ischaemia
Pathophysiology
Aetiology
Acute mesenteric arterial embolism
Acute mesenteric arterial thrombosis
Mesenteric venous thrombosis
Low blood flow states
Other causes of mesenteric ischaemia
Clinical features
Chapter 30 Intestinal obstruction and paralytic ileus
Mechanical obstruction
Classification
Pathology
Clinical features
Clinical examination
Simple obstruction versus strangulating obstruction
Special investigations
Treatment
Closed loop obstruction
Adhesive obstruction
Volvulus
Definition
Aetiology
Sigmoid volvulus
Caecal volvulus
Small intestine volvulus in adults
Volvulus neonatorum
Neonatal intestinal obstruction
Classification
Intestinal atresia
Anorectal atresias
Hirschsprung’s disease
Volvulus neonatorum
Necrotizing enterocolitis
Meconium ileus
Distal intestinal obstruction syndrome
Clinical features
Treatment
Intussusception
Definition
Terminology
Aetiology
Clinical features in infants
Treatment in infants
Paralytic ileus
Aetiology
Postoperative ileus
Sequelae
Clinical features
Differential diagnosis
Treatment
Pseudo-obstruction
Treatment
Additional resources
Chapter 31 Hernia
Definition
Abdominal wall hernias
Aetiology
Varieties
Clinical features
Inguinal hernia
Anatomy (Figure 31.2)
Indirect inguinal hernia
Direct inguinal hernia
Treatment
Femoral hernia
Anatomy
Clinical features
Richter’s hernia
Treatment
Umbilical hernia
Exomphalos
Treatment
Congenital umbilical hernia
Treatment
Paraumbilical hernia
Treatment
Divarication of the recti
Epigastric hernia
Treatment
Incisional hernia
Treatment
Differential diagnosis of midline hernia
Endometrioma of the abdominal wall
Unusual hernias
Obturator hernia
Spigelian hernia
Gluteal hernia
Sciatic hernia
Lumbar hernia
Parastomal hernia
Diaphragmatic hernias
Congenital diaphragmatic hernia
Traumatic diaphragmatic hernias
Acquired hiatal hernias
Classification
Clinical features
Treatment
Reflux oesophagitis
Additional resources
Chapter 32 The liver
Liver enlargement
Physical signs
Causes of hepatomegaly
Jaundice
Bilirubin metabolism (Figure 32.1)
Classification and pathogenesis
Prehepatic jaundice
Hepatic jaundice
Posthepatic (obstructive) jaundice
Causes
Diagnosis
History
Examination
Special investigations ( Table 32.1)
Summary of investigations of jaundice
Congenital abnormalities
Riedel’s lobe
Polycystic liver
Liver trauma
Clinical features
Treatment
Acute infections of the liver
Pyogenic liver abscess
Amoebic liver abscess
Hydatid disease of the liver
Pathology
Clinical features
Special investigations
Treatment
Cirrhosis
Definition
Aetiology
Consequences of cirrhosis
Clinical features of cirrhosis
The effects of liver failure
Clinical features
Special investigations
Treatment
Management of haemorrhage from gastro-oesophageal varices
Prophylaxis against haemorrhage
Establishing the diagnosis
Immediate treatment
Stopping the haemorrhage
Treatment of ascites
Hepatorenal syndrome
Liver neoplasms
Classification
Hepatocellular carcinoma
Pathology
Clinical features
Special investigations
Treatment
Cholangiocarcinoma
Metastases
Treatment of secondary tumours
Liver surgery
Anatomical considerations
Surgical resections
Additional resources
Chapter 33 The gallbladder and bile ducts
Congenital anomalies
Cholelithiasis (gallstones)
Bile composition and function
Gallbladder physiology
Gallstone types
Cholesterol stones
Pigment stones
Mixed stones
The pathological effects of gallstones
Clinical manifestations of gallstones
Biliary colic
Acute cholecystitis
Chronic cholecystitis
Stones in the common bile duct (choledocholithiasis)
Ascending cholangitis
Courvoisier’s law4 (Figure 33.4)
Special investigations
Treatment
Complications of cholecystectomy
Gallbladder polyps
Pathology
Clinical features
Treatment
Carcinoma of the gallbladder
Pathology
Clinical features
Treatment
Cholangiocarcinoma
Pathology
Clinical features
Treatment
Additional resources
Chapter 34 The pancreas
Congenital anomalies
Annular pancreas
Heterotopic pancreas
Acute pancreatitis
Aetiology
Pathology
Macroscopic pathology
Clinical features
Differential diagnosis
Special investigations
Management
Severe acute pancreatitis
Supportive treatment
Surgery
Prognosis
Complications
Chronic pancreatitis
Aetiology
Clinical features
Special investigations
Treatment
Pancreatic cysts
Classification
Clinical features
Treatment
Pancreatic tumours
Classification
Pancreatic neuroendocrine tumours
Types of tumours
Insulinoma ( -cell tumour)
Diagnosis: Whipple’s triad10
Special investigations
Treatment
Gastrinoma (Zollinger–Ellison syndrome,11 non--cell islet tumour)
Special investigations
Treatment
Pancreatic carcinoma
Pathology
Spread
Clinical features
Examination
Special investigations
Differential diagnosis
Treatment
Prognosis
Additional resources
Chapter 35 The spleen
Splenomegaly
Physical signs
Classification
Splenectomy
Complications of splenectomy
Ruptured spleen
Clinical features
Special investigations
Treatment
Additional resources
Chapter 36 The lymph nodes and lymphatics
The lymphadenopathies
Classification
Generalized
Clinical examination
Special investigations
Lymphoedema
Primary lymphoedema
Secondary lymphoedema
Special investigations
Differential diagnosis
Treatment of lymphoedema
Conservative
Additional resources
Chapter 37 The breast
Developmental anomalies
Accessory nipples and breasts
Hypoplasia or absence of the breast
Tuberous breasts
Nipple inversion
Symptoms of breast disease
A lump in the breast
Management
Discharge from the nipple
Management
Pain in the breast (mastalgia)
Traumatic fat necrosis
Aetiology
Clinical features
Treatment
Acute inflammation of the breast (mastitis)
Acute bacterial mastitis
Clinical features
Treatment
Periductal mastitis
Clinical features
Chronic inflammatory conditions of the breast
Benign breast disease
Cystic disease
Sclerosing adenosis
Fibroadenoma
Intraductal papilloma
Hamartoma
Gynaecomastia
Clinical features
Treatment
Phyllodes tumour
Clinical features
Treatment
Carcinoma of the breast
Aetiology
Hormonal factors
Genetic factors
Other factors
Classification
Pathology
Rare types of breast cancer
Spread
Prognostic factors
Clinical features
Special investigations
Treatment
Surgical management
Tumour excision
Complications
Surgical management of the axilla
Breast reconstruction
Systemic therapy
Adjuvant radiotherapy
Survival
Paget’s disease of the nipple
Presentation
Treatment
Inflammatory breast cancer
Patients unfit for surgery
Metastatic disease
Carcinoma of the male breast
Breast screening
Prophylactic mastectomy
Additional resources
Chapter 38 The neck
Branchial cyst and sinus
Anatomy
Aetiology
Clinical features
Investigation
Treatment
Tuberculous cervical adenitis
Clinical features
Differential diagnosis
Treatment
Carotid body tumour (chemodectoma)
Pathology
Clinical features
Special investigations
Treatment
Additional resources
Chapter 39 The thyroid
Congenital anomalies
Embryology
Lingual thyroid
Thyroglossal cyst
Treatment
Thyroid physiology
Physiological control of secretion
Pharmacological control of secretion
Pathology of goitre
Multinodular goitre
Colloid goitre
Hyperplasia
Clinical features in thyroid disease
The thyroid swelling
Retrosternal goitre
Tracheal displacement
Vocal cord integrity
Regional nodes
The physiological state of the patient
Hyperthyroidism
History
Examination
Aetiology
Hypothyroidism
Congenital hypothyroidism
Adult hypothyroidism
Hashimoto’s disease
Treatment
Riedel’s thyroiditis
De Quervain’s thyroiditis
Investigations in thyroid disease
Clinical classification of thyroid swellings
Outline of treatment of goitre
Euthyroid nodular enlargement
Hyperthyroidism
Antithyroid drugs
-Adrenergic blocking drugs
Drugs and surgery combined
Radioactive iodine
Complications of thyroidectomy
Hypoparathyroidism
Thyroid crisis
Recurrent laryngeal nerve injury
Haemorrhage
Thyroid tumours
Classification
Benign adenoma
Thyroid carcinoma
Pathology
Clinical features
Treatment of differentiated thyroid cancer
Radioiodine ablation (RAI)
TSH suppression
Thyroglobulin
Additional resources
Chapter 40 The parathyroids
Anatomy and development
Physiology
Effects of increased PTH production
Hypoparathyroidism
Clinical features
Hyperparathyroidism
Primary hyperparathyroidism
Pathology
Parathyroid carcinoma
Secondary hyperparathyroidism
Tertiary hyperparathyroidism
Ectopic PTH production
Clinical features of hyperparathyroidism
Special investigations
Medical management
Indications for surgery
Bilateral neck exploration
Unilateral neck exploration
Focused parathyroidectomy
Minimally invasive parathyroidectomy
Complications of parathyroid surgery
Management of persistent or recurrent primary hyperparathyroidism
Additional resources
Chapter 41 The thymus
Tumours
Clinical features
Treatment
Myasthenia gravis
Clinical features
Treatment
Chapter 42 The adrenal glands
Physiology
Adrenal cortex
Adrenal medulla
Pathology
Enzyme disorders
Cushing’s syndrome
Clinical features
Special investigations
Treatment
Primary hyperaldosteronism (Conn’s syndrome)
Special investigations
Treatment
The adrenogenital syndromes (Figure 42.1)
Congenital adrenogenital syndrome
Acquired adrenogenital syndrome
Clinical features
Differential diagnosis
Treatment
Non-functioning tumours of the adrenal cortex
Adrenocortical carcinoma
Special investigations
Treatment
Adrenomedullary tumours
Classification
Phaeochromocytoma and paraganglioma (PPGL)
Clinical features
Special investigations
Treatment
Ganglioneuroma
Adrenal ‘incidentaloma’
Special investigations
Hypertension
Classification
Renovascular hypertension
Mechanism of renal hypertension (Figure 42.3)
Unilateral renal diseases producing hypertension
Additional resources
Chapter 43 The kidney and ureter
Congenital anomalies
Embryology (Figure 43.1)
Common renal anomalies (Figure 43.2)
Horseshoe kidney
Duplex system
Polycystic disease
Pathology
Presentation of adult polycystic kidney disease
Special investigations
Treatment
Renal cysts
Clinical features
Special investigations
Treatment
Haematuria
Classification
Management
Injury to the kidney
Clinical features
Special investigations
Treatment
Hydronephrosis
Pathology
Clinical features
Complications
Special investigations
Treatment
Urinary tract calculi
Aetiology
Composition of urinary calculi
Clinical features (Figure 43.4)
Special investigations
Complications
Treatment
Acute ureteric colic
Treatment of the cause
Urinary tract infections
Cystitis
Special investigations
Treatment
Reflux nephropathy
Vesicoureteric reflux
Intrarenal reflux
Clinical features
Special investigations
Treatment
Pyonephrosis
Special investigations
Treatment
Renal abscess
Clinical features
Special investigations
Treatment
Renal tuberculosis
Pathology
Clinical features
Special investigations
Treatment
Renal failure
Acute kidney injury
Aetiology
Clinical features
Special investigations
Management
Replenish the intravascular volume
Diuretics
Hyperkalaemia
Acute tubular necrosis
Pathology
Clinical features
Treatment
Chronic renal failure
Renal tumours
Classification
Nephroblastoma (Wilms’ tumour)
Pathology
Clinical features
Special investigations
Treatment
Renal cell carcinoma
Pathology
Spread
Clinical features
Treatment
Tumours of the renal pelvis and ureter
Clinical features
Treatment
Additional resources
Chapter 44 The bladder
Congenital anomalies
Embryology
Urachal anomalies
Treatment
Bladder exstrophy (ectopia vesicae)
Treatment
Rupture of the bladder
Intraperitoneal rupture
Extraperitoneal rupture
Clinical features
Special investigations
Treatment
Diverticulum of the bladder
Complications
Clinical features
Special investigations
Treatment
Bladder stone
Aetiology
Clinical features
Special investigations
Treatment
Bladder tumours
Pathology
Urothelial carcinoma
Aetiology
Pathology
Clinical features
Special investigations
Treatment
Staging
Low-risk non-muscle-invasive cancers
High-risk non-muscle-invasive cancers
Muscle-invasive cancers
Additional resources
Chapter 45 The prostate
Benign prostatic enlargement
Pathology
Clinical features
Lower urinary tract symptoms
Symptoms of the sequelae
Examination
Special investigations
Treatment
Complications of prostatectomy
Urinary retention
Causes of urinary retention
Clinical features
Special investigations
Treatment
Bladder neck obstruction
Posterior urethral valves
Failure of bladder neck relaxation
Treatment
Prostatitis
Clinical features
Prostate cancer
Pathology
Clinical features
Special investigations
The role of PSA in diagnosis
Multiparametric magnetic resonance imaging
Prostate biopsy
Treatment
Metastatic prostate cancer
Additional resources
Chapter 46 The male urethra
Anatomy
Congenital anomalies
Hypospadias
Epispadias
Posterior urethral valves (see also Chapter 45)
Urethral injury and trauma in the male
Anterior urethral injuries
Posterior urethral injuries
Clinical features
Special investigations
Management
Complications
Urethral stricture
Clinical features
Special investigations
Treatment
Chapter 47 The penis
Phimosis
Clinical features
Treatment
Paraphimosis
Treatment
Balanitis
Treatment
Penile cancer
Pathology
Clinical features
Treatment
Erectile dysfunction
Aetiology
Examination
Special investigations
Treatment
Additional resources
Chapter 48 The testis and scrotum
Abnormalities of testicular descent
Embryology
Classification of maldescent
Differential diagnosis: the retractile testis
Treatment
Complications of maldescent
Scrotal swelling
Examination
Special investigation
Epididymal cysts
Hydrocoele
Primary or idiopathic hydrocoele (Figure 48.2)
Secondary hydrocoele
Treatment
Acute infections of the testis and epididymis
Blood-borne infection
Ascending infection
Clinical features
Treatment
Differential diagnosis
Chronic infections of the testis
Gumma
Tuberculosis
Torsion of the testis
Aetiology
Clinical features
Differential diagnosis
Treatment
Varicocoele
Clinical features
Treatment
Disorders of the scrotal skin
Idiopathic scrotal oedema
Fournier’s gangrene
Carcinoma of the scrotum
Tumours of the testis
Aetiology
Pathology
Seminoma
Non-seminomatous germ cell tumour
Spread
Clinical presentation
Special investigations
Treatment
Prognosis
Male infertility
Aetiology
Clinical features
Special investigations
Treatment
Additional resources
Chapter 49 Transplantation surgery
Historical background
Classification of grafts
Organ donors
Living donors
Deceased donors
Exclusions to organ donation
Organ preservation
Cold storage
Hypothermic machine perfusion
Normothermic machine perfusion
Organ recipients
The immunology of organ transplantation
The major histocompatibility complex
The human leucocyte antigen system
Organ matching
ABO matching
Lymphocytotoxic cross-match
MHC matching
Rejection
Hyperacute rejection
Acute rejection
Chronic rejection
Principles of immunosuppressive therapy
Complications of transplantation
Early complications
Late complications
Malignancy post-transplant
Results of clinical organ transplantation
Kidney transplantation
Pancreas transplantation
Liver transplantation
Heart, lung and combined heart–lung transplantation
Additional resources
Index
EULA