Surgery—On Call: Day-to-Day Surgical Care Sunil Ravinder Paul K
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1Dr Sunil's Surgery — On Call DAY-TO-DAY SURGICAL CARE2
3Dr Sunil's Surgery — On Call DAY-TO-DAY SURGICAL CARE
THIRD EDITION
K Sunil Ravinder Paul MBBS, MS, (CMC, Vellore), FICS Consultant and Head of Dept of Surgery SDA Hospital, Ottapalam, Kerala 679 104 Former Consultant Surgeon Patan Hospital, United Mission to Nepal, Kathmandu, Nepal E-mail:anuradhasunil@hotmail.com
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
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Surgery — On Call
© 2007, K Sunil Ravinder Paul
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 1997
Second Edition: 2000
Third Edition: 2007
9788184480825
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd, Sector 60, Noida
5Dedicated to
Anuradha, my wife
Lalitha & Daniel, my parents
Vasantha & Jaganatham, my parents-in-law
Ramani & Ashish Das
Rajini, Anuroop, Abshek & Abninav
6
7FOREWORD
It gives me great pleasure to write the foreword for Dr Sunil's book: Surgery — On Call.
This book, what I feel, is not a general book on surgery care. It is a pint-sized encyclopedia that must be kept by all the surgical residents themselves. The book contains a number of charming mnemonics like BASU for the diagnosis of typhoid, and simple algorithms and charts that will undoubtedly guide the junior surgeons in their career.
I must congratulate Dr Sunil especially for his excellent work in Chapters 28 and 33. Medical problem in surgery is a common bugbear for the inexperienced surgeons, and the succinct chapters will throw much needed light in that area. Similarly, common postoperative problems, that often threaten the peace and sleep of the junior members of our fraternity, are clearly dealt with in tabular form.
I honestly believe that this book will find its room in the shelves of many senior surgeons, and in the coat pocket (for quick reference) of many a junior ones. I pray and hope that Dr Sunil continues his terrific work into several more editions in the years to come, and I sincerely hope that the gems of the book is adequately utilised by seniors and juniors alike.
Regards,
JP Rajkumar
MS, FICS, Dip,NB (Surg.), FRCS (Eng.), FRCS (Edin), FRCS (Glasgow), FRCS (Ireland), FIMSA, FAIS, FRSM (London), FAGE (Gastro), FACG (USA), FICA (USA)
Director, Rigid Hospitals, Chennai
Professor, Sree Ramachandra Medical College, Chennai
Board Examiner, FRCS.8
9PREFACE
The writing of this book started randomly. My tenure as a consultant in the United Mission Hospital at Kathmandu, Nepal involved teaching medical students and junior doctors, the clinical aspects of surgery. I always counselled them to think and question themselves as to why problems occurred. This involved considerable repetition of explanations and instructions everyday.
During a break for tea in the OR one day, one of my senior colleagues, Peter Block, suggested “Why don't you write a book and put all that you teach into it”. That is how the writing of this handbook was initiated.
Many new developments have taken place in the field of surgery. I have added new chapters taking into account recent advances and trends. Some old chapters have been rewritten and revised.
This latest edition (Third edition) has been written with evidence-based surgery and medicine. It provides information and practical tips which are useful to all the practising doctors (interns, postgraduates, surgical and general practitioners).
I hope that this new edition will help contribute to the knowledge and skills of everyone practising surgery in a much better way. I expect that the common problems we see daily will be dealt with more effectively so that our patients will have the better health care.
K Sunil Ravinder Paul10
11ACKNOWLEDGEMENTS
I am thankful to my alma-mater, Christian Medical College, Vellore, and my teachers, specially:
Dr AS Fenn, Dr Booshnam Moses, Dr Banerjee Jesudasan, Dr Prakash Khanduri, Dr Aravindan Nair, Dr David Sadhu, Dr Sunil Agarwal, Dr Benjamin Perikath, Dr Sanjay Govil and Dr Verghese Mathai.
These people inspired, encouraged and taught me much during my training in surgery at Vellore.
I thank Dr Rajkumar for his encouraging words, and for what I have learnt from him.
Dr Peter Block, a Canadian Surgeon, whom I worked with at United Mission Hospital, Kathmandu, Nepal motivated and encouraged me to write this book.
Dr JL Baidya, Chief of Surgical Services, United Mission Hospital, Kathmandu, Nepal and Late Dr AS Fenn, Former Principal and Head of the Department of Surgery, Christian Medical College, Vellore advised me on almost all sections of this book and gave me the benefit of their knowledge and experience.
I thank also the following doctors for their assistance at various stages.
Dr Carlton Tavares, Dr Pushpa Isaac, Dr Suja and Dr Lohith, Dr Brigitta Alda, Dr Charles Nankivell, Dr Khakurel, Dr CP Maskey, Dr KE Mammen, Dr Dilip Mathai, Dr Meenakshi, Dr Bejoy Peethambaran, Dr Subhasis Misra, and Dr Anish.
Ramesh and Prasad Sherin for their cheerful and efficient typing and computer work. Walter Diller, Sisir Bista, Narayanan, 12Laxman, Adnan Alam, Guheshwari, Rosalind Thomas, Daniel N, CV Sumesh, Sunil Kumar P, Kripakaran P, Dileep, Vijay Kumar, offered assistance in the work involving this book.
I have taken some articles and help from some Journals (British Medical Journal, Surgery International, Recent advances of Surgery) and Dr Sanjay's book on fluids.
I thank my wife, Dr Anuradha Sunil, Professor and Head of Oral Pathology Dept, Royal Dental College, Chalesseri, Palakkad for her valuable support, encouragement and proof- reading without which I could not have written this handbook.
Not the least, I wish to express my deep gratitude to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for nicely bringing out the book.
13
Nothing is new under the sun
Today's new is tomorrow's old
New for someone, old for others
Every thing new may not be relevant
Contempt for old is risky.
14
Winners don't do things differently but do things in a different way!
15ABBREVIATIONS ABC
: Airway Breathing Circulation
ABPI
: Ankle-Brachial Pressure Index
ABG
: Arterial Blood Gases
AC
: Ante Cibal
AFB
: Acid Fast Bacilli
AIDS
: Acquired Immuno Deficiency Syndrome
ARDS
: Adult Respiratory Distress Syndrome
ATT
: Anti-tuberculous Treatment
BP
: Blood Pressure
BPH
: Benign Prostatic Hypertrophy
BSA
: Body Surface Area
BUN
: Blood Urea Nitrogen
BT
: Bleeding Time
CDU
: Colour Doppler Ultrasound
C/S
: Culture and Sensitivity
CCF
: Congestive Cardiac Failure
CSF
: Cerebrospinal Fluid
CT
: Clotting Time
CT Scan
: Computerised Tomography Scan
CVA
: Cerebro-vascular Accident
CVP
: Central Venous Pressure
CXR
: Chest X-ray
CVP
: Central Venous Pressure
DIC
: Disseminated Intravascular Coagulation
DPC
: Delayed Primary Closure
DPL
: Diagnostic Peritoneal Lavage
DVT
: Deep Vein Thrombosis
ECG
: Electrocardiogram
16ERCP
: Endoscopic Retrograde Cholangiopancreatogram
FDP
: Fibrin Degradation Products
FNAC
: Fine Needle Aspiration Cytology
FS
: Frozen Section
GCS
: Glasgow Coma Scale
GNB
: Gram-negative Bacteria
GERD
: Gastro-esophageal Reflux Disease
Hb
: Haemoglobin
Hct
: Hematocrit
HIV
: Human Immunodeficiency Virus
HT
: Hypertension
IBS
: Irritable Bowel Syndrome
IHD
: Ischemic Heart Disease
IPPV
: Intermittent Positive Pressure Ventilation
IV
: Intravenous
IVC
: Inferior Vena Cava
K+
: Potassium
Kg
: Kilogram
KUB
: Kidney Ureter Bladder X-ray
LAS
: Lateral Anal Sphincterotomy
LFT
: Liver Function Tests
LOS
: Lower Oesopheal Sphincter
LP
: Lumbar Puncture
MEq
: Milli Equivalent
Mmol
: Millimole
M1
: Myocardial Infarction
Na
: Sodium
MODS
: Multiple Organ Dysfunction Syndrome
MRI
: Magnetic Resonance Imaging
NS
: Normal saline
NSAIDS
: Non-steroidal Anti-Inflammatory Drugs
NUD
: Non-ulcer Dyspepsia
17PC
: Post Cibal
PCV
: Packed Cell Volume
PUO
: Pyrexia of Unknown Origin
PPI
: Proton Pump Inhibitor
PT
: Prothrombin Time
PTC
: Percutaneous Transhepatic Cholangiogram
PTT
: Partial Thromboplastin Time
PUJ
: Pelvi-ureteric Junction
PV
: Per Vagina
Q4H
: Every Four Hours
Q6H
: Every Six Hours
Q8H
: Every Eight Hours
Q12H
: Every Twelve Hours
RAI
: Radioactive Iodine
RBS
: Random Blood Sugar
RL
: Ringer Lactate
RSTL
: Relaxed Skin Tension Lines
SC
: Subcutaneous
SIRS
: Systemic Inflammatory Response Syndrome
TB
: Tuberculosis
TFT
: Thyroid Function Tests
TPR
: Temperature, Pulse, Respiration
TSH
: Thyroid Stimulating Hormone
TT
: Tetanus Toxoid
TURP
: Trans-urethral Resection of Prostate
US
: Ultrasound
UTI
: Urinary Tract Infection
VUJ
: Vesico-ureteric Junction
VP scan
: Ventilation Perfusion Scan
WHO
: World Health Organisation