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Comprehensive Textbook of Surgery
Dinesh Vyas, Nav Yash Gupta, Vijay Mittal, Sanjeev V Chhangani, Tarun Kumar, Rahul Kalla
CHAPTER 1:
Fluid and Electrolyte
INTRODUCTION
Normal Body Water and Electrolyte Distribution
ELECTROLYTE DISTURBANCES
Hyponatremia
Symptoms
Signs
Management
Hypernatremia (Fig. 1.2)
Symptoms
Signs
Management
Hyperkalemia
Symptoms
ECG Findings
Management
Hypokalemia (Fig. 1.4)
Symptoms/Signs
ECG Findings
Management
Hypermagnesemia (Fig. 1.5)
Hypomagnesemia
Symptoms/Signs
ECG Findings
Management
Calcium Homeostasis
Hypocalcemia
Hypercalcemia
METABOLIC DISTURBANCES
Metabolic Acidosis
Causes of a High Anion Gap Acidosis
Causes of Normal Anion Gap Acidosis
Metabolic Alkalosis (Fig. 1.8)
Respiratory Alkalosis
Respiratory Acidosis
Types of Parenteral Solutions (Table 1.4)
SPECIAL CONSIDERATIONS
Burns
GASTRIC OUTLET OBSTRUCTION (GOO)
Biliary Fistula
Colonic Diarrhea
Liver Cirrhosis
CHAPTER 2:
History of Surgery: Origin and Propagation of Plastic Surgery
INTRODUCTION
Sushruta Instruments and Techniques (Figs 2.11 and 2.12)
Propagation of Plastic Surgery from Ancient India to Europe
Gentlemen's Magazine (1794) Carried a Sensational Article
Tribute to Sushruta by McDowell (1975)
CHAPTER 3:
Preoperative Cardiac Risk Stratification
INTRODUCTION
AIM OF PREOPERATIVE RISK STRATIFICATION
EVALUATION
Patient Characteristics—Identifying the High-Risk Patient
History
Physical Examination
Diagnostic Studies
Surgery Characteristics
Urgency of Surgery
Stepwise Approach for Perioperative Cardiac Assessment (Fig. 3.1)
Anesthesia Consideration
Medical Therapy to Reduce Perioperative Cardiac Events
Perioperative Beta Blockade
Perioperative Calcium Channel Blockers
Perioperative Alpha Agonists
Perioperative Statins
Perioperative Nitroglycerin
Coronary Revascularization to Reduce Perioperative Cardiac Events
Preoperative CABG
Preoperative PCI
Management of Patients with CAD
MONITORING AND SURVEILLANCE
Detecting Perioperative MI
Role of Echocardiography
Role of Pulmonary Artery Catheter
MANAGEMENT OF SPECIFIC SITUATIONS
Hypertension
Valvular Heart Disease
VENOUS THROMBOEMBOLISM PROPHYLAXIS
MANAGEMENT OF ANTICOAGULATION
ARRHYTHMIAS
PACEMAKERS AND DEFIBRILLATORS
Perioperative Management of Implantable Cardiac Devices
HEART FAILURE
SYSTEMS ISSUES
CHAPTER 4:
Surgical Critical Care
INTRODUCTION
ACUTE RESPIRATORY FAILURE AND MECHANICAL VENTILATION
Clinical Signs and Symptoms
Diagnosis
Management
Noninvasive Positive Pressure Ventilation (NIPPV)
Interface and Settings
Mechanical Ventilation
Ventilation Strategy Vs Modes
HEMODYNAMIC SUPPORT AND RESUSCITATION
Clinical Presentation and Characterization
Management
Hemodynamic Monitoring and Resuscitation
Fluids Vs Pressors
Adjuvant Therapy in Shock
ABDOMINAL COMPARTMENT SYNDROME
Diagnosis
Management
PREVENTING ERRORS AND IATROGENIC COMPLICATIONS
FUTURE DIRECTION
CHAPTER 5:
Trauma: Utmost Attention Needed
INTRODUCTION/HISTORY
PREHOSPITAL CARE
Emergency Room and Trauma Team
Coordinated Care of Patient
PRIMARY SURVEY
IMPORTANCE OF AIRWAY CONTROL
IDENTIFYING SHOCK AND TREATMENT
EMERGENCY DEPARTMENT THORACOTOMY
Clear Indications
Penetrating Thoracic Injury
Blunt Thoracic Injury
Relative Indications
Contraindications
Operative Technique
SECONDARY SURVEY
History
Physical Examination
HEAD INJURY
Evaluation
Acute Subdural Hematoma
Epidural Hematoma
Intracerebral Hematoma/Contusion
Surgical Management
Acute Epidural Hematoma
Acute Subdural Hematomas
Nonsurgical Management
NECK INJURY
SPINE INJURY
Screening
Initial Management
Management
APPLICATION IN YOUR SETUP
Head and Neck
DETAILS OF FOLLOWING ARE COVERED IN TIPS AND TEASERS CHAPTER
CHAPTER 6:
Hernia—Femoral and Inguinal, and Scrotal Diseases
GENITAL EXAMINATION
Differential Diagnosis for Testicular Pain
PAINLESS TESTICULAR CONDITIONS
INGUINAL AND FEMORAL HERNIAS—DIAGNOSIS
MANAGEMENT OF INGUINAL HERNIA'SURGICAL REPAIR
LICHTENSTEIN REPAIR
Laparoscopic Repair
Surgical Complications Hernia Repair
CHAPTER 7:
Pediatric Surgery
PHYSIOLOGY
PHYSIOLOGICAL ASPECT OF CHILDREN
Metabolism/Nutrition
Renal Physiology and Fluids/Electrolytes
Pulmonary Physiology
Cardiac Physiology
Differences in Pediatric and Adult Cardiac Physiology
TORTICOLLIS
Congenital
Acquired
Management
Cystic Hygroma
Presentation
Management
Treatment
BRANCHIAL CLEFT REMNANTS
Embryology
Pathophysiology
Management
Diagnosis
Treatment
Thyroglossal Duct Cysts
Pathophysiology
Management
Diagnosis
Treatment
THORAX
Chest Wall Anomalies
Embryology
Types
Pectus Excavatum
Management
Treatment
Pectus Carinatum
Management
Nonoperative Treatment
Operative Treatment
Sternal Cleft
Surgical Correction
Pulmonary Sequestration
Diagnosis
Treatment
Esophageal Atresia/Tracheoesophageal Fistula
Pathogenesis
Congenital Diaphragmatic Hernia
Pathophysiology
Treatment
Abnormalities of Abdominal Wall
Gastroschisis
Presentation
Pathogenesis
Diagnosis
Management
Definitive Treatment
Omphalocele
Definition
Pathogenesis
Diagnosis and Treatment
Exstrophy of the Bladder
Definition
Pathophysiology
Diagnosis and Treatment
Umbilical Hernia
Definition
Pathophysiology
Diagnosis and Treatment
Congenital Inguinal Hernia/Hydrocele
Definition
Pathophysiology
Diagnosis and Treatment
Common Cystic Lesion in the Abdominal Cavity
GASTROINTESTINAL TRACT
Hypertrophic Pyloric Stenosis
Duodenal Atresia/Stenosis/Web
Intestinal Atresia/Stenosis
Necrotizing Enterocolitis (NEC)
Meconium Ileus
Malrotation
Hirschsprung's Disease
Intussusception
Imperforate Anus
Biliary Atresia
Oncology
Neuroblastoma
Nephroblastoma (Wilms' Tumor)
Hepatoblastoma
Testicular Tumors
Pediatric Urology
Types
Clinical Symptoms
Laboratory Findings
Diagnostic Test
Treatment
Hypospadias
Pathophysiology
Etiology
Types
Clinical Symptoms
Treatment
Ureterocele
Clinical Presentation
Diagnosis
Treatment
Congenital Ureteropelvic Junction (UPJ) Obstruction
Pathophysiology
Presentation
Diagnosis
Treatment
Vesicoureteral Reflux (VUR)
Presentation
Indication
Classification
Treatment
Undescended Testis
Autosomal Recessive Polycystic Renal Disease
Horseshoe Kidney
Other Types of Fusion
CHAPTER 8:
Benign Breast Diseases
INTRODUCTION
SCREENING
IMAGING
Mammography
Breast Ultrasound
MRI
BENIGN BREAST LESIONS
NONPROLIFERATIVE BREAST LESIONS
BREAST CYSTS
Simple Cysts
Complicated Cysts
Complex Cysts
FIBROCYSTIC CONDITION
Proliferative Lesions without Atypia Fibroadenoma
Juvenile Fibroadenoma
ATYPICAL HYPERPLASIA
MISCELLANEOUS BREAST LESIONS
Phyllodes Tumor
BREAST ABSCESS
MASTITIS
FAT NECROSIS
HAMARTOMA
GALACTOCELE
CHAPTER 9:
Malignant Breast Diseases
EPIDEMIOLOGY
PRIMARY BREAST CANCER
PATHOLOGY
Noninvasive Breast Cancer
INVASIVE BREAST CANCER
Diagnosis
Inspection
Ductography
Ultrasound
MRI
BIOPSY
BREAST CANCER STAGING AND BIOMARKERS
PROGNOSIS
CHEMOPREVENTION
SURGICAL TECHNIQUES
Excisional Biopsy with Needle Localization
Sentinel Lymph Node Dissection
Conservation Therapy
Mastectomy
Reconstruction
Radiation Therapy
Adjuvant Chemotherapy
CHAPTER 10:
Melanoma
INTRODUCTION
Genetics and Melanoma
Staging of Melanoma
Diagnosis of Melanoma
Treatment of the Melanoma
SITE-SPECIFIC CONSIDERATIONS
EVALUATION OF LYMPHATIC INVOLVEMENT
CHEMOTHERAPY AND RADIOTHERAPY
TREATMENT OF LOCAL RECURRENCE AND IN-TRANSIT METASTASIS
METASTATIC DISEASE
CHAPTER 11:
Small Bowel Neoplasms
GENERAL CONSIDERATIONS
CLINICAL PRESENTATION
DIAGNOSIS
STAGING
BENIGN NEOPLASMS
Adenomas
Lipomas
Hamartomas
Benign GISTs
MALIGNANT NEOPLASMS
Carcinoid Tumors
Lymphomas
Staging of Lymphoma (Ann Arbor Classification)
Adenocarcinoma
Malignant GIST
Metastatic Neoplasms in Small Bowel
CHAPTER 12:
Diseases of Pancreas
SURGICAL EMBRYOLOGY AND ANATOMY
PHYSIOLOGY
ACUTE PANCREATITIS
Introduction
Etiology
CLINICAL FINDINGS
Differential Diagnosis
Laboratory Findings
Imaging
PREDICTORS OF SEVERITY OF ACUTE PANCREATITIS
TREATMENT OF ACUTE PANCREATITIS
Supportive Treatment
Pain Management
Antibiotics
Nutrition
INDICATIONS FOR SURGERY
CHRONIC PANCREATITIS
Introduction
Etiology
Clinical Presentation
Diagnosis
Imaging
Treatment
Pancreatic Enzyme Supplementation
Pain Management
Surgery
PANCREATIC PSEUDOCYST
PANCREATIC FISTULAS
PANCREATIC CANCER
Incidence and Epidemiology
Molecular Biology
Pathology
Solid Epithelial Tumors
Cystic Epithelial Tumors
Signs and Symptoms
Blood Tests
Imaging Studies
Staging of Pancreatic Cancer
Surgery
Palliative Treatment of Pancreatic Cancers
Radiation and Chemotherapy
PANCREATIC NEUROENDOCRINE TUMORS
Introduction
Nonfunctional Endocrine Tumors
Functional Endocrine Tumors
Insulinoma
Gastrinoma (Zollinger-Ellison Syndrome)
Glucagonoma
VIPoma (Verner Morrison Syndrome)
Somatostatinoma
CHAPTER 13:
Large Bowel Tumors
GENERAL CONSIDERATIONS
EPIDEMIOLOGY
COLORECTAL CARCINOGENESIS
COLORECTAL POLYPS
INHERITED COLORECTAL CANCERS
Familial Adenomatosis Polyposis
Hereditary Nonpolyposis Colorectal Cancer
Modified Amsterdam Criteria
SCREENING FOR COLON CANCER
Fecal Occult Blood Test—Guaiac Test
Flexible Sigmoidoscopy
Colonoscopy
Virtual Colonoscopy
Double Contrast Barium Enema
SPORADIC COLON CANCER
PRESENTATION
ROUTES OF SPREAD
Direct Spread
Lymphatic Spread
Hematologic Spread
STAGING
Tumor Stage (T)
Nodal Stage (N)
Distant Metastasis (M)
Stage Grouping
PREOPERATIVE EVALUATION
TREATMENT
Colon Resection
Surgical Management of Metastases
Laparoscopic Colectomy
LYMPH NODE ASSESSMENT
ADJUVANT TREATMENT
PROGNOSIS
SURVEILLANCE
CHAPTER 14:
Carotid Artery Atheromatous Disease
INTRODUCTION
ANATOMY OF CAROTID ARTERIES
ETIOLOGY AND RISK FACTORS
PATHOPHYSIOLOGY
Presentation
Management
Investigations
Treatment
Indications for Treatment
THE OPTIMUM INTERVENTION
Best Medical Treatment
Carotid Endarterectomy
Informed Consent
Timing of Surgery
Preoperative Medical Treatment
Technique of Carotid Endarterectomy
Special Scenarios
High Bifurcation
How to Avoid/Minimize Nerve Injuries
When to Abandon a Planned CEA
How to Manage the Perioperative Neurological Deficits
When to Reoperate for Recurrent Stenosis
How to Manage Infected Prosthetic Patch
Perioperative Complications
Carotid Angioplasty and Stenting
Technique of CAS
Prerequisites
Procedure
Postprocedure Care
Complications
SUMMARY POINTS
CHAPTER 15:
Peripheral Vascular Diseases
ETIOLOGY
ATHEROSCLEROSIS
PREVALENCE AND EPIDEMIOLOGY
RISK FACTORS FOR PAD
AGE AND GENDER
SMOKING
DIABETES
HYPERLIPIDEMIA AND HYPERCHOLESTEROLEMIA
HYPERTENSION
OBESITY AND PHYSICAL EXERCISE
HOMOCYSTEINEMIA
OTHERS
CLINICAL MANIFESTATIONS, SEVERITY AND PROGRESSION OF PAD
CLINICAL EXAMINATION
INSPECTION
PALPATION
AUSCULTATION
ADJUVANT TESTS
MEASUREMENT OF DISEASE SEVERITY AND IMAGING
HAND-HELD DOPPLER AND THE ABPI
CONTINUOUS WAVE DOPPLER
SEGMENTAL PRESSURE STUDIES
ARTERIAL DUPLEX ULTRASOUND
ANGIOGRAPHY
CT ANGIOGRAPHY
MR ANGIOGRAPHY
MANAGEMENT OF PAD
GENERAL MANAGEMENT
RISK FACTOR/LIFESTYLE MODIFICATION
SMOKING CESSATION
BLOOD PRESSURE CONTROL
GLUCOSE CONTROL
EXERCISE
BEST MEDICAL THERAPY
ANGIOTENSIN CONVERTING ENZYME INHIBITORS
HMG-CoA REDUCTASE INHIBITORS (STATINS)
ANTI-PLATELET AGENTS
OTHERS
ADVANCED MANAGEMENT OF PAD: ENDOVASCULAR TREATMENT AND SURGERY
ENDOVASCULAR TREATMENT
SUBINTIMAL ANGIOPLASTY
STENTING
SURGERY
DECIDING ON BEST INTERVENTIONAL TREATMENT AND THE ANATOMICAL CONSIDERATIONS
SUPRAINGUINAL TREATMENT
INFRAINGUINAL TREATMENT
Above Knee (AK) Arterial Disease
Below Knee (BK) Arterial Disease
ADJUVANT THERAPY AFTER ENDOVASCULAR TREATMENT
ADJUVANT THERAPY AFTER SURGERY
COMPARING ENDOVASCULAR THERAPY WITH SURGERY
GRAFT SURVEILLANCE
OTHER TREATMENTS
AMPUTATION
CHAPTER 16:
Abdominal Aortic Diseases
ANATOMY AND EXPOSURE
CONGENITAL ANOMALIES
VENOUS ANOMALIES
AORTIC DISEASE
AORTOILIAC OCCLUSIVE DISEASE
Overview
Diagnosis
Surgical Treatment
Endovascular Treatment
Stents
AORTIC ANEURYSMAL DISEASE
Overview
Pathophysiology
Diagnosis and Clinical Findings
Treatment
Open Repair
Endovascular Repair
Paravisceral and Thoracoabdominal Aortic Aneurysms
Perioperative Care of Patients
Long-Term Care of Patients
Inflammatory Aneurysm
Aortocaval Fistula
Primary Aortoenteric Fistula
Primary Mycotic Abdominal Aortic Aneurysm
Horseshoe Kidney
Iliac Artery Aneurysms
Femoral and Popliteal Artery Aneurysms
CHAPTER 17:
Gastrointestinal Endoscopy: A Bird's Eye View
ESOPHAGUS
STOMACH
SMALL INTESTINE
LARGE INTESTINE
BILIOPANCREATIC SYSTEM
CHAPTER 18:
Obstetrical Problems for Surgeons
PHYSIOLOGICAL CHANGES IN PREGNANCY
Cardiovascular System
Pulmonary Function
Renal Function
Hematologic Laboratory Values
Serum Chemistries
Liver, Biliary and Pancreatic Enzymes
Thyroid Function
ACUTE ABDOMINAL PAIN IN PREGNANCY
Differential Diagnosis
Obstetrical Diseases
Gynecologic Diseases
Non-Ob-Gyn Diseases
Ectopic Pregnancy
Etiology
Signs and Symptoms
Diagnosis
Treatment
Spontaneous Abortion
Etiology
Clinical Findings of Spontaneous Abortion
Preterm Labor (PTL)
Abruptio Placenta
Etiology
Signs and Symptoms
Diagnosis
Managements
Torsion/Rupture of Ovarian Cyst
Pyelonephritis
Etiology
Diagnosis
Management
Pancreatitis in Pregnancy
Appendicitis in Pregnancy
Etiology
Diagnosis
Management
Cholelithiasis/Cholecystitis
Etiology
Diagnosis
Management
GENITAL BLEEDING IN PREGNANCY
First Trimester in Pregnancy
Second to Third Trimester in Pregnancy
Postpartum
Placenta Previa
Etiology
Diagnosis
Management
Uterine Atonic Bleeding
Etiology
Management
DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM
Etiology
Diagnosis
Pulmonary Embolism
Deep Vein Thrombosis
Management
Pulmonary Embolism
Deep Vein Thrombosis
OBSTETRICAL EMERGENCY
NAUSEA AND VOMITING IN PREGNANCY
PRE–ECLAMPSIA AND ECLAMPSIA
Etiology
Diagnosis and Classification
Management
Mild Pre-eclampsia
Severe Pre-eclampsia
Eclampsia
HELLP Syndrome
Antihypertensive Drug in Pregnancy
VAGINAL BIRTH AFTER CESAREAN (VBAC)
CHAPTER 19:
Gynecological Problems for Surgeons
DIFFERENTIAL DIAGNOSIS OF PELVIC MASS
Benign Tumor
Benign to Borderline Malignancy
Malignant Tumor
PAP SMEAR, CERVICAL INTRAEPITHERIAL NEOPLASIA, CERVICAL CANCER
Pap Smear
Cervical Intraepitherial Neoplasia (CIN)
Classification
Management
Cervical Cancer
Etiology and Classification
Management
ENDOMETRIAL HYPERPLASIA AND ENDOMETRIAL CANCER
Endometrial Hyperplasia
Etiology
Diagnosis and Classification
Management
Endometrial Cancer
Etiology
Diagnosis, Histology and Classification
Management
ENDOMETRIOSIS AND ADENOMYOSIS
Endometriosis
Adenomyosis
OVARIAN CYST AND OVARIAN CANCER
Ovarian Cyst
Etiology
Ovarian Cancer
Etiology
Findings and Diagnosis
Management
UTERINE MYOMA
MENOPAUSE AND OSTEOPOROSIS
STD AND PID
Sexually Transmitted Disease
Chlamydia Trachomatis
Neisseria Gonorrhoeae
Human Papilloma Virus
Herpes Virus Type 2
Gardnerella Vaginalis
Treponema Pallidum
Trichomonas Vaginalis
PELVIC INFLAMMATORY DISEASE (PID)
OCP AND HRT
Oral Contraceptive Pills
Introduction
Complications and Contraindications
Hormone Replacement Therapy
URINARY INCONTINENCE
Diagnosis
Classification and Management
Stress Urinary Incontinence
Detrusor Overactivity
CHAPTER 20:
Role of Interventional Radiology in Surgery
INTRODUCTION
PRINCIPLES
PATIENT EVALUATION AND PRE-PROCEDURE REQUISITES
SCOPE OF INTERVENTION RADIOLOGY IN SURGERY
Nonvascular Interventions
Vascular Interventions
Role of Imaging in Trauma
CONCLUSION
CHAPTER 21:
Surgical Infections
SURGICAL INFECTIONS
INFLAMMATION AND THE IMMUNE BASIS OF INFECTION
HOST FACTORS
MICROBIOLOGY
Surgical Site Infections
Community Acquired Infections
Tetanus
Postoperative Fever
MANAGEMENT OF SURGICAL INFECTIONS
Infection Control
Antimicrobial Prophylaxis
CHAPTER 22:
Perioperative Acute Kidney Injury
INTRODUCTION
DEFINITION AND INCIDENCE
Etiology
Risk Factors
Preoperative Risk Factors
Intraoperative Risk Factors
PREOPERATIVE RISK PREDICTION SCORES
Noncardiac Surgery
Cardiac Surgery
MEASURES TO PREVENT KIDNEY INJURY
SUMMARY
PERIOPERATIVE EVALUATION OF PATIENTS WITH KIDNEY DISEASE
PREOPERATIVE ASSESSMENT
POSTOPERATIVE ASSESSMENT
Fluid, Electrolytes and Acid-base Disturbances
Acute Renal Failure
Pharmacology
Dialysis Access
CHAPTER 23:
Surgical Education
INTRODUCTION
SELECTION OF RESIDENTS/POSTGRADUATES
SURGICAL TRAINING
TRAINING IN THE USA
MEDICAL COUNCIL OF INDIA/NATIONAL BOARD OF EXAMINATION
ETHICS
WORKING HOURS
STRUCTURED CURRICULUM
SKILLS LAB
RESEARCH
CERTIFICATION
FURTHER TRAINING
CHANGES NEEDED IN THE SYSTEM
CHAPTER 24:
Cancer: An Epidemiology
HISTORICAL CONTEXT
DEFINITION AND SCOPE OF EPIDEMIOLOGY
MEASURES OF DISEASE FrEQUENCY
Population at Risk
Prevalence and Incidence
Cumulative Incidence Rate of Risk
Comparing Disease Occurrence
ABSOLUTE COMPARISON
Attributable Fraction (Exposed)
Population Attributable Risk
Relative Comparison
Types of Epidemiological Studies
Cancer Registries
International Comparison
Cancer Registration in India
Regional Variation within India
National Estimates
Worldwide Regional Distribution
CHAPTER 25:
Teasers and Tips
TRAUMA
Suspicion of Renal Injury
GCS E4M6V5
Pediatric Trauma Accident
Neurotrauma
Head Injury
Neurotrauma Patient Management
Neurosurgical Interventions
Indications for ICP—Continuous Monitoring
Evaluation of Spine Injury
ER Intubation: Rapid Sequence: LOAVES
Children—LOAVES
Classification of Shock
GENERAL TRAUMA
Burn
Most Common Cause of Mortality in Burn
Admission Criteria of Burn Patient
Changes in Starvation
Colon and GI Cancer
Rectal Cancer: Different with Colon in Certain Ways
CONGENITAL ANOMALIES
Transplant
Conditions Mask Brain Death
Contraindication of Kidney Transplant
Endocrine Surgery
Risk Factors for Thyroid Cancer
Liver and Portal Hypertension
Lymphoma and Hematological Issues for Surgeons
Thoracic Surgery, Head and Neck, Esophageal Cancer and Lung Cancer
Transplantation
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