Principles and Practice of Surgery, 7th Edition

Front Cover
Inside Front Cover
Principles and Practice of Surgery
Copyright
Contents
Preface
Acknowledgements
Contributors
International Advisory Board
Section 1: Principles of perioperative care
Chapter 1: Metabolic response to injury, fluid and electrolyte balance and shock
The metabolic response to injury
Features of the metabolic response to injury
Factors mediating the metabolic response to injury
The acute inflammatory response
The endothelium and blood vessels
Afferent nerve impulses and sympathetic activation
The endocrine response to surgery
Consequences of the metabolic response to injury
Hypovolaemia
Fluid-conserving measures
Blood flow-conserving measures
Increased energy metabolism and substrate cycling
Thermogenesis
Basal metabolic rate
Catabolism and starvation
Catabolism
Carbohydrate metabolism
Fat metabolism
Protein metabolism
Starvation
Changes in red blood cell synthesis and coagulation
Anabolism
Factors modifying the metabolic response to injury
Fluid and electrolyte balance
Normal water and electrolyte balance
Assessing losses in the surgical patient
Insensible fluid losses
The effect of surgery
The stress response
'Third-space' losses
Loss from the gastrointestinal tract
Intravenous fluid administration
Types of intravenous fluid
Crystalloids
Dextrose-saline solutions
Colloids
Maintenance fluid requirements
Treatment of postoperative hypovolaemia and/or hypotension
Specific water and electrolyte abnormalities
Sodium and water
Water depletion
Water excess
Hypernatraemia
Hyponatraemia
Potassium
Hyperkalaemia (K >5.5mmol/L)
Hypokalaemia (<3.0mmol/L)
Other electrolyte disturbances
Calcium
Magnesium
Phosphate
Acid-base balance
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Shock
Definition
Classification of shock
Hypovolaemic shock
Septic shock
Cardiogenic shock
Anaphylactic shock
Neurogenic shock
Pathophysiology
Macrocirculation
Microcirculation
Cellular function
The effect of shock on individual organ systems
Cardiovascular
Respiratory
Renal
Nervous system
Gastrointestinal
Hepatobiliary
Management
General principles
Airway and breathing
Circulation
Hypovolaemic shock
Septic shock
Cardiogenic shock
Anaphylactic shock
Chapter 2: Transfusion of blood components and plasma products
Introduction
Blood donation
Blood components
Red blood cells in additive solution
Platelets
Fresh frozen plasma (FFP)
Cryoprecipitate
Plasma products
Human albumin
Factor VIII and factor IX concentrates
Prothrombin complex concentrates
Immunoglobulin preparations (90% IgG)
Red cell serology
ABO antigens
Rhesus antigens (RH)
Other red cell antigens
Pretransfusion testing
Maximal surgical blood ordering schedule (MSBOS)
Indications for transfusion
Blood administration
Adverse effects of transfusion
Autologous transfusion
Preoperative donation
Isovolaemic haemodilution
Cell salvage
Transfusion requirements in special surgical settings
Blood component use in major haemorrhage
Cardiopulmonary bypass
Methods to reduce the need for blood transfusion
Acute volume replacement
Mechanisms for reducing blood use in surgery
Preoperative
Intraoperative
Postoperative
Better blood transfusion
Future trends
Chapter 3: Nutritional support in surgical patients
Introduction
Assessment of nutritional status
Assessment of nutritional requirements
Causes of inadequate intake
Methods of providing nutritional support
Enteral nutrition
Oral route
Methods of administration of enteral feeds
Nasogastric or nasojejunal tubes
Gastrostomy and jejunostomy
Complications of enteral nutrition
Parenteral nutrition
Indications for total parenteral nutrition
Composition of total parenteral nutrition solutions
Administration of total parenteral nutrition
Complications of total parenteral nutrition
Catheter problems
Thrombophlebitis
Infection
Metabolic complications
Peripheral venous nutrition
Monitoring of nutritional support
Chapter 4: Infections and antibiotics
Importance of infection
Biology of infection
Bacterial factors
Host defence systems
Preventing infection in surgical patients
Preoperative MRSA screening
Aseptic technique
Hand decontamination
Personal protective equipment for staff
Skin preparation
Surgical instruments
Maintaining patient homeostasis
Creutzfeldt-Jakob disease and other prion diseases
Prophylactic use of antibiotics
Timing and dose
Antibiotic choice
Carriage of resistant organisms and prophylaxis
Prophylaxis for immunosuppressed patients
Management of surgical infections
Diagnosis
Antibiotic therapy
Specific infections in surgical patients
Surgical site infection (SSI)
Diagnosis
Treatment
Prevention
Urinary tract infections
Emergence of multiresistant bacteria
Respiratory tract infections
C. difficile infection (CDI)
Diagnosis
Treatment
Infection control
Fungal infections
Risk factors
Infections of prosthetic devices
Infections primarily treated by surgical management
Abscess
Necrotising fasciitis
Diabetic foot infections
Gas gangrene
Infections following trauma
Tetanus
Healthcare-associated infections
Chapter 5: Ethics, preoperative considerations, anaesthesia and analgesia
Ethical and legal principles for surgical patients
Principles in surgical ethics
Principalism
Autonomy
Beneficence: doing good
Nonmalfeasance: avoiding harm
Justice: promoting fairness
Informed consent
General considerations
Consent in specific circumstances
Children
Mental illness
Transient/irreversible cognitive impairment
Confidentiality
Specific topics
Euthanasia and 'end-of-life' issues
Abortion
Negligence
Human Tissue Act
Completion of a death certificate
Postmortem examination
Research governance
Ethics committees
Preoperative assessment
Assessment of operative fitness and perioperative risk
Perioperative medicine
Oxygen delivery in minimising operative risk
Systematic preoperative assessment
Cardiovascular system
Respiratory system
Smoking
Preoperative exercise
Alcohol
Nutritional status
Obesity
Drug therapy
Long-term steroid therapy
Antiplatelet therapy and anticoagulants
Oral contraceptives and hormone-replacement therapy
Psychiatric drugs
Allergies
Pregnancy
Previous operations and anaesthetics
Preoperative investigations
Haematology
Full blood count
Coagulation screen
Cross-matching
Biochemistry
Urea and electrolytes
Liver function tests
Cardiac investigations
Respiratory investigations
Cardiopulmonary exercise testing
Patients where there is increased risk of transmission of blood borne viruses or other infection
Preoperative screening for methicillin-resistant Staphylococcus aureus or other resistant organisms
Assessment of the patient for emergency surgery
Preoperative review
Venous thromboembolism prophylaxis
Antibiotic prophylaxis
Preoperative anxiolytic medication
Preoperative fasting
Perioperative implications of chronic disease
Cardiovascular disease
Ischaemic heart disease
Myocardial infarction
Heart failure
Valvular heart disease
Pacemakers
Hypertension
Perioperative management of patients with cardiovascular disease
Drug therapy
β-Blockers
Angiotensin-converting enzyme (ACE) inhibitors
Perioperative haemodynamic therapy
Respiratory disease
Anaesthetic technique
Intraoperative ventilatory management
Postoperative analgesia
Physiotherapy
Postoperative ventilation
Diabetes mellitus
Diabetic comorbidity
Vascular disease
Renal disease
Neuropathy
Infection
Effect of surgical stress on diabetic control
Principles of perioperative diabetes management
Methods of insulin administration
Chronic renal failure
Dialysis-dependent patients
Nondialysis-dependent patients
Jaundice
Hepatitis
Coagulopathy
Acute renal failure
Cirrhosis
Abnormal coagulation
Anticoagulant therapy
Inherited disorders of coagulation
Acquired coagulopathy
Anaemia
Musculoskeletal disease
Miscellaneous conditions
Anaesthesia and the operation
Anaesthesia
General anaesthesia
Local anaesthetic agents
Spinal and epidural anaesthesia
Spinal anaesthesia
Epidural anaesthesia
Peripheral nerve block
Local infiltration
Topical anaesthesia
Postoperative analgesia
Pain assessment
Postoperative analgesic strategy
Epidural analgesia
Patient-controlled analgesia
Parenteral and oral opioid regimens
Strong opioids
Weak opioids
Paracetamol and NSAIDs
Ketamine
Neuropathic pain
Postoperative nausea and vomiting
Day surgery
Facilities
Patient pathway
Admission for day surgery
Discharge criteria
Chapter 6: Principles of the surgical management of cancer
The biology of cancer
Carcinogenesis
Invasion and metastasis
Natural history and estimate of cure
The management of patients with cancer
Screening
Screening for inherited cancer
The cancer patient's journey
Symptoms that may initiate a patients 'cancer journey'
Local effects
Systemic effects
Consultation with the GP
Referral to a specialist/cancer centre
Investigations
Diagnostic investigations
Staging investigations
Treatment
Benign tumours
Malignant tumours
Adjuvant treatment
Surgery for metastases
Follow-up
Palliation of advanced cancer
Prognosis and counselling
Care of the dying
Chapter 7: Trauma and multiple injury
Introduction
The importance of trauma
The 'golden hour'
The 'platinum 10 minutes'
Temporal distribution of trauma deaths
Mechanisms of injury
Blunt trauma
Penetrating trauma
Miscellaneous trauma
Injury severity
Purpose
Limitations
Trauma scoring systems
Physiological scores
The Glasgow Coma Scale (GCS)
Revised Trauma Score (RTS)
Anatomical scores
Abbreviated Injury Scale (AIS)
Injury Severity Score (ISS)
Combination scores
Trauma Related Injury Severity Score (TRISS)
Trauma systems, centres and teams
Trauma system
Trauma Centres
Trauma team
Shock
Definition
Classification of shock
Management of shock
Resuscitation
Definition
ATLS history
ATLS in practice
ATMIST handover from prehospital team to trauma team
Primary survey
Catastrophic haemorrhage
Practical tips and tricks
Secondary survey
Tertiary survey
Airway management in the trauma patient
Vascular access in the trauma patient
ABCDE: initial management options of the common life-threatening conditions
Fluid resuscitation
Imaging
Plain radiography
Ultrasound
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Interventional radiology (IR)
Specialised imaging studies
Critical decision-making
Incisions and decisions
'Bad thoughts lead to good outcomes'
Subdivide trauma patients by physiology
The trauma patient in extremis
Surgery for trauma
Damage control surgery
Trauma laparotomy
Identification and management of abdominal injury
Retroperitoneal haematoma
Trauma laparotomy sequence
Trauma thoracotomy
Surgical access to the chest
Surgical strategy in the chest
Emergency room thoracotomy (ERT)
Junctional zone trauma
Chapter 8: Practical procedures and patient investigation
Introduction
General precautions
Aseptic technique
Local anaesthesia
Suturing
Suture materials
Nonabsorbable sutures
Absorbable sutures
Suturing the skin
Airway procedures
Maintaining the airway
Procedure
Ventilation by mask
Procedure
The laryngeal mask airway
Procedure
Endotracheal intubation
Procedure
Surgical airway
Procedure
Changing a tracheostomy tube
Procedure
Thoracic procedures
Intercostal tube drainage
Procedure
Removal of an intercostal drainage tube
Procedure
Pleural aspiration
Procedure
Abdominal procedures
Nasogastric tube insertion
Procedure
Fine-bore nasogastric tubes
Procedure
Oesophageal tamponade
Procedure
Abdominal paracentesis
Procedure
Vascular procedures
Venepuncture
Procedure
Safety measures
Venepuncture for blood culture
Procedure
Peripheral venous cannulation
Procedure
Venous cut-down
Procedure
Central venous catheter insertion
Internal jugular vein cannulation
Procedure
Subclavian vein cannulation
Procedure
Peripherally-inserted central venous catheter (PICC line)
Procedure
Arterial blood sampling
Procedure
Needle pericardiocentesis
Procedure
Urinary procedures
Urethral catheterisation
Procedure in the male
Procedure in the female
Suprapubic catheterisation
Procedure
Central nervous system procedures
Lumbar puncture
Procedure
Excision of lumps and swellings (e.g., sebaceous cyst, lipoma, dermoid, lymph node)
Imaging
Plain radiography
Contrast studies
Computed tomography (CT)
Ultrasonography
Magnetic resonance imaging (MRI)
Radioisotope imaging
Positron emission tomography (PET)
Chapter 9: Postoperative care and complications
Introduction
Immediate postoperative care
Airway obstruction
Haemorrhage
Surgical ward care
General care
Tubes, drains and catheters
Fluid balance
Blood transfusion
Nutrition
Complications of anaesthesia and surgery
General complications
Pulmonary complications
Postoperative hypoxaemia
Pulmonary collapse
Pulmonary infection
Respiratory failure
Acute respiratory distress syndrome (ARDS)
Pleural effusion
Pneumothorax
Cardiac complications
Myocardial ischaemia/infarction
Cardiac failure
Arrhythmias
Postoperative shock
Urinary complications
Postoperative urinary retention
Urinary tract infection
Renal failure
Cerebral complications
Cerebrovascular accidents (CVA)
Neuropsychiatric disturbances
Delirium tremens (acute alcohol withdrawal syndrome)
Venous thrombosis and pulmonary embolism
Deep venous thrombosis (DVT)
Pulmonary embolism
Wound complications
Infection
Dehiscence
Postoperative fever
Chapter 10: Evidence-based practice and professional development
Introduction
Levels of evidence
Cochrane review
Meta-analysis
Systematic review
Randomised controlled trial
Cohort study
Case-control study:
Case series and case reports
Care pathways and guidelines
Clinical governance
Clinical audit
Quality improvement
Critical appraisal
Continuing professional development
Section 2: Gastrointestinal surgery
Chapter 11: The abdominal wall and hernia
Umbilicus
Developmental abnormalities
Persistent vitello-intestinal duct
Urachus
Umbilical sepsis
Umbilical tumours
Disorders of the rectus muscle
Haematoma of the rectus sheath
Desmoid tumour
Abdominal hernia
Inguinal hernia
Surgical anatomy
Indirect inguinal hernia
Clinical features
Direct inguinal hernia
Clinical features
Management of uncomplicated inguinal hernia
Indirect inguinal hernia
Direct hernia
Sportsmans hernia
Femoral hernia
Surgical anatomy
Clinical features
Surgical repair of femoral hernia
Ventral hernia
Epigastric hernia
Umbilical hernia
Paraumbilical hernia
Incisional hernia
Parastomal hernia
Rare external hernias
Internal hernia
Complications of hernia
Irreducibility
Obstruction
Strangulation
Management of complicated hernia
Chapter 12: The acute abdomen
Introduction
Aetiology
Pathophysiology of abdominal pain
Somatic pain
Visceral pain
Pathogenesis
Inflammation
Peritonitis
Clinical features
Infarction
Clinical features
Perforation
Clinical features
Obstruction
Clinical assessment
History
Site of pain
Nature of pain
Radiation of pain
Onset of pain
Severity of pain
Progression of pain
Movement of pain
Examination
Inspection of the abdomen
Palpation
Percussion
Auscultation
Rectal examination
Specific clinical signs in acute abdominal pain
Murphy's sign
Boas's sign
Grey Turner's and Cullen's signs
Rovsing's sign
Investigations
Blood tests
FBC, C-reactive protein and U&Es
Serum amylase
Liver function tests
Blood gas analysis
Serum calcium
Sickle tests
Blood glucose
Urinalysis
Dipstick testing
Bacteriology
Pregnancy test
Urinary porphobilinogen
Radiological investigations
Plain x-rays
Contrast radiology
Ultrasonography
Computed tomography
Angiography
Endoscopic investigations
Peritoneal investigations
Peritoneal lavage
Laparoscopy
Management
Peritonitis
Primary peritonitis
Postoperative peritonitis
Intraabdominal abscess
Acute appendicitis
Anatomy
Epidemiology
Aetiology
Pathogenesis
Clinical features
History
Examination
Variations in clinical features
Complications
Investigations
Management
Management of an 'appendix mass'
Prognosis
Nonspecific abdominal pain
Gynaecological causes of the acute abdomen
Mittelschmerz and ruptured corpus luteum
Ruptured ectopic pregnancy
Complications of an ovarian cyst
Acute salpingitis
Chapter 13: The oesophagus, stomach and duodenum
Surgical anatomy
Oesophagus
Stomach and duodenum
Surgical physiology
Oesophagus
Stomach
Gastric secretions
History and symptoms
Dysphagia
Odynophagia
Heartburn
Dyspepsia
Regurgitation and vomiting
Abdominal pain
Examination
Investigations
Blood tests
Helicobacter pylori tests
Chest x-ray
Contrast swallow/meal
Endoscopy
Computed tomography
Endoluminal ultrasound
Staging laparoscopy
Positron emission tomography
Manometry and pH studies
Gastric emptying studies
Diagnosis and management: oesophagus
Gastrooesophageal reflux disease and Barrett's oesophagus
Diagnosis and management
Antireflux surgery
Hiatus hernia
Clinical features
Management
Achalasia
Clinical features
Management
Diffuse oesophageal spasm
Management
Nutcracker oesophagus
Pouches
Clinical features
Investigations
Management
Perforation
Aetiology
Intraluminal
Outside the wall
Spontaneous
Clinical features
Investigations
Erect chest x-ray
CT and contrast swallow
Management
Corrosive oesophagitis
Investigations and Management
Tumours of the oesophagus
Benign tumours
Carcinoma of the oesophagus
Clinical features
Investigations
Management
Surgical resection
Postoperative care
Radiotherapy and chemotherapy
Palliation
Diagnosis and management: gastroduodenal
Peptic ulceration
Pathology
Aetiology
Helicobacter pylori
Nonsteroidal antiinflammatory drugs (NSAIDs)
Smoking
Genetic factors
Zollinger-Ellison syndrome
Other factors
Clinical features
Diagnosis
Management of uncomplicated peptic ulcer disease
Medical management
Eradication of H. pylori
Duodenal ulcers
Gastric ulcers
Surgical management
Duodenal ulceration
Gastric ulceration
Complications of peptic ulceration requiring operative intervention
Perforation
Duodenal ulcers
Gastric ulcers
Clinical features
Diagnosis
Management
Duodenal ulcers
Gastric ulcers
Acute haemorrhage
Diagnosis
History and examination
Blood tests
Management
Resuscitation
Detection and endoscopic treatment
Surgical management
Obstruction
Gastric neoplasia
Benign gastric neoplasms
Malignant gastric neoplasms
Gastric carcinoma
Epidemiology
Aetiology
Early gastric cancer
Advanced gastric cancer
Factors affecting survival in advanced gastric cancer
Clinical features of gastric malignancy
Diagnosis
Staging of gastric carcinoma
Treatment with curative intent
Palliation
Prognosis
Other gastric tumours
Lymphomas
Carcinoid tumours
Miscellaneous disorders of the stomach
Ménétriers disease
Gastritis
Dieulafoy's lesion
Bezoars
Miscellaneous conditions of the duodenum
Duodenal obstruction
Surgery for obesity
Operations for obesity and related comorbidities
Complications of obesity surgery
Chapter 14: The liver and biliary tract
The liver
Anatomy
Segmental anatomy
Blood supply and function
Jaundice
Diagnosis
History and clinical examination
Biochemical and haematological investigations
Radiological investigations
Ultrasonography
Magnetic resonance imaging (MRI)
Endoscopic retrograde cholangiopancreatography (ERCP)
Percutaneous transhepatic cholangiography (PTC)
Computed tomography (CT)
Other radiological investigations
Liver biopsy
Laparoscopy
Managing the patient with jaundice
Congenital abnormalities
Liver trauma
Hepatic infections and infestations
Pyogenic liver abscess
Clinical features
Investigations
Management
Amoebic liver abscess
Clinical features
Investigations
Management
Hydatid disease
Clinical features
Investigations
Management
Portal hypertension
Effects of portal hypertension
Clinical features
Acute variceal bleeding
Management
Active resuscitation
Endoscopy and control of bleeding
Emergency portosystemic shunting
Types of shunt procedure
Prevention of further bleeding
Ascites
Tumours of the liver
Benign hepatic tumours
Cavernous haemangioma
Biliary hamartoma
Focal nodular hyperplasia (FNH)
Liver cell adenoma
Primary malignant tumours of the liver
Hepatocellular carcinoma (hepatoma)
Clinical features
Investigations
Management
Cholangiocarcinoma
Other primary malignant tumours
Metastatic tumours
Liver resection
Liver transplantation
The gallbladder and bile ducts
Anatomy of the biliary system
Physiology
Bile salts and the enterohepatic circulation
Congenital abnormalities
Biliary atresia
Choledochal cysts
Gallstones
Pathogenesis
Cholesterol stones
Pigment stones
Pathological effects of gallstones
Acute cholecystitis and its complications
Mucocoele
Chronic cholecystitis
Fistulation
Choledocholithiasis
Common clinical syndromes associated with gallstones
Biliary colic
Acute cholecystitis
Management of acute cholecystitis
Chronic cholecystitis
Choledocholithiasis
Courvoisiers law
Other benign conditions of the gallbladder
Cholesterosis
Adenomyomatosis
Acute acalculous cholecystitis
Investigation of patients with suspected gallstones
Blood tests
Plain abdominal x-ray
Ultrasonography
Cholangiography
Surgical treatment of gallstones
Open cholecystectomy
Laparoscopic cholecystectomy
Exploration of the common bile duct
Complications of cholecystectomy
Intraoperative complications
Bleeding
Bile duct injury
Postoperative course
Haemorrhage
Infective complications
Bile leakage
Retained stones
Bile duct stricture
Postcholecystectomy syndrome
Atypical 'biliary' pain
Nonsurgical treatment of gallstones
Management of acute cholangitis
Other benign biliary disorders
Asiatic cholangiohepatitis
Primary sclerosing cholangitis
Tumours of the biliary tract
Carcinoma of the gallbladder
Carcinoma of the bile ducts
Clinical features
Management
Chapter 15: The pancreas and spleen
The pancreas
Surgical anatomy
Surgical physiology
Exocrine function
Endocrine function
Pancreatic pain
Congenital disorders of the pancreas
Pancreatitis
Acute pancreatitis
Aetiology
Gallstone pancreatitis
Alcohol-associated pancreatitis
Other causes
Clinical features of acute pancreatitis
Diagnosis
Radiology
Differentiation between gallstone- and alcohol-associated pancreatitis
Assessment of severity in acute pancreatitis
Management
Conservative treatment
Endoscopic treatment
Surgical treatment
Complications
Infected acute necrotic collection
Percutaneous drainage/debridement
Endoscopic drainage
Surgical debridement
Walled-off pancreatic necrosis
Pseudocyst/pancreatic abscess
Progressive jaundice
Persistent duodenal ileus
Gastrointestinal bleeding
Gastrointestinal ischaemia/fistulae
Prognosis
Chronic pancreatitis
Aetiology
Pathophysiology
Clinical features
Investigations and diagnosis
Management
Conservative management
Endoscopic treatment
Surgical treatment
Tropical pancreatitis
Neoplasms of the exocrine pancreas
Adenocarcinoma of the pancreas
Aetiology
Pathology
Pancreatic ductal adenocarcinoma
Intraductal papillary mucinous neoplasm (IPMN)
Mucinous cystic neoplasm
Serous cystic neoplasm
Metastases
Solid pseudopapillary tumour of the pancreas
Acinar cell carcinoma of the pancreas
Ampullary tumours
Cholangiocarcinoma
Clinical features of pancreatic neoplasms
Investigations and multidisciplinary management (MDM) planning
Curative management
Palliative treatment
Pancreatic neuroendocrine tumours (pNET)
Nonfunctioning pNET
Functioning pNET
Insulinomas
Gastrinomas
Miscellaneous pNET
Multiple endocrine neoplasia type 1
The spleen
Surgical anatomy
Physiology
Circulatory filtration
Immunological function
Haemopoiesis
Indications for splenectomy (nontraumatic)
The purpuras
Idiopathic thrombocytopenic purpura (ITP)
Secondary thrombocytopenia
Haemolytic anaemias
Hereditary spherocytosis
Acquired haemolytic anaemias
Hypersplenism
Segmental portal hypertension (syn. sinistral portal hypertension, left-sided portal hypertension)
Proliferative disorders
Myelofibrosis
Lymphomas
Other tumours
Miscellaneous conditions
Cysts of the spleen
Splenic infarct
Abscess of the spleen
Splenic artery aneurysm
Traumatic splenectomy
Splenic conservation
Other indications for splenectomy
Effects of splenectomy
Postsplenectomy immunisation
Chapter 16: The small and large intestine
Introduction
Surgical anatomy and physiology
Anatomy and function of the small intestine
Anatomy and function of the large intestine and appendix
Clinical assessment of the small and large intestine
Clinical history taking
Examination
Investigation of the luminal gastrointestinal tract
Principles of operative intestinal surgery
Disorders of the appendix
Appendicitis
Appendiceal tumours
Tumours of the appendix
Pseudomyxoma peritonei
Adenocarcinoma of appendix
Inflammatory bowel disease
Crohn's disease
Pathology
Clinical features
Investigations
Management
Medical management
Surgical management
Ulcerative colitis
Pathology
Clinical features
Investigations
Management
Medical
Surgical
Cancer surveillance in ulcerative colitis
Disorders of the small intestine
Small bowel neoplasms
Benign tumours
Malignant tumours
Gastrointestinal stromal tumours (GIST)
Small bowel adenocarcinoma
Lymphoma
Carcinoid tumour
Peutz-Jeghers syndrome
Pathology
Clinical features
Management and surveillance
Meckel's diverticulum
Jejunal diverticulosis
Radiation enteritis
Small bowel ischaemia
Clinical features
Investigations and diagnosis
Management
Chronic mesenteric ischaemia
Small and large bowel obstruction
Pseudoobstruction and nonmechanical gut functional disorder
Paralytic ileus
Pseudoobstruction
Common Disorders in Global Surgical Practice
Round worm infestation
Surgical complications of typhoid fever
Abdominal tuberculosis
Colonic amoebiasis and amoeboma
Non-neoplastic disorders of the large intestine
Colonic diverticular disease
Complicated diverticular disease
Diverticulitis
Perforation
Stricture formation and obstruction
Fistula
Bleeding
Large intestinal ischaemia
Ischaemic colitis
Gangrenous ischaemic colitis
Ischaemic stricture of the colon
Irritable bowel syndrome
Volvulus
Angiodysplasia
Pseudomembranous colitis
Microscopic colitis
Hirschsprung's disease
Acquired megacolon and idiopathic slow-transit constipation
Intestinal stoma and fistula
Stoma
Intestinal fistula
Polyps and polyposis syndromes of the large intestine
Colorectal adenoma
Clinical features
Management
Familial adenomatous polyposis (FAP)
Extracolonic features
Diagnosis and management
Juvenile polyposis syndrome (JPS)
Hyperplastic polyposis syndrome, MUTYH-associated polyposis (MAP) and polymerase proof-reading associated polyposis (PPAP)
Other rare polyposis syndromes
Turcot's syndrome
Cowdens disease
Cronkhite-Canada syndrome
Miscellaneous colorectal polyps
Malignant tumours of the large intestine
Colorectal adenocarcinoma
Aetiology
Diet
Protective agents
Smoking, alcohol and exercise
Inflammatory bowel disease
Genetic susceptibility
Clinical features of established colorectal cancer
Population screening for colorectal cancer
Investigations
Preoperative staging
Management of colorectal adenocarcinoma
Surgery
Elective colorectal resection with curative intent
Emergency colorectal resection
Pathology and staging
Adjuvant therapy
Radiotherapy
Adjuvant chemotherapy
Palliative therapy
Prognosis
Other malignant tumours of the large intestine
Squamous cancer of the large bowel
Carcinoid tumour of the large bowel
Lymphoma
Gastrointestinal stromal tumours (including leiomyosarcoma)
Chapter 17: The anorectum
Introduction
Applied surgical anatomy
Anal musculature and innervation
Anal canal epithelium
The anal (haemorrhoidal) cushions
Lymphatic drainage of the anal canal
Anorectal disorders
Haemorrhoids
Definition
Pathogenesis
Risk factors
Clinical features
Classification
Acute presentation
History
Examination
Management
Nonoperative approaches
Operative approaches
Standard haemorrhoidectomy
Stapled haemorrhoidectomy/haemorrhoidopexy/anopexy
Haemorrhoidal artery ligation operation (HALO)
Fissure-in-ano
Definition
Pathogenesis
Aetiology
Paediatric
Clinical features
History
Examination
Management
Nonoperative
Operative approach
Perianal abscess
Predisposing factors
Pathogenesis
Clinical features
True perianal abscess
Intersphincteric abscess
Ischiorectal abscess
Supralevator abscess
Management
Fistula-in-ano
Clinical features and assessment
Management
Miscellaneous benign perianal lumps
Perianal haematoma
Anal warts
Fibroepithelial anal polyp
Anal skin tags
Anal cancer
Histological types
Risk factors
Clinical features and assessment
Staging
Management
Rectal prolapse
Pathogenesis
Predisposing factors
Clinical features and assessment
Management
Childhood rectal prolapse
Mucosal rectal prolapse
Full-thickness rectal prolapse
Solitary rectal ulcer syndrome
Anal incontinence
Aetiology
Clinical features and assessment
History
Examination
Investigation
Conservative management
Surgical management
Pruritus ani
Management
Pilonidal disease
Epidemiology
Pathogenesis
Risk factors
Clinical features
Management
Acute abscesses
Chronic discharging disease
Nonoperative approach
Operative procedures
Section 3: Surgical specialties
Chapter 18: Plastic surgery including common skin and subcutaneous lesions
Introduction
Structure and function of the skin
Wounds
Types of wound
Principles of wound healing
Inflammatory phase (Days 1-6)
Proliferative phase (Days 3-21)
Maturation or remodelling phase (Weeks 3-52+)
Abnormal scarring
Factors influencing wound healing
Blood supply
Infection
Nutritional status
Intercurrent disease
Surgical technique
Wound infection
Classification
Clinical features
Prevention
Management
Involvement of other structures
Devitalised skin flaps
Wounds with skin loss
Skin grafts
Flaps
Burns
Mechanisms
Local effects of burn injury
General effects of burn injury
Classification
Burn size
Burn depth
Superficial and superficial partial-thickness burns
Deep partial-thickness burns
Full-thickness burns
Determination of burn depth
Mechanism
Appearance
Sensation
Prognosis in burns
Associated respiratory injury
Management
First aid
Transfer to hospital
Adequate ventilation
Initial assessment and management
Prevention and treatment of burn shock
Oral intake
Nutritional management
Blood transfusion
Organ failure and burn shock
Respiratory complications
Renal failure
Sepsis
Curlings ulcer and gastric erosions
Initial cleansing and debridement
Dressings
Exposure
Evaporative dressings
Semi-occlusive and occlusive dressings
Topical antibacterial agents
'Biological' dressings
Relief of constriction (escharotomy)
Restoration of epidermal cover
Long-term functional and cosmetic outcomes
Skin and soft tissue lesions
Diagnosis
Infections
Cellulitis
Necrotising fasciitis
Hidradenitis suppurativa
Cysts
Epidermoid cysts
Dermoid cysts
Tumours of the skin
Benign lesions
Papillomas
Squamous cell papillomas (SCC) (viral warts)
Seborrhoeic keratoses (senile warts)
Fibro-epithelial polyps (acrochordon or skin tags)
Dermatofibroma
Keratoacanthoma (molluscum sebaceum)
Benign naevi (moles)
Special types of naevi
Premalignant lesions
Actinic (solar) keratosis
In situ or intraepidermal squamous cell carcinoma (Bowens disease)
Malignant lesions
Basal cell carcinoma (rodent ulcer)
Squamous cell carcinoma
Marjolin's ulcer
Malignant melanoma (MM)
Lentigo maligna (in situ melanoma/Hutchisons melanotic freckle)
Superficial spreading melanoma (SSMM)
Nodular melanoma
Other types of malignant melanoma
Spread of malignant melanoma
Management of malignant melanoma
Clinical and pathological staging
Vascular tumours
Infantile haemangiomas (strawberry naevi)
Tumours of nerves
Neurilemmoma (Schwannoma)
Neurofibroma
Tumours of muscle and connective tissues
Lipoma
Sarcoma
Dermatofibrosarcoma protruberans (DFSP)
Dermal sarcoma
Liposarcoma
Fibrosarcoma
Rhabdomyosarcoma
Angiosarcoma and Kaposi's sarcoma
Chapter 19: The breast
Anatomy and physiology
Overview
Anatomy
Congenital abnormalities
Hormonal control of breast development and function
Assessment of a patient with breast disease
History
Clinical examination
Assessment of regional nodes
Imaging
Mammography
Ultrasonography
Magnetic resonance imaging (MRI)
Core biopsy and fine needle aspiration (FNA) cytology
Core biopsy
Punch biopsy
Fine-needle aspiration cytology
Open biopsy
Triple assessment
Accuracy of investigations
Sentinel lymph node biopsy
Nipple discharge
Benign breast conditions
Fibroadenoma
Breast lumpiness and pain
Lumpiness or nodularity
Other lumps
Noncyclical breast pain
Breast cysts
Duct ectasia
Epithelial hyperplasia
Benign neoplasms
Duct papilloma
Lipoma
Phyllodes tumour
Breast infection
Lactating infection
Nonlactating infection
Central (periareolar) infection
Mammary duct fistula
Peripheral nonlactating abscesses
Tubercular mastitis
Skin-associated infection
Breast cancer
Epidemiology
Risk factors for breast cancer
Age
Geographical variation
Menstrual and pregnancy factors
Breast cancer in developing countries
Radiation
Benign disease
Diet
Exogenous hormones
Physical activity, weight and height
Genetics
High risk genes
Other genes
Genetic testing
Management
Types of breast cancer
Noninvasive cancer
Invasive cancer
Hormone receptors
Growth factor receptors
Testing for receptors
Cancer types
Screening for breast cancer
Mammographic features of breast cancer
Staging of breast cancer
The curability of breast cancer
Prognosis of breast cancer
Presentation of breast cancer
Management of operable breast cancer
In situ breast cancer
Operable breast tumours
Local therapy
Breast-conserving surgery
Axillary surgery in women with operable invasive breast cancer
Radiotherapy
Modified radical mastectomy
Systemic therapy
Adjuvant chemotherapy
Adjuvant hormone therapy
Anti-HER2 therapy
Neoadjuvant therapy
Breast cancer in pregnancy
Pregnancy after treatment for breast cancer
Complications of treatment
Radiotherapy
Chemotherapy
Hormonal treatments
Psychological aspects
Breast reconstruction
Follow-up
Management of locally advanced breast cancer
Management of metastatic or advanced breast cancer
Chemotherapy
Hormonal treatment
Anti-HER2 therapy
Local treatments in metastatic breast cancer
Specific problems in patients with metastatic breast cancer
Bone disease
Hypercalcaemia
Marrow infiltration
Spinal cord compression
Pleural effusion
Liver metastases
Brain metastases
Miscellaneous tumours of the breast
Secondary tumours
Male breast
Gynaecomastia
Male breast cancer
Chapter 20: Endocrine surgery
Introduction
Thyroid gland
Surgical anatomy and development (see also Chapter 26)
Thyroid function
Assessment of thyroid disease
Enlargement of the thyroid gland (goitre)
Clinical features
'Physiological' enlargement
Nontoxic nodular goitre
Aetiology
Pathology
Clinical features
Investigations
Management
Thyrotoxic goitre
Thyroiditis
Subacute thyroiditis (de Quervains disease)
Autoimmune thyroiditis (Hashimoto's disease)
Aetiology
Clinical features
Investigations
Management
Riedel's thyroiditis
Solitary thyroid nodules
Other forms of neoplasia
Hyperthyroidism
Primary thyrotoxicosis (Grave's disease)
Pathophysiology
Clinical features
Diagnosis
Management
Antithyroid drugs
Radioactive iodine
Surgery
Toxic multinodular goitre and toxic adenoma
Pathophysiology
Clinical features
Diagnosis
Management
Malignant tumours of the thyroid
Papillary carcinoma
Clinical features
Management
Follicular carcinoma
Clinical features
Management
Anaplastic carcinoma
Clinical features
Management
Medullary carcinoma
Clinical features
Management
Lymphoma
Thyroidectomy
Technique
Complications
Haemorrhage
Nerve damage
Hypothyroidism
Hypoparathyroidism
Scar complications
Patient information
Parathyroid glands
Surgical anatomy
Calcium metabolism
Hypercalcaemia and hypocalcaemia
Primary hyperparathyroidism
Pathology
Clinical features
Diagnosis
Management
Secondary and tertiary hyperparathyroidism
Hypoparathyroidism
Parathyroidectomy
Patient information
Pituitary gland
Surgical anatomy
Anterior pituitary
Tumours of the anterior pituitary
Pathophysiology
Acromegaly
Hyperprolactinaemia
Cushings disease
Surgical hypophysectomy
Radiation therapy
Replacement therapy
Posterior pituitary
Pathophysiology
Adrenal gland
Surgical anatomy and development
Adrenal cortex
Cortical function
Cushings syndrome
Clinical features
Investigations
Management
Adrenal adenoma
Adrenal carcinoma
Pituitary disease
Hyperaldosteronism
Primary hyperaldosteronism (Conn's syndrome)
Clinical features
Diagnosis
Management
Secondary hyperaldosteronism
Adrenogenital syndrome (adrenal virilism)
Pathophysiology
Clinical features
Management
Adrenal feminisation
Adrenal medulla
Pathophysiology
Phaeochromocytoma
Pathology
Clinical features
Investigations
Management
Nonendocrine adrenal medullary tumours
Ganglioneuromas
Neuroblastomas
Adrenal 'incidentaloma'
Adrenalectomy
Indications
Technique
Replacement therapy
Patient information
Other surgical endocrine syndromes
Apudomas and multiple endocrine neoplasia
The APUD cell series
Multiple endocrine neoplasia syndromes
MEN type I
MEN type II
Carcinoid tumours and the carcinoid syndrome
Chapter 21: Vascular and endovascular surgery
Introduction
Pathophysiology of arterial disease
Clinical features
Mechanism of injury
Haemodynamic mechanism
Thrombosis
Atheroembolism
Thromboembolism
Chronic lower limb arterial disease
Anatomy
Clinical features
Symptoms
Intermittent claudication
Epidemiology
Clinical features
Critical limb ischaemia
Rest pain
Examination findings
Pulse status
Ankle/brachial pressure index
Diabetic vascular disease
The diabetic foot
Sensory neuropathy
Motor neuropathy
Autonomic neuropathy
Management
Management of lower limb ischaemia
Medical management
Endovascular management
Intermittent claudication
Critical limb ischaemia
Indications for arterial reconstruction
Intermittent claudication
Principles of arterial reconstruction
Endarterectomy
Bypass grafting
Extraanatomic bypass
Complications of arterial reconstruction
Blockage of the graft
Infection of prosthetic grafts
Buerger's disease (thromboangiitis obliterans)
Clinical features
Investigations
Treatment
Raynaud's phenomenon
Amputation
Indications
Level of amputation
Surgical principles
Rehabilitation and limb fitting
Phantom pain
Arterial disease of the upper limb
Overview
Aetiology
Management
Cerebrovascular disease
Definitions
Stroke
Transient ischaemic attack
Amaurosis fugax
Carotid artery disease
Pathophysiology
Assessment
Management
Medical therapy
Carotid endarterectomy
Carotid stenting
Asymptomatic carotid disease
Vertebrobasilar disease
Intravenous thrombolysis or mechanical thrombectomy
Renal artery disease
Pathophysiology
Management
Mesenteric artery disease
Acute limb ischaemia
Aetiology
Classification
Clinical features
Management
Acute embolus
Thrombosis in situ
Trauma
Intraarterial drug administration
Thoracic outlet syndrome
Postischaemic syndrome
Reperfusion injury
Compartment syndrome
Aneurysmal disease
Site
Aetiology
Atherosclerotic
Mycotic
Morphology
True aneurysms
False aneurysms
Abdominal aortic aneurysm
Epidemiology
Clinical features
Asymptomatic AAA
Symptomatic AAA
Ruptured AAA
Open AAA repair
Endovascular aneurysm repair
Iliac aneurysms
Femoral aneurysms
Popliteal aneurysms
Pathophysiology of venous disease
Physiology
Varicose veins
Epidemiology
Clinical features
Cosmetic issues
Symptoms
Complications
Indications for treatment
Aetiology
Examination and investigation
Management
Conservative treatment: for uncomplicated varicose veins
Surgery
Endovenous treatment
Superficial thrombophlebitis
Chronic venous insufficiency
Pathophysiology
Assessment
History
Examination
Investigations
Management
Medical therapy
Dressings
Compression therapy
Elastic compression hosiery
Surgical and endovenous therapy
Venous thromboembolism
Epidemiology
Pathophysiology
Aetiology
Diagnosis
Venous gangrene
Prevention
Rationale
General measures
Physical methods
Pharmacological methods
Management
Overview
Uncomplicated DVT
Complicated DVT
Thrombolysis
Surgical thrombectomy
Pharmacomechanical thrombectomy
Venous stenting
Caval filters
Other forms of venous thrombosis
Superior vena cava thrombosis
Subclavian and axillary vein thrombosis
Lymphoedema
Pathophysiology
Primary lymphoedema
Secondary lymphoedema
Clinical features
Symptoms
Signs
Investigation
Management
Physical methods
Drugs
Antibiotics
Surgery
Filariasis
Epidemiology
Clinical features
Treatment
Vascular access for haemodialysis
Methods
Access planning and preoperative assessment
Primary access
Secondary and tertiary access
Assessing a vascular access
Complications of vascular access
Failure to mature
Stenosis and thrombosis
Infection
Aneurysm and pseudoaneurysm
Ischaemic steal syndrome (ISS)
Chapter 22: Cardiothoracic surgery
Basic considerations
Pathophysiological assessment
Assessment of risk
Mortality
Stroke
Specific aspects of surgical technique
Cardiopulmonary bypass
Myocardial preservation
Cardioplegia
Postoperative care
Intensive care
Complications
Recovery time
Acquired cardiac disease
Ischaemic heart disease
Coronary artery disease
Assessment
Indications
Coronary bypass
Results
Surgery for the complications of coronary artery disease
Mitral valve regurgitation
Chronic
Acute
Post-myocardial infarction ventricular septal defect
Left ventricular aneurysm
Cardiac valvular disease
Assessment
Surgical management
Endocarditis
Aortic valve disease
Stenosis
Regurgitation
Surgical outcomes
Mitral valve disease
Stenosis
Regurgitation
Surgical outcomes
Tricuspid valve disease
Multiple and repeat valve procedures
Aortic aneurysm
Tubulosaccular aneurysms
False `aneurysms
Aortic dissection
Aortoannulo ectasia
Assessment
Surgery for aortic pathology
Pericardial pathology
Pericardial effusion
Pericardial constriction
Cardiac trauma
Cardiac tamponade with penetrating trauma
Congenital cardiac disease
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
Tetralogy of Fallot
Thoracic surgery
Assessment
Bronchogenic carcinoma
Aetiology, pathology and presentation
Assessment for pulmonary resection
Fitness for resection
Staging
Resection
Survival
Metastatic disease
Other lung tumours
Mesothelioma
Mediastinum
Mass lesions
Video-assisted thoracic surgery
Infection
Pneumothorax
Management
Emphysema
Interstitial lung disease
Pleuropulmonary infection
Empyema
Bronchiectasis
Pulmonary tuberculosis
Chest wall deformities
Cervical sympathectomy
Postoperative care
Pain control
Management of secretions
Fluid management
Late management
Cardiac and pulmonary transplantation
Chapter 23: Urological surgery
Assessment
General points
Urinary tract symptoms
Pain
Disorders of micturition
Haematuria
Dysuria
Frequency, nocturia, urgency
Incontinence
Oliguria/anuria
Others
Examination
Investigations
Urine
Blood tests
Ultrasonography
Plain x-ray film
Intravenous urography
Computed tomography (CT) scanning
Retrograde pyelography
Special radiological investigations
Nuclear imaging
Urodynamic studies
Semen analysis
Biochemical screening for stones
Upper urinary tract (kidney and ureter)
Anatomy
Physiology
Simple renal cysts
Polycystic kidney disease
Horseshoe kidneys
Other developmental anomalies
Benign tumours
Nephroblastomas
Epidemiology
Clinical features
Investigations
Management
Renal cell carcinoma
Epidemiology
Clinical features
Investigations
Pathology
Tumour staging
Management
Upper urinary tract urothelial cell cancer
Epidemiology
Clinical features
Investigations
Management
Urinary tract calculi
Mechanism of stone formation
Types and causes of stone formation
Radiolucent calculi
Clinical features
Investigations
Management
Infections of the kidney
Acute pyelonephritis
Chronic pyelonephritis
Renal and perinephric abscess
Emphysematous pyelonephritis
Genitourinary tuberculosis
Pathogenesis
Clinical features
Investigations and diagnosis
Management
Urinary tract obstruction
Pelviureteric junction obstruction
Clinical features
Investigations
Management
Renal trauma
Lower urinary tract (bladder, prostate and urethra)
Anatomy
Physiology
Neurological control of micturition
The micturition cycle
Storage (or filling) phase
Emptying (or micturition) phase
Lower urinary tract trauma
Bladder
Open injuries
Closed injuries
Clinical features
Investigations
Management
Urethra
Open injuries
Closed injuries
Clinical features
Investigations
Management
Bladder tumours
Pathology
Staging
Clinical features
Investigations
Management
Superficial bladder tumours (Ta, T1)
Invasive bladder tumour (T2-T4)
Prognosis
Benign prostatic hyperplasia
Pathology
Clinical features
Investigations
Management
Conservative management
Medical management
Surgical management
Acute retention
Chronic retention
Endoscopy transurethral prostate resection
Open prostatectomy
Carcinoma of the prostate
Epidemiology
Pathology
Clinical features
Investigations
Management
Organ-confined disease
Locally advanced disease
Metastatic prostate cancer
Prognosis
Vesicoureteral reflux
Aetiology
Pathology
Investigations
Management
Urethral obstruction
Pathology
Clinical features
Investigations
Management
Disorders of micturition: incontinence
Overview
Structural disorders
Clinical assessment
Structural causes of incontinence in males
Postprostatectomy
Chronic outflow obstruction
Prostate cancer
Postmicturition dribble incontinence
Chronic illness and debility
Structural causes of incontinence in females
Childbirth and operations
Cystitis
Ectopic ureter
Cervical cancer
Neurogenic disorders
Clinical assessment
Aetiology of abnormal micturition
Impaired cortical control
Emotional state
Drugs
Damage to the spinal cord
Principles of management
Neurologically intact patients
Neuropathic patients
External genitalia
Anatomy
Physiology
Circumcision
Congenital abnormalities of the penis
Hypospadias
Epispadias
Disorders of erection (impotence)
Priapism
Peyronie's disease
Carcinoma of the penis
Inflammation of the penis
Undescended testes (cryptorchidism)
Retractile testis
Ectopic testis
True undescended testis
Torsion of the testis
Testicular tumours
Pathology
Clinical features
Investigations
Management
Prognosis
Epididymo-orchitis
Tubercular epididymo-orchitis
Hydrocoele
Cyst of the epididymis
Varicocoele
Chapter 24: Neurosurgery
Introduction
Surgical anatomy and physiology
The skull
The spine
The brain
The meninges and cerebrospinal fluid
The cranial nerves
The spinal cord
Blood supply
Anterior circulation
Posterior circulation
Intracranial pressure
Brain herniation syndromes
Subfalcine (cingulate gyral) herniation
Transtentorial (uncal) herniation
Foraminal (tonsillar) herniation
False localising signs
Investigations
Plain x-ray
Computed tomography
Magnetic resonance imaging
CT and MR angiography
Cerebrovascular disease
Subarachnoid haemorrhage
Saccular intracranial aneurysms
Investigations
Management of aneurysmal SAH
Primary intracerebral haemorrhage
Arteriovenous malformations
Cavernomas
Neurotrauma
Assessment
Glasgow Coma Score
Neurological examination
Other systems
Management
Skull fracture
Extradural haematoma
Subdural haematoma
Intracerebral haematoma and contusions
Diffuse axonal injury
Traumatic spinal injury
Intracranial infections
Bacterial infections
Tuberculous meningitis
Tuberculomas
Neurocysticercosis
Postsurgical infection
Meningitis
Intracranial tumours
Tumours of the skull
Gliomas
Meningiomas
Schwannomas
Pituitary tumours
Craniopharyngiomas
Brain metastasis
Clinical features of intracranial tumours
Symptoms of raised ICP
Focal neurological deficit
Seizures
Personality disintegration
Diagnosis
Management
Paediatric neurooncology
Spinal dysraphism
Open spinal dysraphism
Closed spinal dysraphism
Hydrocephalus
Aetiology and clinical features
Management and prognosis
Malformations of the skull
Craniosynostosis
Cranial dermal sinuses and angular dermoids
Functional neurosurgery
Movement disorders
Epilepsy
Vertebral column
Spinal degenerative disease
Aetiology and clinical features
Management
Peripheral nerve lesions
Carpal tunnel syndrome
Ulnar nerve compression at the elbow
Meralgia paraesthetica
Chapter 25: Transplantation surgery
Introduction
Transplant immunology
The recipient's immune response to the donor organ
Early events
The afferent arm of the immune response
Afferent arm
Antigen presentation
T-cell receptor binding and costimulation
T-cell activation
B-cell activation
Efferent arm
Patterns of allograft rejection
Hyperacute rejection
Acute rejection
Chronic allograft damage
Testing for histocompatibility
Tissue typing
Cross-match
Immunosuppression
Immunosuppressive drugs
Corticosteroids
Antiproliferative agents
Azathioprine
Mycophenolate mofetil (MMF)
Calcineurin inhibitors
Cyclosporin (CYA)
Tacrolimus
Sirolimus
Antibody therapies
New therapies
General risks of immunosuppression
Infection
Malignancy
Organ donation
Deceased donation
Donation after circulatory death
Extended criteria donors (ECD)
Organ preservation
Living donation
Living donor kidney transplantation
Donor selection
Operative approaches
Procedure-related morbidity and mortality
Living donation for liver transplantation
Renal transplantation
Indications and patient assessment
The operative procedure
Back-table preparation
Recipient operation
Postoperative management
Management of delayed graft function
Complications
Outcome
Recent developments in renal transplantation
Liver transplantation
Indications and patient assessment
The operative procedure
Back-table preparation
Recipient operation
Living donor liver transplant
Postoperative management and complications
Outcome
Pancreas transplantation
Indications and patient assessment
The operative procedure
Back-table preparation
Recipient operation
Postoperative management and complications
Outcome
Pancreatic islet transplantation
Heart and lung transplantation
Indications and patient assessment
Heart
Lung
The operative procedure
Heart
Lung
Postoperative management and complications
Heart
Lungs
Combined heart and lung transplant
Outcome
Summary
Chapter 26: Ear, nose and throat surgery
Ear
Anatomy
External ear
Middle ear
The inner ear
Physiology
Assessment
Clinical features
Examination
Audiometry
Temporal bone imaging
Diseases of the pinna
Bat ears
Trauma
Tumours
Diseases of the external auditory meatus
Wax
Otitis externa
Tumours
Diseases of the middle ear
Acute suppurative otitis media
Otitis media with effusion, or `glue ear
Chronic suppurative otitis media
Tubotympanic or mucosal disease
Atticoantral or squamous disease
Otosclerosis
Diseases of the inner ear
Deafness
Vertigo
Disorders of the facial nerve
Nose
Anatomy
Physiology
Assessment
Clinical features
Examination
Imaging
Diseases of the nose
Trauma
Chronic rhinitis
Nasal polyps
Epistaxis
Paranasal sinuses
Anatomy
Diseases of the paranasal sinuses
Sinusitis
Tumours
Nasopharynx
Anatomy
Diseases of the nasopharynx
Adenoids
Tumours
Oral cavity
Anatomy
Diseases of the mouth
Stomatitis and gingivitis
Mouth ulcers
Retention cysts
Leukoplakia
Tumours
Assessment
Carcinoma of the tongue
Retromolar trigone
Floor of the mouth
The hard palate
Oropharynx
Anatomy
Diseases of the oropharynx
Pharyngitis
Tonsillitis
Snoring and sleep apnoea
Tumours
Hypopharynx
Anatomy
Physiology of swallowing
Assessment
Clinical features
Examination
Imaging
Diseases of the hypopharynx
Pharyngeal pouch
Tumours
Larynx
Anatomy
Physiology of voice
Assessment
Clinical features
Examination
Imaging
Diseases of the larynx
Congenital disorders
Laryngitis
Vocal cord palsy
Tumours
Neck
Anatomy
Assessment
Clinical features
Examination
Imaging
Diseases of the neck
Assessment
Thyroglossal cyst
Branchial cyst and fistula
Other cystic swellings
Lymph node swellings
Neck node metastases in head and neck cancer
Lymphoma
Tuberculous cervical lymphadenitis
Tracheostomy
Salivary gland anatomy
Salivary gland disease
Salivary gland tumours
Pleomorphic adenoma
Warthins tumour
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Complications of parotidectomy
Carotid body tumour
Chapter 27: Orthopaedic surgery
Introduction
History
Age
Birth and developmental history
Dominant hand
Occupation
Trauma
Details of previous treatment
Past medical history
Drug history
Examination
Look
Feel
Move (active and passive)
Description of deformity
Investigations
Plain x-rays
Ultrasound
Nerve conduction tests and electromyography
Computed tomography
Magnetic resonance imaging
Bone scans
Osteoarthritis: degenerative disease of the joints
Medical management of OA
Drug therapy
Off-loading
Injections
Other conservative treatments
Surgical management of OA
Inflammatory disorders
Rheumatoid arthritis
Ankylosing spondylitis
Bone and joint infection
Osteomyelitis
Acute osteomyelitis
Chronic osteomyelitis
Septic arthritis
Musculoskeletal tuberculosis
Spinal tuberculosis
Tuberculous hip
Tuberculous knee
Poliomyelitis
Orthopaedic procedures
Arthroscopy
Arthrodesis
Osteotomy
Arthroplasty
Hemiarthroplasty
Total joint replacement
Interposition arthroplasty
Excision arthroplasty
Paediatric orthopaedic surgery
Developmental dysplasia of the hip (DDH)
Perthes disease
Cerebral palsy (CP)
Slipped upper femoral epiphysis (SUFE)
Congenital club foot (congenital talipes equinovarus or CTEV)
Scoliosis
Angular deformities
Metabolic bone diseases
Rickets and osteomalacia
Osteoporosis
Musculoskeletal tumours
Osteoid osteoma
Chondroblastoma
Osteochondroma
Giant cell tumour
Simple bone cyst
Osteosarcoma
Ewing's sarcoma
The upper limb
The shoulder
Anterior dislocation
Impingement syndrome
Rotator cuff disease
Osteoarthritis
The elbow
Tennis and golfers' elbow
Rheumatoid elbow
The hand and wrist
Wrist disease
Carpal tunnel disease
Trigger finger
Dupuytren's disease
The lower limb
The hip joint
Avascular necrosis of the femoral head
Hip arthroscopy
The knee joint
History
Meniscal injuries
Ligamentous injuries
The foot and ankle
Trauma and fractures
General approach
Examination
Joint dislocation
Fracture management
Classification
Children
Principles of fracture healing
Delayed union
Nonunion
Malunion
Open fractures
Intraarticular fractures
Conservative treatment
Compartment syndrome
Volkman's ischaemic contracture
Operative treatment
Some specific fractures
Pelvic fractures
Fractures of the femoral neck
Colles' fractures
Forearm fractures
Scaphoid fractures
Ankle fractures
Tibial plateau fractures
Appendix: Laboratory reference ranges
Index