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Handbook of Colorectal Surgery
David E Beck
SECTION 1: BASIC PRINCIPLES AND SKILLS
1:
Anatomy
MACROSCOPIC ANATOMY
Small bowel
Colon
Rectum
Anus
VASCULAR ANATOMY
NERVOUS SUPPLY
BOWEL WALL
2:
Pathophysiology
COLONIC MOTILITY
Colonic motor activity
Colonic myoelectric activity
Marker and scintigraphic studies
COLONIC MOTILITY DISORDERS
Irritable bowel syndrome and diverticular disease
Postoperative ileus
Colonic pseudo-obstruction (Ogilvie's syndrome)
WATER AND ELECTROLYTE TRANSPORT
Absorption
Secretion
BACTERIAL BARRIER
INTESTINAL GAS
ANORECTAL PHYSIOLOGY
Anal canal pressures and anal sphincters
Anorectal angle
Anorectal sensation
Rectal compliance
Reflexes
Defecation
3:
History and physical examination
History
Present illness
Review of systems
Past medical history
Family history
PHYSICAL EXAMINATION
Abdominal examination
Anorectal examination
Patient positioning
Physical inspection
Digital palpation
Anoscopy
4:
Diagnostic imaging
PLAIN RADIOGRAPHS
BARIUM ENEMA
SMALL BOWEL EXAMINATION
Ultrasonography
Diagnostic
Intraluminal
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
POSITRON EMISSION TOMOGRAPHY
COLOGRAPHY AND WIRELESS CAPSULE
Angiography
NUCLEAR MEDICINE/SCINTIGRAPHY
PHYSIOLOGIC EXAMINATIONS
5:
Endoscopy
Proctoscopy
Patient preparation
Diagnostic technique
Therapy
Complications
FLEXIBLE FIBEROPTIC SIGMOIDOSCOPY
Patient preparation
Diagnostic technique
Dithering
Alpha maneuver
Torquing
Hooking
External compression
Slide-by maneuver
Complications
Colonoscopy
Patient preparation
Diagnostic technique
Therapy
Complications
Bleeding
Transmural burn
Perforation
SCOPE CLEANING AND DISINFECTION
6:
Minimally invasive surgery
Equipment
Table
Laparoscopic tower
Instruments for pneumoperitoneum and access
Laparoscopic instruments
PATIENT SELECTION AND INDICATIONS
Procedures
Stomas
Creation of the stoma
Loop ileostomy
Loop sigmoid colostomy
End ileostomy
End colostomy
Takedown or closure of the stoma
Laparoscopically assisted procedures
Polyps
Diverticular disease
Inflammatory bowel disease
Colorectal carcinoma
Miscellaneous conditions
Complications
Trocar-related complications
Pneumoperitoneum-related complications
Procedure-related complications
Learning curve
CURRENT AND FUTURE ROLE
7:
Intestinal stomas
SELECTING THE STOMA SITE
Ileostomy
Creation
Closure
Complications
CONTINENT ILEOSTOMY
Creation
Complications
Valve slippage
Valve prolapse
Fistula formation
Volvulus
Perforation
Pouchitis
Crohn‘s disease
Revision
Colostomy
Creation
Closure
Complications
ENTEROSTOMAL THERAPY
General principles
Colostomy irrigation
SECTION 2: PERIOPERATIVE MANAGEMENT
8:
Preoperative preparation
NUTRITION AND FLUID MANAGEMENT
Goals
Nutritional assessment
Requirements
Methods of support
Enteral
Parenteral
Role in specific diseases
Preoperative preparation
Ulcerative colitis
Crohn's disease
Malignancies
Postoperative use
BOWEL PREPARATION
Mechanical preparation options
Dietary restriction
Cathartics
Enemas
Oral lavage
SUMMARY OF TRIALS AND META-ANALYSES
Antibiotic preparation options
Rationale
Bowel flora
Methods
MISCELLANEOUS PREOPERATIVE EVALUATIONS AND MANAGEMENT
Deep venous thrombosis prophylaxis
Laboratory requirements
INFORMED CONSENT
9:
Anesthetic management
PREOPERATIVE EVALUATION
RISK FACTORS
Neurologic
Pulmonary
Cardiac
Hepatic/renal
Age
ASA Classification
CHOICE OF ANESTHESIA
General anesthesia
Regional anesthesia
Local anesthesia
Conscious sedation
ADDITIONAL CONSIDERATIONS
Urgent/emergent induction
Invasive monitoring
Volume management
Temperature regulation
Patient positioning
Postoperative pain control
10:
Postoperative management
GENERAL CARE
Pain management
Ambulation
Fluid monitoring and laboratory tests
Postoperative bowel function
Physiology
Oral Intake
Diarrhea medications
Drains
WOUND CARE
INTRAVENOUS FLUIDS
Transfusions
Antibiotics
SECTION 3: DISEASE PROCESSES
11:
Hirschsprung disease, colorectal anomalies, and pediatric colorectal conditions
HIRSCHSPRUNG DISEASE
Embryology and anatomy
Pathophysiology
Evaluation and treatment
Symptoms
Evaluation
Initial therapy
Surgical approach
Outcome
IMPERFORATE ANUS
Embryology and anatomy
Evaluation and treatment
Evaluation
Evaluation in boys
Evaluation in girls
Initial therapy
Surgical approach
Outcome
Duplications
NEONATAL SMALL LEFT COLON SYNDROME
NECROTIZING ENTEROCOLITIS
COLONIC ATRESIA
12:
Functional colorectal disorders
Constipation
Definition
Causes
Evaluation
Treatment
Inadequate fiber
Colonic inertia
Pseudo-obstruction of the colon
Pelvic floor outlet obstruction
ANAL INCONTINENCE
Definition
Causes
Mechanical injury
Neurogenic causes
Irritable bowel syndrome (IBS)
Diminished rectal capacity
Idiopathic causes
Evaluation
Anal physiology
Treatment
Medical
Surgical
13:
Diverticular disease
Pathophysiology
Incidence
Pathogenesis
DIAGNOSIS AND TREATMENT
Acute diverticulitis
Peridiverticular inflammation
Peridiverticular abscess/phlegmon
Intra-abdominal or pelvic abscess
Generalized peritonitis
Chronic diverticulitis
Diverticular fistulas
Colonic obstruction
Surgical procedures for diverticulitis
Emergency operations
Elective resection
Diverticular hemorrhage
Conclusion
14:
Inflammatory bowel disease: ulcerative colitis and Crohn's disease
ULCERATIVE COLITIS
History
Epidemiology
Etiologic factors
Infectious causes
Immunologic causes
Genetic causes
Clinical Features
History
Physical examination
Endoscopic findings
Radiologic studies
Histopathologic Findings
Macroscopic
Microscopic
Nonoperative treatment
Sulfasalazine and aminosalicylates (ASA)
Corticosteroids
Operative treatment
Elective indications
Urgent indications
Emergent indications
Procedure
Proctocolectomy
Ileorectostomy
Continent ileostomy (Kock pouch)
Subtotal colectomy
Restorative proctocolectomy (ileoanal reservoir)
Technical tips for the mucosectomy
Technical tips for the double-stapled ileoanal reservoir
Reservoir construction
Complications
CROHN'S DISEASE
History
Epidemiology
Etiologic factors
Clinical Features
History
Physical examination
Endoscopic findings
Radiologic findings
Histopathologic findings
Nonoperative treatment
Nutrition
Corticosteroid therapy
Aminosalicylates (ASA)
Antibiotics
Immunosuppressive agents
Biologicals
Operative treatment
Specific situations
PREGNANCY AND INFLAMMATORY BOWEL DISEASE
Surveillance
Surveillance in ulcerative colitis
Dysplasia
Impact of surveillance
Method of surveillance
Surveillance in Crohn‘s disease
FUTURE DIRECTIONS
15:
Rectal prolapse and intussusception
Pathophysiology
Evaluation
Physical examination
Endoscopic studies
Radiologic studies
Physiologic studies
Treatment
Nonoperative treatment
Operative treatment
Abdominal procedures
Perineal procedures
Conclusion
16:
Hemorrhoids
Anatomy
Pathophysiology
Etiologic factors
Classification
EVALUATION AND TREATMENT
Symptoms
Physical examination
Nonoperative treatment
Diet and stool-bulking agents
Rubber band ligation
Infrared photocoagulation
Sclerotherapy
Cryotherapy
Electrocautery
Operative treatment
Thrombosed external hemorrhoids
Operative hemorrhoidectomy
Complications
Summary
17:
Anorectal abscess and fistula-in-ano
ANORECTAL ABSCESS
Anatomy
Pathophysiology
Etiologic factors
Classification
Evaluation and Treatment
Symptoms
Assessment
Operative Therapy
Fistula-in-ano
Pathophysiology
Classification
Evaluation and treatment
Symptoms
Assessment
Operative treatment
18:
Pruritus ani and fissure-in-ano
PRURITUS ANI
Anatomy
Pathophysiology
Etiologic factors
Classification
Symptoms
Evaluation
Treatment
Fissure-in-ano
Anatomy
Pathophysiology
Symptoms
Evaluation
Nonoperative treatment
Operative treatment
19:
Pilonidal disease
ETIOLOGIC FACTORS
Incidence
Microbiology
CLASSIFICATION AND PHYSICAL FINDINGS
Management
Preoperative preparation
Abscess
Sinus
Complex or recurrent disease
Conclusion
20:
Sexually transmitted diseases and colorectal infections
VIRAL DISEASES
Cytomegalovirus
Herpes simplex
Human immunodeficiency virus
Human papillomavirus
Molluscum contagiosum
BACTERIAL DISEASES
CAMPYLOBACTER JEJUNI
Chlamydia
Chancroid
Gonorrhea
Granuloma inguinale
Hidradenitis suppurativa
Mycobacterium avium-intercellulare
Salmonella
Shigella species
Syphilis
PARASITIC DISEASES
Amebiasis
Cryptosporidiosis
Giardiasis
Isospora
21:
Polyps
Histopathology
Normal colonic epithelium
Hamartomas
Juvenile polyps
Cronkhite–Canada syndrome
Pentz–Jeghers syndrome
Hyperplastic polyps
Inflammatory polyps
Adenomatous polyps
Tubular adenoma
Villous adenoma
Tubulovillous adenoma
Adenoma–carcinoma sequence
Risk of malignancy in colorectal polyps
MANAGEMENT OF COLORECTAL POLYPS
Benign polyps
Malignant colorectal polyps
Villous tumors of the rectum
Famial adenomatous polyposis syndromes
Turcot's Syndrome
Gardner's Syndrome
Management of polyposis patients
Management of extracolonic manifestations of polyposis coli
POLYP FOLLOW-UP
22:
Malignancy of the colon, rectum, and anus
COLON AND RECTUM
Anatomy
Pathophysiology
Incidence and risk factors
Adenocarcinoma
Epithelial tumors
Lymphatic malignancies
Gastrointestinal stromal tumors
Evaluation and treatment
Diagnosis
Treatment
Follow-up care
Prognosis and staging
Anus
Anatomy
Anal canal
Epidermoid carcinoma
Melanoma
Anal margin
Premalignant lesions
Malignant lesions
23:
Other conditions: colonic volvulus, ischemia, radiation injury and trauma
COLONIC VOLVULUS
Sigmoid volvulus
Etiologic factors
Presentation and diagnosis
Treatment
Results
Cecal volvulus
Etiologic factors
Presentation and diagnosis
Treatment
Results
Transverse colon volvulus
Etiologic factors
Presentation and diagnosis
Treatment
Results
ISCHEMIC COLITIS
Etiologic factors and pathophysiology
Diagnosis
Treatment
RADIATION INJURY
Pathophysiology
Diagnosis
Treatment
COLORECTAL TRAUMA
Etiologic factors
Diagnosis
Treatment
Preoperative considerations
Operative treatment
SECTION 4: APPENDIXES
Appendix I
PREOPERATIVE ORDERS
POSTOPERATIVE ORDERS
Perineal cases
Abdominal cases
DISCHARGE INSTRUCTIONS
Abdominal operations
Anal-rectal surgery
Appendix II
COMMON COLORECTAL MEDICATIONS
TABLE KEY
Appendix III
ANSWERS TO ROUNDS QUESTIONS
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
INDEX
TOC
Index
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