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Snapshots in Gastroenterology
S Devaji Rao
CHAPTER 1:
Acute Abdominal Pain
Introduction
ACUTE UPPER ABDOMINAL PAIN
Definition
Diagnosis
Symptoms
Past History
Family History
Signs
General
Abdomen
Differential Diagnosis of Acute Upper Abdominal Pain of GI Etiologies
Investigations
Blood tests
Radiology
Management
Clinical Pearl
ACUTE LOWER ABDOMINAL PAIN
Definition
Diagnosis
Symptoms
Past History
Family History
Signs
General
Abdomen
Differential Diagnosis of Acute Lower Abdominal Pain of GI Etiologies
Investigations
Blood Tests
Radiology
Management
Clinical Pearls
COLIC
Definition
Diagnosis
Clinical Features
Eliciting History
Past History
Family History
Differential Diagnosis by Clinical History
Clinical Examination
General
Abdomen
Investigations
Hematology
Radiology
Management
CHAPTER 2:
Chronic Abdominal Pain
INTRODUCTION
ETIOLOGY
DIAGNOSIS
Symptoms
Past History
Family History
Personal History
Menstrual History
Clinical Examination
General
Abdomen
Scars, Swellings and Sinuses
Differential Diagnosis of Chronic Abdominal Pain of GI Etiologies
Investigations
Blood Tests
Radiology
Vascular Studies
Endoscopy
Radionuclide Imaging
Laparoscopy
Exploratory Laparotomy
MANAGEMENT
Clinical Pearls
CHAPTER 3:
Dysphagia
SURGICAL ANATOMY OF ESOPHAGUS
PHYSIOLOGY OF SWALLOWING
DYSPHAGIA
Introduction
Causes of Dysphagia
Oropharyngeal Dysphagia
Drug-induced
Radiation-induced
Prosthesis-induced
Post-surgery
Diagnosis
Symptoms and Signs
Complication
Management
Clinical Pearls
CHAPTER 4:
Diarrhea
DEFINITION
TYPES OF DIARRHEA
ACUTE DIARRHEA
Etiology and Pathogenesis
Management
DYSENTERY
Definition
Causes of Dysentery
Pathogenesis
Diagnosis
Symptoms and Signs
Investigations
Complications
Complications of Amebic Dysentery
Management
Clinical Pearls
TRAVELER'S DIARRHEA
Introduction
Management
Prevention
CHRONIC DIARRHEA
Definition
Pathogenesis
Classifications
Epidemiological Classification
Classification Based on Stool Characteristics
Systemic Diseases Associated with Chronic Diarrhea
Endocrine Diseases
Hematologic Diseases
Immune System Disorders
Diagnosis
Symptoms
Signs
Investigations
Management
Clinical Pearls
CHAPTER 5:
Constipation and Fecal Incontinence
ANATOMY OF ANORECTUM
PHYSIOLOGY OF DEFECATION
CONSTIPATION
Introduction
Etiology of Constipation
Diagnosis
Symptoms
Signs
Investigations
Management
Refractory Constipation
Surgical Therapy of Functional Bowel Disorders
Clinical Pearls
FECAL INCONTINENCE
Introduction
Etiology and Pathogenesis
Diagnosis
Investigations
Management
Medical
Surgical
Clinical Pearls
CHAPTER 6:
Nausea and Vomiting
Introduction
CAUSES OF NAUSEA AND VOMITING
PATHOGENESIS
DIAGNOSIS
Management
Clinical Pearls
CHAPTER 7:
Gaseousness
BELCHING
Introduction
Etiology
Diagnosis
Management
BLOATING
Introduction
Etiology
FLATULENCE
Introduction
Etiology
Diagnosis
Management
CHAPTER 8:
Jaundice
BILIRUBIN METABOLISM
ANATOMY OF BILIARY SYSTEM
DISORDERS OF BILIRUBIN METABOLISM
GILBERT's SYNDROME (GS)
Introduction
Etiology and Pathogenesis
Diagnosis
Symptoms and Signs
Investigations
Complications
Detoxification of Certain Drugs
Differential Diagnosis
Clinical Pearls
CRIGLER–NAJJAR SYNDROME
Introduction
Crigler–Najjar Syndrome, Type I
Diagnosis
Management
Crigler–Najjar Syndrome, Type II
Investigations
Differential Diagnosis
Management
Clinical Pearl
DUBIN–JOHNSON SYNDROME (DJS)
Introduction
Pathophysiology
Diagnosis
Prognosis
ROTOR SYNDROME
Introduction
LUCEY–DRISCOLL SYNDROME
Etiology
OBSTRUCTIVE JAUNDICE
Causes
Investigations
CHAPTER 9:
Gastrointestinal Hemorrhage
UPPER GASTROINTESTINAL BLEED
Introduction
Etiology
Risk Factors
Diagnosis
Clinical Presentation
Investigations
MANAGEMENT (Step by Step)
Clinical Pearls
LOWER GASTROINTESTINAL BLEED
Introduction
Etiology
Risk Factors
Diagnosis
Clinical Presentation
Abdomen
Rectum
Investigations
Management
Clinical Pearls
OBSCURE GASTROINTESTINAL BLEED
Introduction
Etiology
Associated Factors
Diagnosis
Symptoms
Signs
Investigations
Management
Management Depends on the Cause
Clinical Pearls
CHAPTER 10:
Esophagus
ANATOMY AND PHYSIOLOGY
Musculature
Arterial Supply
Venous Drainage (Through Submucosal Plexus)
Nerve Supply
Lymphatics (Through Submucosal Plexus)
Physiology
Approach to a patient with esophageal pathology
Signs and Symptoms
Investigations
Atresia of esophagus
Introduction
Classification
Diagnosis
Symptoms and Signs
Investigations
Management
ACHALASIA CARDIA (CARDIOSPASM)
Introduction
Associated Pathologies
Association with Malignancy
Diagnosis
Symptoms and Signs
Investigations
Differential Diagnosis
Complications
Management
Medical
Surgical
Clinical Pearls
ESOPHAGEAL WEBS
Introduction
Diagnosis
Symptoms
Signs
Investigations
Complications
Management
Clinical Pearls
SCHATZKI'S RING
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
DIVERTICULA OF THE ESOPHAGUS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
HIATUS HERNIA
Introduction
Classification
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
REFLUX ESOPHAGITIS (GASTROESOPHAGEAL REFLUX DISEASE—GERD)
Introduction
Etiology and Pathogenesis
Risk Factors
Diagnosis
Symptoms
Heartburn
Investigations
Endoscopic Grading System for GERD
Savary-Miller Classification (Fig. 10.11C)
Los Angeles Classification of GERD (Fig. 10.11D)
Complications
Management
Clinical Pearls
Surgical Therapy for GERD
Principles of Surgical Therapy
Advantages of Surgical Therapy over Medical Therapy
Preoperative Assessment (Table 10.2)
Transthoracic Belsey Mark IV operation
Procedure
Anesthesia
Incision
Surgical Procedure (Fig. 10.12A)
Clinical Pearls
TRANSTHORACIC NISSEN FUNDOPLICATION
Principles
Surgical Procedures
NISSEN'S FUNDOPLICATION (OPEN PROCEDURE)
Indications for Open Procedure
Position
Anesthesia
Incision
Surgical procedures
Postoperative Care
Complications
MODIFIED HILL REPAIR
Principles
Position
Anesthesia
Incision
Surgical Procedures
Postoperative Care
What do These Procedures should Achieve?
Postoperative Results
COLLIS GASTROPLASTY
Clinical Pearls
Hill Repair
Nissen Repair
Endoscopic Treatment of GERD
Endoscopic Suturing/Stapling
NDO Plicator
Stretta Procedure
Gatekeeper Reflux Repair System
EndoCinch Suturing System
Summary
BARRETT'S ESOPHAGUS
Introduction
Etiology and Pathogenesis
Types of Barrett's Esophagus
Diagnosis
Symptoms and Signs
Investigations
Principles of Therapy in Barrett's Esophagus
Management
Clinical Pearls
STRICTURES OF ESOPHAGUS
Etiology
Diagnosis
Symptoms
Investigations
Management
Clinical Pearls
ESOPHAGEAL INJURY
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
INFECTIONS OF ESOPHAGUS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
DIFFUSE ESOPHAGEAL SPASM
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
FOREIGN BODIES OF ESOPHAGUS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Complications
Management
Clinical Pearls
ESOPHAGEAL VARICES
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Medical
Interventional Nonsurgical
Surgical
Minimally invasive
MALLORY–WEISS TEAR OF ESOPHAGUS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
BENIGN TUMORS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
ESOPHAGEAL MALIGNANCY
Introduction
Etiology
Risk Factors for Squamous Cell Carcinoma
Risk Factors for Adenocarcinoma
Pathological Features
Spread of Esophageal Malignancy
TNM Classification
Diagnosis
Symptoms
Signs
Investigations
Complications
Management
Curative Surgery
Palliative Procedures
ESOPHAGEAL RESECTIONS
Resections of Esophagus (Fig. 10.26)
Reconstructions after Resections (Fig. 10.27)
Indications
TRANSHIATAL ESOPHAGECTOMY
Surgical Technique (Fig. 10.28)
Transection of Esophagus
POSTESOPHAGECTOMY COMPLICATIONS
Clinical Pearls
CHAPTER 11:
Stomach and Duodenum
SURGICAL ANATOMY
Physiology
Acid Secretion
Pepsinogen Secretion
Intrinsic Factor
Gastric Mucosal Barrier
Gastric Hormones
APPROACH TO A PATIENT WITH UPPER GASTROINTESTINAL PATHOLOGY
Signs and Symptoms
Investigations
GASTRIC VOLVULUS
Introduction
Etiology
Pathogenesis
Diagnosis
Symptoms and Signs
Investigations
Differential Diagnosis
Management
GASTRITIS
Introduction
Classification
Helicobacter pylori Gastritis
Introduction
Diagnosis
Management
Clinical Pearls
Stress Gastritis
Bile Reflux Gastritis
Lymphocytic Gastritis
Autoimmune Gastritis
Granulomatous Gastritis
Eosinophilic Gastritis
ACID PEPTIC DISEASE
Introduction
Risk Factors
Results of High Acidity in the Stomach
Classification of Gastric Ulcers
Diagnosis
Symptoms and Signs
Investigations
Complications
Management
Medical
Endoscopic
Surgical
Clinical Pearls
ZOLLINGER–ELLISON SYNDROME (ZES)
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
GASTROPARESIS
Introduction
Etiology
Diagnosis
Symptoms and Signs
Investigations
Management
GASTRIC POLYPS
Introduction
Classification of Gastric Polyps and their Incidence
Diagnosis
Symptoms and Signs
Investigations
Endoscopic and Histologic Features of Gastric Polyps
Risk of Malignancy Associated with Gastric Polyps
Differential Diagnosis
Management
Clinical Pearls
GASTRIC MALIGNANCY
Adenocarcinoma
Introduction
Risk Factors
H. pylori and Gastric Malignancy
Macroscopic Appearances of Gastric Malignancy
Microscopic Variety of Gastric Malignancy
Spread of Gastric Cancer
TNM Classification of Gastric Malignancy
Diagnosis
Symptoms and Signs
Investigations
Management
Curative Treatment
Note
Palliative Treatment
Clinical Pearls
Gastric Lymphoma
Introduction
Risk Factors for GI Lymphomas
MALT Lymphoma
Pathological Types of GI Lymphomas
Musshoff Classification of Ann Arbor Staging of Gastric Lymphomas
Diagnosis
Management
Clinical Pearls
CONGENITAL PYLORIC STENOSIS
Introduction
Etiology and Pathogenesis
Diagnosis
Symptoms
Signs
Investigations
Management
INJURIES OF DUODENUM
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
BEZOARS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Medical
Surgical
DIEULAFOY'S ULCER
Introduction
Diagnosis
Symptom
Investigation
Management
MENETRIER'S DISEASE
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Medical
Surgical
BARIATRIC SURGERY
Introduction
Classification of Obesity
Types of Bariatric Surgery Procedures (Fig. 11.25)
Indications for Bariatric Surgery
Advantages and Complications of LAGB
Advantages and Complications of LSG
Complications of VBG
Advantages and Complications of BPD
Advantages and Complications of RYGB
SURGERIES OF STOMACH AND DUODENUM (TABLE 11.9)
Preoperative Management
PARTIAL/SUBTOTAL GASTRECTOMY
Surgery Steps (Figs 11.29A and B)
Reconstructions after Gastrectomy
Gastrojejunostomy (Side to Side)
Surgery Steps (Fig. 11.31A)
Clinical Pearls
Postoperative Management
COMPLICATIONS OF GASTRIC SURGERY AND MANAGEMENT
Early Intragastric Hemorrhage
Introduction
Diagnosis
Investigation
Management
Delayed Intragastric Hemorrhage
Introduction
Diagnosis
Management
Extragastric Hemorrhage
Introduction
Diagnosis
Management
Duodenal Stump Leakage
Introduction
Diagnosis
Investigations
Management
Clinical Pearl
Suture Line Leak
Diagnosis
Management
Clinical Pearls
Gastric Remnant Necrosis
Introduction
Diagnosis
Management
Stomal obstruction
Introduction
Diagnosis
Management
Acute Afferent Loop Obstruction
Diagnosis
Management
Clinical Pearls
Jejunal Loop (Efferent Loop) Herniation
Diagnosis
Management
Clinical Pearl
Intra-Abdominal Abscess
Introduction
Diagnosis
Management
Clinical Pearl
Postoperative Pancreatitis
Introduction
Diagnosis
Management
Clinical Pearls
Postoperative Jaundice
Introduction
Diagnosis
Management
LONG-TERM COMPLICATIONS OF GASTRIC SURGERY
Alkaline reflux gastritis
Introduction
Diagnosis
Investigations
Management
Clinical Pearl
Early Dumping Syndrome
Introduction
Etiology and Pathogenesis
Diagnosis
Investigations
Management
Clinical Pearls
Late Dumping Syndrome
Introduction
Etiology and Pathogenesis
Diagnosis
Investigations
Management
Clinical Pearls
Post-Vagotomy Diarrhea
Introduction
Etiology
Diagnosis
Management
Clinical Pearls
Malabsorption and Weight Loss
Introduction
Etiology
Diagnosis
Management
Clinical Pearls
Anemia
Introduction
Etiology
Diagnosis
Investigations
Management
Clinical Pearls
Chronic Gastric Atony
Introduction
Etiology
Diagnosis
Management
Clinical Pearl
Small Gastric Remnant Syndrome
Introduction
Diagnosis
Management
Roux Syndrome
Introduction
Etiology and Pathogenesis
Diagnosis
Management
Clinical Pearls
Gastric Remnant Carcinoma
Introduction
Diagnosis
Management
Clinical Pearl
Anastomotic Ulcer
Introduction
Diagnosis
Management
Recurrent Ulcer
Introduction
Etiology
Diagnosis
Management
Clinical Pearls
Gastrojejunocolic fistula
Introduction
Pathogenesis
Diagnosis
Management
Chronic Afferent Loop Obstruction
Introduction
Etiology and Pathogenesis
Diagnosis
Investigations
Management
Chronic Efferent Loop Obstruction
Introduction
Diagnosis
Management
Internal Hernia
Introduction
Diagnosis
Management
Clinical Pearl
Jejunogastric Intussusception
Introduction
Diagnosis
Management
Clinical Pearl
CHAPTER 12:
Small Intestine
ANATOMY
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
Histology
PHYSIOLOGY
Absorption and Secretion
Motility
APPROACH TO THE PATIENT WITH SMALL BOWEL DISEASE
Signs and Symptoms
Investigations
Enteroclysis
Enteroscopy
SMALL BOWEL ATRESIA
Introduction
Etiology and Pathogenesis
Diagnosis
Clinical Presentation
Investigations
Management
VOLVULUS OF MIDGUT
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Medical
Surgical
Clinical Pearl
INJURIES OF SMALL INTESTINE
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
INTUSSUSCEPTION
Introduction
Etiology
In Children
In Adults
Diagnosis
Symptoms
Signs
Investigations
Complications
Management
Clinical Pearls
ABDOMINAL TUBERCULOSIS
Introduction
Classification
Diagnosis
Symptoms and Signs
Investigations
Management
CROHN'S DISEASE
Introduction
Risk Factors
Diagnosis
Clinical Presentation
Extraintestinal Manifestations
Investigations
Radiology
Endoscopy
Tissue Diagnosis
Serology
Classification
Severity of Crohn's Disease
Harvey–Bradshaw index
Complications
Differential Diagnosis
Management
Clinical Pearls
WHIPPLE'S DISEASE
Introduction
Etiology
Diagnosis
Clinical Presentation
Investigations
Management
Clinical Pearl
CELIAC DISEASE
Etiology and Pathogenesis
Diagnosis
Clinical Presentation
Investigations
Management
Clinical Pearl
IRRITABLE BOWEL SYNDROME
Introduction
Classification
Etiology and Pathogenesis
Diagnosis
Symptoms
Sign
Investigations
Differential Diagnosis
Management
Clinical Pearls
STRICTURES
Introduction
Diagnosis
Clinical Presentation
Investigations
Management
PARALYTIC ILEUS
Introduction
Diagnosis
Clinical Presentation
Investigation
Management
ISCHEMIC ENTERITIS/MESENTERIC VASCULAR OBSTRUCTION
Introduction
Arterial Diseases
Venous Diseases
Pathogenesis
Classification
Diagnosis
Clinical Presentation
Investigations
Management
Clinical Pearls
INTESTINAL OBSTRUCTION
Introduction
Etiology and Pathogenesis
Diagnosis
Clinical Presentation
Investigation
Management
Clinical Pearls
DIVERTICULITIS OF SMALL BOWEL
Introduction
Diagnosis
Clinical Presentation
Investigations
Management
Meckel's Diverticulitis
Introduction
Diagnosis
Clinical Presentation
Investigations
Differential Diagnosis
Complications
Uncommon Complications
Management
Clinical Pearls
ANGIODYSPLASIA
Introduction
Etiology
Diagnosis
Clinical Presentation
Investigations
Management
BENIGN TUMORS
Introduction
Diagnosis
Clinical Presentation
Investigation
Management
MALIGNANT TUMORS
Lymphoma
Introduction
Risk Factors
Etiology and Pathogenesis
Classification
Diagnosis
Investigations
Management
Clinical Pearls
Adenocarcinoma
Introduction
Risk Factors
Diagnosis
Management
Clinical Pearls
Carcinoid Tumor
Introduction
Etiology and Pathogenesis
Diagnosis
Clinical Pearls
SURGERY OF SMALL BOWEL
Ileal resection
Incision
Surgical Technique (Fig. 12.21)
Hand-sewn Technique (Fig. 12.23)
Clinical Pearls
End-to-end Anastomosis (Stapled) (Fig. 12.24)
End-to-side Anastomosis (Stapled) (Fig. 12.25)
Side-to-side Anastomosis (Stapled) (Fig. 12.26)
POSTOPERATIVE COMPLICATIONS
Anastomotic Leakage
Introduction
Clinical Presentation
Management
Intra-Abdominal Abscess
Introduction
Diagnosis
Management
Anastomotic Stricture
Introduction
Diagnosis
Clinical Presentation
Investigation
Management
Clinical Pearl
Adhesions
Introduction
Diagnosis
Investigation
Management
Internal Fistulae
Introduction
Diagnosis
Management
External Fistulae
Introduction
Diagnosis
Investigations
Management
Surgical
Nutritional Deficiencies
Introduction
Etiology and Pathogenesis
Diagnosis
Investigations
Management
Short Bowel Syndrome
Diagnosis
Investigation
Complications
Management
Surgical
Clinical Pearls
CHAPTER 13:
Vermiform Appendix
SURGICAL ANATOMY
Blood Supply
Lymphatic Drainage
Nerve Supply
CONGENITAL ANOMALIES
ACUTE APPENDICITIS
Introduction
Types of Appendicitis
Diagnosis
Symptoms
Signs
Tenderness at McBurney's Point
Rovsing's Sign
Blumberg's Sign
Cope's Psoas Test
Obturator Sign
Baldwing's Sign
Appendicitis in Special Situations
Investigations
Clinical Scoring Systems
Differential Diagnosis
Complications
Management
Clinical Pearls
RECURRENT APPENDICITIS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
NEOPLASMS OF APPENDIX
Carcinoid Tumors
Introduction
Etiology and Pathogenesis
Diagnosis
Investigations
Management
Mucinous Tumors
Introduction
Classification
Pathogenesis
Diagnosis
Investigations
Differential Diagnosis
Complications
Management
SURGERY OF APPENDIX
Indications
Appendicectomy
Surgical Technique
Open Appendicectomy
Laparoscopic Appendicectomy
Clinical Pearls
COMPLICATIONS OF APPENDICECTOMY
Hemorrhage from Appendicular Stump
Introduction
Etiology
Diagnosis
Management
Paralytic Ileus
Introduction
Etiology and Pathogenesis
Diagnosis
Management
Wound Infection after Appendicectomy
Introduction
Diagnosis
Management
Pelvic/Paracolic Abscess
Introduction
Diagnosis
Management
Rupture of Stump
Introduction
Diagnosis
Management
Hernia (Postappendicectomy)
Introduction
Diagnosis
Management
Intestinal Obstruction
Introduction
Diagnosis
Management
CHAPTER 14:
Large Intestine
ANATOMY
Histology
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
PHYSIOLOGY
VOLVULUS
Introduction
Risk Factors
Sigmoid Volvulus
Etiology and Pathogenesis
Diagnosis
Differential Diagnosis
Management
Clinical Pearls
Cecal Volvulus
Introduction
Etiology and Pathogenesis
Diagnosis
Management
Clinical Pearls
Transverse Colon Volvulus
Introduction
Etiology and Pathogenesis
Diagnosis
Management
Clinical Pearl
Ileosigmoid Knotting
Introduction
Etiology and Pathogenesis
Diagnosis
Differential Diagnosis
Management
Clinical Pearl
INJURIES OF LARGE INTESTINE
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
ULCERATIVE COLITIS
Introduction
Etiology and Pathogenesis
Risk Factors
Diagnosis
Symptoms and Signs
Extraintestinal Manifestations
Investigations
Differential Diagnosis
Complications
Management
Medical
Clinical Pearls
PSEUODMEMBRANOUS COLITIS
Introduction
Etiology and Pathogenesis
Risk Factors
Diagnosis
Symptoms and Signs
Investigations
Differential Diagnosis
Management
Medical
Surgical
Clinical Pearls
RADIATION COLITIS
Introduction
Diagnosis
Symptoms and Signs
Investigation
Management
Medical
Endoscopic
Surgical
ISCHEMIC COLITIS
Introduction
Etiology
Diagnosis
Symptoms and Signs
Investigations
Differential Diagnosis
Complications
Management
Indications for Surgery
Clinical Pearls
OGILVIE'S SYNDROME
Introduction
Etiology
Pathogenesis
Diagnosis
Symptoms and Signs
Investigations
Complications
Management
Medical
Endoscopic
Surgical
Clinical Pearls
DIVERTICULITIS
Introduction
Etiology and Pathogenesis
Risk Factors
Diagnosis
Symptoms
Signs
Investigations
Differential Diagnosis
Complications
Management
Indications
Clinical Pearls
CECAL DIVERTICULITIS
Introduction
Classification
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
COLORECTAL POLYPS
Introduction
Anatomy (Fig. 14.15B)
Classification
Neoplastic Polyps
Adenomas
Etiology and Pathogenesis
Diagnosis
Differential Diagnosis
Complications
Management
Clinical Pearls
Non-neoplastic Polyps
Hyperplastic Polyps
Hamartomas
Inflammatory Polyps
Lymphoid Polyps
Clinical Pearls
POLYPOSIS SYNDROMES
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Surveillance
Clinical Pearls
COLONIC MALIGNANCY
Introduction
Risk Factors
Etiology and Pathogenesis
Malignant Polyps
Duke's Classification
Spread of Colonic Malignancy
Synchronous Lesions
TNM Classification
Diagnosis
Symptoms and Signs
Investigations
Management
Curative
Palliative
Screening for Colonic Cancers
Clinical Pearls
HEREDITARY NON-POLYPOSIS COLORECTAL CANCER (HNPCC)
Introduction
Criteria for HNPCC
Diagnosis
Investigation
Management
Clinical Pearls
SURGERIES OF COLON
Varieties of Operations on Large Bowel
Types of Large Bowel Resections (Refer Fig. 14.23)
Varieties of Reconstructions of Large Bowel (Refer Fig. 12.20B)
Indications
All Colonic Resections Need Optimization
Colonic Resections
Essential Steps (Fig. 14.24)
Hand-sewn Technique (Fig. 14.25)
Clinical Pearls
Stapled Anastomosis
ILEORECTAL/ILEOANAL ANASTOMOSIS
ILEAL POUCH–ANAL ANASTOMOSIS
Complications
COMPLICATIONS OF COLONIC SURGERY WOUND INFECTION AFTER COLONIC SURGERY
Anastomotic Leakage
Complications
Management
Anastomotic Stricture After Colonic Anastomosis
Investigations
Management
Clinical Pearl
Adhesions
Management
External Urinary Fistulae After Colonic Surgery
External Colonic Fistulae
Investigations
Management
Surgical
CHAPTER 15:
Rectum and Anal Canal
ANATOMY
Histology
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
PHYSIOLOGY
APPROACH TO THE PATIENT WITH ANORECTAL DISEASE
Signs and Symptoms
Investigations
HIRSCHSPRUNG'S DISEASE
Introduction
Etiology
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearl
ANORECTAL MALFORMATIONS
Introduction
Etiology and Pathogenesis
Classification
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
INJURIES OF RECTUM
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
HEMORRHOIDS
Introduction
Etiology
Pathogenesis
Theories of Development of Hemorrhoids
Classification
Diagnosis
Symptoms and Signs
Signs
Investigations
Differential Diagnosis
Complications
Management
Medical Treatment for Hemorrhoids
Dietary and Lifestyle Modifications
Vasotopic Drugs
Topical Applications
Invasive Treatment
Nonoperative/Office Procedures
Sclerotherapy
Materials Required
Procedure
Complications
Infrared Photocoagulation
Principle
Materials Required
Procedure
Complications
Rubber Band Ligation
Principle
Materials Required
Procedure
Complications
Bipolar Diathermy and Direct Current Electrotherapy
Surgical Treatment
Principle
Indications
Relative Contraindications
Open Hemorrhoidectomy (Milligan and Morgan)
Procedure
Closed Hemorrhoidectomy (Ferguson and Heaton)
Principle
Procedure
Laser Hemorrhoidectomy
Stapled Hemorrhoidectomy
Principle
Materials Required (Fig. 15.8)
Procedure
Technique
Postoperative Complications
Clinical Pearls
PERIANAL HEMATOMA
Introduction
Diagnosis
Symptoms and Signs
Management
ANAL FISSURES
Introduction
Classification
Pathologies Associated with Recurrent Anal Fissures
Diagnosis
Symptoms and Signs
Management
Acute Fissure
Chronic Fissures
Clinical Pearls
Operative Procedures for Fissures
Lateral Internal Anal Sphincterotomy (Fig. 15.13A)
Procedure
Closed Internal Anal Sphincterotomy (Fig. 15.13B)
Procedure
ANORECTAL ABSCESSES
Introduction
Etiology
Nonspecific
Specific
Pathogenesis
Diagnosis
Symptoms
Signs
Investigations
Management
FISTULA IN ANO
Introduction
Classification
Etiology
Diagnosis
Symptoms
Signs
Goodsall's Rule
Investigations
Management
Clinical Pearls
Surgical Treatment of Anal Fistulae
Principle
Preoperative Preparation
Anesthesia
Lay-open Technique (Fistulotomy) (Fig. 15.20A)
Seton (Fig. 15.20B)
Anorectal Advancement Flap (Fig. 15.20C)
Fistulectomy
Clinical Pearls
Postoperative Care
Complications
Incontinence
Recurrence
Recent Advances
Clinical Pearls
AMEBIC PROCTITIS AND ULCERS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
RECTAL POLYPS
Introduction
Diagnosis
Symptoms and Signs
Investigation
Management
RECTAL MALIGNANCY
Introduction
Diagnosis
Symptoms and Signs
Investigations
Endoscopy
Tissue Diagnosis
Radiology
Management
Clinical Pearls
Surgical Treatment for Rectal Cancer
Margins
Total Mesorectal Excision (Fig. 15.24)
Clinical Pearls
Abdominoperineal Resection (Fig. 15.25)
Surgical Technique
Complications
Low Anterior Resection (Fig. 15.27)
Surgical Technique
ANAL MALIGNANCY
Introduction
Types of Malignancies
Risk Factors
Macroscopic and Microscopic Appearances
Spread of Anal Canal Malignancy
Diagnosis
Symptoms
Signs
Investigations
Differential Diagnosis
Management
Curative
Palliative
Clinical Pearls
RECTAL PROLAPSE
Introduction
Diagnosis
Symptoms
Signs
Differential Diagnosis
Management
Abdominal Procedures
Perineal Procedures
Clinical Pearls
SOLITARY RECTAL ULCER
Introduction
Diagnosis
Symptoms and Signs
Investigations
Differential Diagnosis
Management
CHAPTER 16:
Intestinal Stomas
INTRODUCTION
INPUT STOMAS
Gastrostomy (Fig. 16.1)
Indications
Open Surgical Gastrostomy
Percutaneous Endoscopic Gastrostomy (PEG)
An Exclusive Kit is Available for PEG Procedure (Fig. 16.6)
JEJUNOSTOMY (FIG. 16.7)
Open Surgical Jejunostomy (Witzel's Type) (Figs 16.8A to D)
Surgery Steps
Direct Percutaneous Endoscopic Jejunostomy (Figs 16.10A to H)
Percutaneous Endoscopic Gastrostomy with Jejunal Extension (PEG–J) (Fig. 16.11)
Clinical Pearls
Postoperative Management
Caring for the PDEG-J Tube
COMPLICATIONS OF INPUT STOMAS
Intraperitoneal Leak
Diagnosis
Management
Excoriation and Infection of Stoma
Diagnosis
Management
OUTPUT STOMAS
Introduction
Physiology
Output
Volume
Nutrition
Preoperative Evaluation and Considerations
Standard Stoma Sites
ILEOSTOMY
COLOSTOMY
Diverting Stomas
Creation of Stomas
End Ostomy
Loop Ostomy (Figs 16.17A to D)
End Loop Ostomy
Divided Colostomy
Hartmann's Operation
Clinical Pearls
Postoperative Management of Ostomy
Long-term Management of Colostomy
APPLIANCES
Adhesive or Non-adhesive Appliance
Disposable or Non-disposable (Reusable)
Drainable or Non-drainable
Fitting the One Piece Appliance (Figs 16.21A and D):
Fitting the Two Piece Appliance (Fig. 16.22A to F)
Emptying or Changing the Bag
Cleaning the Bag
PROBLEMS
Problems of the Appliance
Odor
Leakage
Detachment of Bag
Problems of the Adhesive
Management
Problems of the Skin
Trauma
Skin irritation
Allergy
COMPLICATIONS OF OSTOMY
Necrosis
Mucocutaneous Infection
Separation of Ostomy
Stricture, Stenosis and Retraction
Prolapse
Parastomal Hernia
Fistula Formation
Perforation
Diversion Colitis
Clinical Pearls
CONTINENT ILEOSTOMY
Postoperative Management
COMPLICATIONS
Nipple Valve Slippage
Leakage from Suture Lines
Necrosis of the Exit Conduit
Fecal Incontinence
Retention
Profuse Diarrhea
Volvulus of Reservoir
Clinical Pearls
CHAPTER 17:
Liver
SURGICAL ANATOMY
Portal Circulation
Venous Drainage
Arterial Supply
Biliary Drainage
Lymphatics
Nerves
Clinical Pearls
PHYSIOLOGY
Formation of Bile
Composition of Bile
Bilirubin Metabolism (Refer Table 8.1)
Vascular Physiology
APPROACH TO THE PATIENT WITH LIVER DISEASE
Physical Examination
General Examination
Vital Signs
Examination of Abdomen
Investigations
In Summary
HEPATOMEGALY
Introduction
Etiology
INJURIES OF LIVER
Introduction
Classification
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
VIRAL HEPATITIS
Introduction
Acute and Chronic Hepatitis
Etiology and Pathogenesis
Diagnosis
Symptoms and Signs
Investigations
Tissue Diagnosis
Complications
Management
Immune Modulators
Oral Nucleoside Analogs
Oral Nucleotide Analog of Adenosine Monophosphate
Response to Therapy
Prevention
Clinical Pearls
AUTOIMMUNE HEPATITIS
Introduction
Types of Autoimmune Hepatitis
Pathogenesis
Diagnosis
Clinical Presentation
Investigations
Management
Response to Therapy
Clinical Pearls
ALCOHOLIC LIVER DISEASE (ALD)
Introduction
Etiology and Pathogenesis
Types of Alcoholic Liver Disease
Risk Factors
Diagnosis
Symptoms
Signs
Investigations
Tissue Diagnosis
Management
Prognosis
Clinical Pearls
ALCOHOL WITHDRAWAL SYNDROME
Introduction
Diagnosis
Symptoms
Signs
Investigations
Radiology
Management
Clinical Pearls
NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
Introduction
Pathogenesis
Diagnosis
Symptoms
Signs
Investigations
Diagnosis of Non-alcoholic Steatohepatitis (NASH) is Made on Three Criteria
Management
Clinical Pearls
DRUG-INDUCED LIVER DISEASE (DILD)
Introduction
Etiology and Pathogenesis
Risk Factors
Diagnosis
Symptoms
Signs
Investigations
Management
Clinical Pearls
METABOLIC LIVER DISEASES
Hemochromatosis
Introduction
Types of Hemochromatosis
Pathogenesis
Triggering Factors
Diagnosis
Symptoms
Signs
Investigations
Differential Diagnosis
Complications
Management
Clinical Pearls
Wilson's Disease
Introduction
Pathogenesis
Diagnosis
Investigations
Complications
Management
Clinical Pearls
Alpha1 Antitrypsin Deficiency
Introduction
Pathogenesis
Diagnosis
Investigations
Complications
Management
Surgical
Clinical Pearls
CIRRHOSIS
Introduction
Etiology
Pathogenesis
Classification
Diagnosis
Symptoms
Signs
Investigations
Complications
Management
Clinical Pearls
PRIMARY BILIARY CIRRHOSIS
Introduction
Etiology and Pathogenesis
Diagnosis
Symptoms
Signs
Investigations
Complications
Management
Medical
Surgical
PORTAL VEIN THROMBOSIS
Introduction
Etiology
Diagnosis
Symptoms and Signs
Investigations
Management
BUDD–CHIARI SYNDROME
Introduction
Etiology
Pathogenesis
Diagnosis
Symptoms and Signs
Investigations
Differential Diagnosis
Complications
Management
Clinical Pearls
PORTAL HYPERTENSION
Etiology
Diagnosis
Symptoms
Signs
Investigations
Complications
Management
Nonbleeding Varices
Varices Bled Previously
Clinical Pearls
ASCITES
Introduction
Etiology and Pathogenesis
Diagnosis
Symptoms
Signs
Investigations
Ascitic Fluid Analysis
Management
Medical
Surgical
Clinical Pearls
HEPATIC ENCEPHALOPATHY
Introduction
Etiology and Pathogenesis
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
HEPATORENAL SYNDROME
Introduction
Classification
Pathogenesis
Diagnosis
Symptoms and Signs
Management
Clinical Pearls
FOCAL LIVER MASSES
Introduction
Diagnosis
History
Symptoms and Signs
Investigations
Management
Clinical Pearls
LIVER ABSCESS
Pyogenic Liver Abscess
Diagnosis
Differential Diagnosis
Complications
Management
Clinical Pearls
Amebic Liver Abscess
Introduction
Pathogenesis
Diagnosis
Differential Diagnosis
Complications
Management
Indications for percutaneous drainage
Clinical Pearls
CYSTIC LIVER DISEASES
Introduction
Classification
CONGENITAL LIVER CYSTS
Introduction
Classification
Diagnosis
Symptoms and Signs
Investigations
Complications
Management
Clinical Pearls
HYDATID CYST OF LIVER
Introduction
Pathogenesis
Diagnosis
Symptoms and Signs
Complications
Management
Clinical Pearls
NEOPLASTIC LIVER CYSTS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
BENIGN LIVER TUMORS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Summary
Clinical Pearls
HEPATOBLASTOMA
Introduction
Etiology and Pathogenesis
Risk Factors
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearl
PRIMARY LIVER MALIGNANCY
HEPATOCELLULAR CARCINOMA
Introduction
Risk Factors
Types of Hepatocellular Carcinoma
Spread of Hepatocellular Carcinoma
Diagnosis
Symptoms and Signs
TNM Classification of Hepatocellular Carcinoma
Investigations
Paraneoplastic Syndromes Related to HCC
Differential Diagnosis
Management
Curative
Palliative (unresectable tumors)
Clinical Pearls
METASTATIC LIVER DISEASE
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Curative
Palliative (unresectable tumors)
Clinical Pearls
SURGICAL PROCEDURES: SHUNT PROCEDURES
Introduction
Classification of Portosystemic Shunt Procedures
Clinical Pearls
HEPATECTOMY
Hepatic Resections
Classification
Incisions
Procedure
Postoperative Course
Complications
Clinical Pearls
LIVER TRANSPLANTATION
Post-transplant Management
Complications
Clinical Pearls
CHAPTER 18:
Gallbladder and Bile Ducts
ANATOMY
Gallbladder
Bile Ducts
Arterial Supply
Venous Drainage
Nerve Supply
PHYSIOLOGY
ANOMALIES
BILIARY ATRESIA
Introduction
Triggering Factors
Diagnosis
Symptoms
Investigations
Management
CHOLEDOCHAL CYSTS
Introduction
Etiology and Pathogenesis
Classifications
Diagnosis
Symptoms and Signs
In Children
In Adults
Investigations
Complications
Management
Clinical Pearls
GALLSTONES (CHOLELITHIASIS)
Introduction
Etiology and Pathogenesis
Risk Factors
Diagnosis
Symptoms and Signs
Investigations
CHRONIC CHOLECYSTITIS
Introduction
Diagnosis
Symptoms
Signs
Investigations
Differential Diagnosis
Complications
Management
Surgical
Medical
Dissolution
Clinical Pearls
ACUTE CHOLECYSTITIS
Introduction
Etiology and Pathogenesis
Diagnosis
Symptoms
Signs
Investigations
Differential Diagnosis
Complications
Mirizzi's Syndrome
Biliary Sludge
Management
Clinical Pearls
ACALCULOUS CHOLECYSTITIS
Introduction
Etiology and Pathogenesis
Predisposing Factors
Diagnosis
Symptoms
Signs
Investigations
Radiology
Isotope Studies
Differential Diagnosis
Management
Medical
Surgical
Clinical Pearl
EMPHYSEMATOUS CHOLECYSTITIS
Introduction
Risk Factors
Diagnosis
Symptoms and Signs
Investigations
Blood Tests
Management
Medical
Surgical
Clinical Pearls
CHOLEDOCHOLITHIASIS
Epidemiology and Pathogenesis
Primary Stones
Risk Factors
Secondary Stones
Diagnosis
Symptoms and Signs
Courvoisier's Law
Investigations
Radiology
Radionuclide Studies
Management
Endoscopic
Clinical Pearls
GALLSTONE ILEUS
Etiology and Pathogenesis
Diagnosis
Symptoms and Signs
Investigations
Management
INJURIES TO THE BILIARY TRACT
Introduction
Etiology and Pathogenesis
Classifications
Diagnosis
Symptoms and Signs
Investigations
Differential Diagnosis
Complications
Management
Surgical
Endoscopic
Clinical Pearls
BILE DUCT STRICTURES
Introduction
Diagnosis
Symptoms
Signs
Investigations
Differential Diagnosis
Complications
Management
Clinical Pearls
PRIMARY SCLEROSING CHOLANGITIS (PSC)
Introduction
Pathogenesis
Diagnosis
Symptoms and Signs
Investigations
Complications
Differential Diagnosis
Management
Clinical Pearls
SPHINCTER OF ODDI DYSFUNCTION
Etiology and Pathogenesis
Classification
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
GALLBLADDER POLYPS
Epidemiology
Risk Factors which Increase the Chance of Malignancy of Gallbladder Polyps
Diagnosis
Symptoms and Signs
Investigations
Differential Diagnosis
Management
Clinical Pearls
CARCINOMA OF GALLBLADDER
Introduction
Risk Factors
Pathogenesis
Spread of Gallbladder Malignancy
TNM Classification of Gallbladder Malignancy
Incidental Malignancy of Gallbladder
Diagnosis
Symptoms
Signs
Investigations
Complications
Differential Diagnosis
Management
Curative
Palliative
Prognosis
Clinical Pearls
CHOLANGIOCARCINOMA
Introduction
Etiology and Pathogenesis
Risk Factors
Pathology
Classification
Diagnosis
Symptoms
Signs
Investigations
Differential Diagnosis
Management
Curative
Palliative
Clinical Pearls
OPERATIVE PROCEDURES
Antibiotics in Gallbladder Surgery
Cholecystectomy
When to Operate?
Laparoscopic Cholecystectomy
Surgical Procedure
Procedure
Complications of Laparoscopic Cholecystectomy
Conversion to Open Cholecystectomy
How to Avoid Bile Duct Injury during Laparoscopic Cholecystectomy
Open Cholecystectomy
Complications of Open Cholecystectomy
Complications of Cholecystectomy: Hemorrhage
Introduction
Diagnosis
Management
Clinical Pearl
Bile Leak, Biloma and Biliary Peritonitis
Introduction
Diagnosis
Investigations
Management
Clinical Pearls
Subphrenic or Intra-abdominal Abscess
Introduction
Diagnosis
Management
Clinical Pearl
External Biliary Fistula
Introduction
Diagnosis
Investigations
Management
Biliary Enteric Fistula
Introduction
Diagnosis
Management
Stricture of Common Bile Duct
Introduction
Diagnosis
Investigations
Management
Retained CBD Stones
Introduction
Diagnosis
Management
Trocar Site or Incisional Hernia
Introduction
Diagnosis
Management
Advantages and Disadvantages of Laparoscopic Cholecystectomy over Open Procedure
MANAGEMENT OF CHOLEDOCHOLITHIASIS
Endoscopic Procedures
ERCP Stone Extraction
Endoscopic Sphincterotomy and Stone Extraction
Balloon Sphincteroplasty
Lithotripsy
Mechanical Lithotripsy
Intraductal Short Wave Lithotripsy (ISWL)
Percutaneous Transhepatic Biliary Drainage (PTBD) with Stone Extraction
Open Surgical Procedures
Choledocholithotomy
Cholecystectomy after CBD Clearance
Surgical Biliary Drainage Procedures
Principle
Choledochoduodenostomy (CDD)
Choledochojejunostomy (CDJ)
Complications
CHAPTER 19:
Pancreas
ANATOMY AND PHYSIOLOGY
Pancreatic Duct Anatomy
Vascular and Lymphatic Anatomy
Neuroanatomy
Histology and Physiology
Exocrine Pancreas
Endocrine Pancreas
Clinical Pearls
APPROACH TO A PATIENT WITH PANCREATIC DISEASE
Signs
Abdomen
Physical Examination
General Examination
Vital Signs
Examination of Abdomen
Investigations
Lipase
Tests Pertaining to Pancreatic Structure
Tests of Exocrine Pancreatic Function
Liver Function Tests
Serological Tests
Laparoscopy
Biopsy
ACUTE PANCREATITIS (AP)
Introduction
Etiology
Pathogenesis
Phase I
Phase II
Phase III
Classification
Diagnosis
Symptoms
Signs
Investigations
Criteria to Assess the Severity of Acute Pancreatitis
Interpretation
Glasgow (Simplified Ranson) Criteria
Complications
Differential Diagnosis
Management
Clinical Pearls
CHRONIC PANCREATITIS (CP)
Introduction
Classification and Risk Factors
Pathogenesis
Diagnosis
Symptoms
Signs
Investigations
Radiology
Diagnostic Features of Chronic Pancreatitis
Complications
Management
Medical
Endoscopic
Surgical
Drainage Procedures
Extended Drainage Procedure
Resectional Procedures
Resection with Drainage
Denervation Procedures
Clinical Pearls
PANCREATIC PSEUDOCYST
Introduction
Types of Pseudocyst
Diagnosis
Symptoms and Signs
Investigations
Complications
Management
Clinical Pearls
AMPULLARY AND PERIAMPULLARY CARCINOMA
Introduction
Risk Factors
Diagnosis
Symptoms and Signs
Investigations
Differential Diagnosis
Management
PANCREATIC MALIGNANCY
Introduction
Etiology and Pathogenesis
Risk Factors
Pathologic Features
Spread of Pancreatic Malignancy
TNM Classification of Pancreatic Malignancy
Diagnosis
Symptoms
Signs
Investigations
Differential Diagnosis
Management
Curative
Palliative
Clinical Pearls
CYSTIC NEOPLASMS OF PANCREAS
Introduction
Diagnosis
Symptoms and Signs
Differential Diagnosis
Management
Clinical Pearls
ISLET CELL TUMORS OF PANCREAS
Introduction
Diagnosis
Symptoms and Signs
Investigations
Management
Clinical Pearls
SURGERY OF PANCREAS: PANCREATIC RESECTIONS
Incisions
Surgical Technique of Pancreatoduodenectomy
Complications of pancreatic surgery
Gastrointestinal Hemorrhage
Diagnosis
Management
Diagnosis
Management
Delayed Gastric Emptying
Diagnosis
Management
Biliary Leak
Diagnosis
Management
Pancreatic Leak
Diagnosis
Management
Chylous Ascites
Clinical Presentation
Investigations
Management
Marginal Ulcerations
Diagnosis
Management
Obstructive Jaundice
Clinical Presentation
Investigations
Management
Endocrine and Exocrine Insufficiency
Diagnosis
Management
INDEX
TOC
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