Illustrated Surgery—A Road Map Nilay Mandal
INDEX
Page number followed by f refer to figure
A
Abdominal wall 220
acquired abnormalities
diastasis recti 227
rectus sheath hematoma 227
congenital defect
exomphalos 220
gastroschisis 221
infantile umbilical hernia 222
desmoid tumor 228
omphalomesenteric duct persists 223
urachus 226
Acidosis and alkalosis
metabolic acidosis 25
metabolic alkalosis 26
respiratory acidosis 26
respiratory alkalosis 27
Acquired hemorrhagic disorders
anticoagulant drugs 31
liver diseases 32
thrombocytopenia 32
vitamin k deficiency 31
Acute acalculous cholecystitis
treatment 58
Acute cholangitis 67
Acute cholecystitis 44
clinical presentation 45
investigations 46
pathophysiology 45
treatment 47
Adenoma-carcinoma sequence 364
Adrenal gland 531
adrenal crisis 545
adrenal insufficiency 544
adrenogenital syndrome 543
anatomical variations 531
Cushing syndrome 537
clinical presentation 540
investigations 541
treatment 542
types 537
hyperaldosteronism 534
microscopic features 533
pheochromocytoma 546
clinical presentation 547
etiology 547
investigations 548
treatment 549
Alvarado scoring 384
Anal cushion 413
Anesthesia 1090
epidural 1096
general 1097
complications 1103
intraoperative management 1102
local 1092
preoperative evaluation 1101
spinal 1095
Anomalous anatomy 96
Anterior cord syndrome 609
Appendix 376
acute appendicitis 378
clinical presentation 380
investigations 381
tratment 385
appendicular lump 390
neoplasm
carcinoid tumor 392
B
Balloon tamponade 167
Bascom's theory 420
BCT 464
Biliary dyskinesia
treatment 59
Birads 460
Bladder injuries 659
Body fluids 15
hypovolemia 17
input-output 16
volume overload 18
Borrmann's classification system 269
Brown-Séquard syndrome 609
Burn 674
chemical 692
different mechanisms of burn injury 676
electric 689
late complications 692
management 677
systemic changes 688
C
Calcium oxalate stone 952
Cauda equina syndrome 610
CEAP classification 756
Central cord syndrome 609
Chest drain 616
Cholangiocarcinoma 86
clinical presentation 88
investigations 88
pathology 87
risk factor 87
Cholecystoses
cholesterol polyposis 57
strawberry gallbladder 57
Choledochal cyst 69
clinical presentation 70
investigations 71
treatment 72
Choledocholithiasis 60
clinical features 61
investigations 62
primary bile duct stone 60
secondary bile duct stone 60
treatment 64
Chronic cholecystitis
clinical presentation 49
pathophysiology 49
treatment 50
Chvostek's sign 530
Cleft lip 1085
classification 1086
etiology 1085
treatment 1088
Cleft palate
classification 1088
different techniques of repair 1089
Closed loop obstruction 297
Congenital hemorrhagic disorders
hemophilia 31
B 31
von Willebrand's disease 31
D
Diagnostic peritoneal lavage 627
Diseases of the arteries 696
aneurysmal vascular disease 724
abdominal aortic aneurysms 726
femoral artery aneurysm 737
iliac artery aneurysm 736
popliteal artery aneurysm 737
splanchnic artery aneurysms 737
upper extremity aneurysms 737
arterial occlusive diseases 696
mesenteric arterial insufficiency 721
peripheral arterial occlusive 697
renovascular occlusive 718
diseases of thoracic aorta 738
aortic dissection 742
thoracic aortic aneurysm 739
vascular trauma 746
Diseases of the breast 434
ANDI 449
breast carcinoma 450
clinical presentation 453
diagnosis 454
pathology 450
prognostic factors 472
risk factors 450
spread 453
treatment 462
breast lump 441
breast cyst 444
fat necrosis 445
fibroadenoma 442
galactocele 445
phyllodes tumor 443
sclerosing adenosis 445
duct ectasia 437
gynecomastia 445
lactational breast abscess 434
mastalgia
cyclical 448
noncyclical 449
Mondor's disease 441
nipple discharge 447
nonlactational breast abscess 437
periductal mastitis 437
Diseases of the esophagus 832
achalasia (faliure to relax) 841
Barrett esophagus 855
Boerhaave's syndrome 853
cancer of esophagus 857
classification 858
clinical presentation 858
investigations 858
pathology 857
pretreatment staging 859
risk factors 857
treatment 859
diffuse esophageal spasm 845
epiphrenic diverticulum 848
esophageal perforation 849
gastroesophageal reflux disease (GERD) 837
hiatus hernia 834
Mallory-Weiss tear 853
midesophageal (parabronchial) diverticula 848
nutcracker esophagus 846
pharyngoesophageal (Zenker's) diverticulum 846
stricture of esophagus 854
vigorous achalasia 845
Diseases of the intestine 294
cancer of colon 361
clinical presentation 367
investigations 367
risk factors 362
spread of colon cancer 366
treatment 369
cecal volvulus
management 343
colorectal polyp 353
familial juvenile 355
hyperplastic 353
inflammatory 355
juvenile 354
tubular adenoma 356
villous adenoma 357
Crohn's disease 309
clinical presentation 312
investigations 314
macroscopic and microscopic features 310
treatment 314
diverticular disease of colon 333
clinical presentation 334
management 334
diverticulitis 335
complicated 336
investigations 335
treatment 336
duodenal diverticula 325
familial adenomatous polyposis (FAP) 359
extracolonic manifestations 360
screening 360
treatment 361
variants 361
ileosigmoid knotting 344
intestinal obstruction
small intestinal obstruction 294
intestinal tuberculosis 321
intussusception 306
clinical presentation 307
investigations 307
treatment 308
jejunal and ileal diverticula 324
large bowel obstruction 344
Meckel's diverticulum
clinical presentation 326
diagnosis 328
treatment 329
neoplasm of small intestine
benign 330
malignant 330
metastatic tumor 331
short bowel syndrome
causes 331
clinical presentation 332
treatment 332
sigmoid volvulus 340
clinical presentation 341
investigations 341
management 341
predisposing factors 340
typhoid enteritis 320
ulcerative colitis 345
clinical presentation 347
investigations 349
macroscopic appearance 346
treatment 350
Diseases of the kidney 931
congenital malformations 936
cystic disease 943
hydronephrosis 948
infections 963
acute pyelonephritis 964
chronic pyelonephritis 967
perinephric abscess 969
pyonephrosis 970
renal abscess or carbuncle 971
kidney tumors 975
angiomyolipoma 976
oncocytoma 976
renal cell carcinoma 976
Wilms' tumor 982
other malformations 946
renal stone 950
tuberculosis of kidney 972
urinary symptoms 931
Diseases of the liver 122
amebic liver abscess 131
clinical presentation 133
diagnosis 133
management 134
congenital liver cyst 148
clinical presentation 149
investigation 149
treatment 149
Couinaud system of segmental nomenclature 122
cystadenoma 151
focal nodular hyperplasia 152
hemangioma 153
hepatocellular carcinoma 153
clinical presentation 154
diagnosis 156
treatment 157
hydatid cyst 136
clinical presentation 138
diagnosis 139
Gharbi classification 140
management 141
WHO classification of hydatid cyst 140
liver cell adenoma 152
liver metastases 161
polycystic liver disease associated with polycystic kidney disease
clinical presentation 150
investigations 150
treatment 151
portal hypertension 162
Budd-Chiari syndrome 164
cirrhosis 165
extrahepatic portal vein obstruction 164
noncirrhotic portal 164
pyogenic abscess of liver 125
clinical presentation 128
investigation 128
treatment 129
treatment 162
Diseases of the pancreas
acute pancreatitis 175
assessment of severity 178
clinical presentation 176
complications 181
diagnosis 176
management 179
chronic pancreatitis 187
clinical presentation 188
diagnosis 190
treatment 191
intraductal papillary mucinous tumor 197
mucinous cystadenoma 196
pancreatic carcinoma 199
clinical presentation 200
investigations 201
pathology 199
treatment 204
serous cystadenoma 198
Diseases of the prostate
benign prostatic hyperplasia 1000
Diseases of the skin and its adnexa 881
benign pigmented lesions 898
benign tumors 890
elephantiasis neurofibromatosis 895
lipoma 891
multiple neurofibromatosis 894
neurofibroma 893
papilloma 890
plexiform neurofibromatosis 894
cystic lesions of the skin 881
dermoid cyst 882
sebaceous cyst 881
ganglion 883
malignant lesions
basal cell carcinoma 901
cutaneous melanoma 906
squamous cell carcinoma 903
other malignancies of the skin
angiosarcoma 910
cutaneous metastases 911
Kaposi's sarcoma 910
lymphangiosarcoma 911
premalignant lesions
Bowen's disease 900
erythroplasia of Queyrat 900
solar keratosis 900
xeroderma pigmentosum 901
skin infection 895
carbuncle 896
furuncle (boil) 895
hidradenitis suppurativa 897
impetigo 896
necrotizing fasciitis (Fournier's gangrene) 897
vascular lesions of the skin
hemangiomas 884
other vascular lesions 888
vascular malformations 886
Diseases of the stomach 243
bezoars 286
bleeding peptic ulcer 262
management 262
Dieulafoy's gastric 285
gastric lymphoma 283
gastric outlet obstruction
causes 263
clinical presentation 263
diagnosis 264
investigations 264
treatment 264
gastric varices 287
gastric volvulus 285
gastritis
erosive 266
reflux 266
stress 266
type a 266
type b 266
gastrointestinal stromal tumor 280
clinical presentation 281
immunology 281
investigations 281
prognostic factors 282
treatment 283
malignant neoplasms 267
clinical presentation 273
investigations 274
risk factors 268
treatment 275
Mallory-Weiss tear 284
Ménètrier's disease 284
peptic ulcer disease 243
clinical presentations 247
investigations 248
pathophysiology 246
treatment 251
perforation
diagnosis 258
treatment 258
postvagotomy syndromes 287
early dumping 289
late dumping 290
Diseases of the testes 815
chylocele 828
Fournier's gangrene 829
hematocele 828
hydrocele 825
primary vaginal 826
secondary 828
other scrotal swellings 828
paraphimosis 831
phimosis 830
pyocele 828
sebaceous cyst in scrotum 829
torsion of the testis 822
undescended testis 815
complications 818
factors responsible for testicular descent 817
Fowler-Stephens orchiopexy 821
standard orchiopexy (open approach) 821
varicocele 823
Diseases of the thyroid gland 475
cretinism 476
hypothyroidism 475
neoplasm of thyroid 496
anaplastic thyroid carcinoma 507
follicular adenoma 496
follicular carcinoma 503
medullary carcinoma of thyroid 505
papillary thyroid carcinoma 500
pathogenesis of primary thyroid malignancy 498
staging system 499
types of primary thyroid malignancy 498
nontoxic goiter
nontoxic diffuse (simple goiter) 490
nontoxic multinodular goiter 490
surgical approaches to thyroid 509
thyroiditis
acute (suppurative) 491
chronic lymphocytic (Hashimoto) thyroiditis 494
Riedel's 495
subacute 492
thyrotoxicosis 478
Graves' disease 479
toxic adenoma 489
toxic multinodular goiter 488
Diseases of ureter
ureteral calculi 984
urothelial tumors of renal pelvis and ureter 985
Disorders of lymphatic system 765
acute lymphangitis 766
lymphedema 766
tumors of the lymphatics 773
Diverticulitis 333
Diverticulosis 333
Dukes classification system 374
E
Electrolyte imbalance 18
hypercalcemia 23
hyperkalemia 21
hypermagnesemia 25
hypernatremia 19
hypocalcemia 22
hypokalemia 20
hypomagnesemia 24
hyponatremia 18
Endocrine pancreas 553
glucagonoma 559
insulinoma 554
multiple endocrine neoplasia (MEN) syndromes 560
type I 561
type II 562
somatostatinoma 559
VIPoma 559
Zollinger-Ellison syndrome 555
Endoscopic therapeutic approaches to biliary system 98
ESWL 957
F
FAST 626
Fibrolamellar HCC 154
Fistula 927
causes of persistence of sinus or fistula 928
Flail chest 575
G
Gallbladder carcinoma 78
clinical presentation 80
investigations 80
pathology 79
risk factors 78
treatment 82
Gallstone 41
in Ileus 55
clinical presentation 56
pathophysiology 55
treatment 56
pancreatitis
how it develops 51
investigations 53
treatment 54
pathogenesis 42
risk factors 41
varieties
black pigment 41
brown pigment 41
cholesterol 41
Goodsall's rule 410
H
Hemorrhage
management 32
Hepatectomy 158
Hernia 774
anatomy of the groin 783
epigastric 801
fermoral 797
incisional 802
inguinal 785
sliding 795
strangulated 795
interparietal 812
Littre's 796
lumbar 811
Maydl's 796
obturator 808
perineal 809
sciatic 811
spigelian 810
umbilical 799
Hinchey staging system 336
H. pylori 243
I
Incidentaloma 550
K
Karydakis's explanation 421
L
Lauren classification system 269
Linitis plastica 270
Liver transplantation 159
M
Mammography 459
Massive hemothorax 576
Ménètrier's disease 267
Mesentery
acute mesenteric lymphadenitis 234
cyst 234
malignancies 235
panniculitis 235
Mesorectum 427
Minimally invasive surgery 1039
access 1042
extraperitoneal and subcutaneous 1044
hand-assisted laparoscopic 1045
laparoscopic 1042
advantages and disadvantages 1049
complications 1050
contraindications 1050
different minimal access techniques 1039
endoluminal endoscopy 1040
extracavitary endoscopy 1039
laparoscopy 1039
thoracoscopy 1040
examples of laparoscopic procedures 1049
instrumentation 1045
new techniques of minimally invasive surgery
NOTES 1050
SILS 1051
physiology of pneumoperitoneum 1041
port placement 1045
robotic surgery 1051
advantages 1053
components of Da Vinci robotic system 1052
disadvantages 1053
Myopectineal orifice of Fruchaud 783
N
Neck
anatomy 1074
swellings 1075
branchial cyst 1078
branchial fistula 1079
carotid body tumor 1080
cystic hygroma 1081
lymphadenopathy 1075
sternomastoid tumor 1081
thyroglossal cyst 1082
Neoplasms of testis 1031
Nerve injury 1054
classification of nerve injuries 1056
axonotmesis 1057
neuropraxia 1057
neurotmesis 1058
principles of nerve repair 1059
Nigro regime 431
O
Ogilvie's syndrome 345
Omentum
omental cyst 235
omental graft and transpositions 236
omental infarction 235
Open pneumothorax 575
Organ of Zuckerkandl 546f
Ormond disease 238
P
PAIR 141, 142
Pancreaticoduodenectomy 204
Pantaloon hernia 796
Parathyroid 516
hypoparathyroidism 529
primary 518
secondary 527
tertiary 528
Pediatric appendicitis score 384
Peritoneal cavity 229
abdominal abscess 230
pelvic abscess 232
malignant peritoneal mesothelioma 233
pseudomyxoma peritonei 233
Peutz-Jeghers syndrome 353
Primary sclerosing cholangitis 77
investigations 78
Prostate 1010
carcinoma 1011
prostatitis 1010
Pseudocyst 182
Pugh's modification of child's grading 157
R
Rectum and anal canal 393
anorectal abscess
clinical presentation 404
investigations 404
treatment 405
cancer of the anus 429
clinical presentation 430
risk factors 429
treatment 431
fissure-in-ano 400
clinical presentation 401
treatment 402
fistula-in-ano
classification 406
clinical presentation 407
investigation 409
treatment 410
hemorrhoids or piles 413
clinical presentation 415
treatment 416
types 414
pilonidal sinus 420
clinical presentation 421
treatment 421
prolapse of the rectum 395
clinical presentation 397
investigation 398
treatment 398
rectal cancer 423
clinical presentation 424
preoperative staging 425
spread 423
treatment 425
solitary rectal ulcer syndrome 399
Recurrent pyogenic cholangitis (cholangiohepatitis) 76
treatment 77
Renal injuries 654
Retroperitoneum
abscess 236
fibrosis 237
hematoma 236
neoplasm 239
Richter's hernia 796
Rule of ‘2’ 326
S
Salivary gland pathologies
acute ascending bacterial sialadenitis 866
autoimmune sialadenitis 867
chronic bacterial sialadenitis 867
mucoceles 870
salivary gland tumors 871
carcinoma of salivary gland 874
nonepithelial tumors 875
oncocytoma 874
pleomorphic adenoma 873
Warthin's tumor 874
sialolithiasis 868
surgical procedures for salivary gland pathology
excision of sublingual gland 875
superficial parotidectomy 877
viral sialadenitis 866
Schatzki's ring 854
SEPS 764
Seton 411
Sinus 927
Splenic pathologies 209
accessory spleen 212
anatomy 209
cyst and tumors 214
functions of spleen 211
splenectomy 213, 215, 216
postsplenectomy blood picture 217
prophylaxis 215
splenosis 212
wandering spleen 212
Strangulation obstruction 296
Struvite stone 953
Surgery of hand 1063
infections in hand 1067
injuries in hand 1069
Surgical approaches to gallbladder and biliary system 101
CBD stone (open approach) 115
cholecystectomy 101
choledochoduodenostomy 117
laparoscopic management of CBD stones 112
Roux-en-Y hepaticojejunostomy 118
why bile duct injury 107
Surgical instruments 1106
catheter 1123
Foley's self retaining 1124
Malaecot's 1125
simple rubber 1124
Desjardin's choledocholithotomy forceps 1122
dissecting forceps 1114
instruments used for antiseptic dressing and draping
Rampley's swab holding forceps 1106
instruments used for fixation
towel clip 1107
instruments used for giving incision over the skin
Bard-Parker's handle 1107
surgical blades (scalpel blade) 1108
instruments used for hemostasis 1108
Kocher's hemostatic forceps 1111
mosquito hemostatic forceps 1111
Spencer Well's hemostatic forceps 1109
instruments used for holding tissues
Allis' tissue forceps 1112
Babcock's tissue forceps 1113
Lanes' tissue forceps 1113
instruments used for suturing 1115
needle 1117
needle holder 1115
IV cannula 1130
Moynihan's cholecystectomy forceps 1121
occlusion clamp 1123
other methods of skin closure 1119
parts of an instrument 1106
rectal speculum (proctoscope) 1126
retractor 1119
right angled forceps 1122
Ryle's tube 1131
scissors 1121
suture material 1126
tracheostomy tube 1130
t-tube 1123
T
Tension pneumothorax 574
Tetany 530
TIPS 169
TME 426
Toxic megacolon 348
Transfusion of blood and its components 33
complications 34
indications 33
Trauma 563
abdominal compartment syndrome
risk factors 673
abdominal injuries 624
colon injuries 639
duodenal injuries 630
gallbladder and extrahepatic bile duct injury 629
genitourinary injuries 653
liver injuries 643
pancreatic injuries 634
rectal injuries 641
retroperitoneal injuries 652
small bowel injuries 637
splenic injuries 649
stomach injuries 628
damage control surgery 670
head injury 582
assessment of severity 595
concussion 595
contusion 595
diffuse axonal injury 595
extradural hematoma 588
intracerebral hematoma 594
skull fracture 585
subdural hematoma 591
treatment 596
hospital care 572
maxillofacial injuries 597
fracture maxilla 600
fracture nasal bone 600
fracture of mandible 599
neck injury 602
prehospital management 570
spinal injury 606
management 611
thoracic 612
cardiac injury 620
diaphragmatic injuries 623
esophageal injuries 623
great vessel injury 622
hemothorax 615
pneumothorax 614
pulmonary parenchymal injury 618
rib fracture 612
sternal fracture 613
tracheobronchial injuries 619
types of injury 565
Treatment of wound 12
Trendelenburg's surgery 762
U
Ulcer 914
actinomycosis 926
arterial 916
basic principles of ulcer dressing 926
Bazin's 922
cryopathic 922
decubitus 920
diabetic 919
Martorell's 922
neuropathic 918
soft chancre 925
syphilitic 924
traumatic 915
tropical 924
tuberculous 921
venous 917
Urethra 1016
carcinoma of penis 1025
hypospadias 1019
Peyronie's disease 1024
priapism 1022
urethral stricture 1016
Urethral injuries 662
Uric acid stone 953
Urinary bladder 988
bladder calculi 990
bladder tumor 996
ectopia vesicae 989
patent urachus 988
schistosomiasis of the urinary bladder 994
V
Venous diseases 749
deep vein thrombosis 750
venous insufficiency 754
venous ulcer 765
W
Wound closure techniques 11
Wound healing 1
classification 4
complications 9
factors affecting 8
growth factors 8
phases
inflammatory 5
maturational 7
proliferative 6
processes
regeneration 3
repair 3
types 4
×
Chapter Notes

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1Illustrated Surgery: A Road Map2
3Illustrated Surgery: A Road Map
Nilay Mandal MS (General Surgery) Associate Professor Department of Surgery Bankura Sammilani Medical College Bankura, West Bengal, India
4
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Illustrated Surgery—A Road Map
First Edition: 2016
9789385891205
Printed at
5Dedicated to
My teachers, my parents,
spouse Tapati and daughter
Tannistha, for their love and support6
7Preface
‘Books are the compass and telescopes and sextants and charts which other men have prepared to help us navigate the dangerous seas of human life.’
I strongly believe that in the seas of life we all need some help in any moment from others. I also believe that in midst of seas of medical science, all medical personnels particularly the medical students need a GPS and a philosopher. That GPS can come in his or her life in the form of a teacher or a good book or both.
In my short period of teaching, I have experienced that most of the students can remember the diseases and their management as a whole but without understanding the disease process, it's pathophysiology or the principles of treatment. From my understanding, the reason is so many subjects in a too short period.
In this book I have attempted to describe the diseases in such a illustrative manner so that the students can understand as well as recover his or her memories from the illustrations. Better understanding, not a better memory make a average medical student to a good doctor.
As the book is based on illustrations, most of the diseases are described in a illustrative manner, less text more illustrations.
I hope that the book will be more of a guide book for travelling in seas and mountains of medical science than a reference book. Your safe journey can only make me happy.
Wish you a happy journey.
Nilay Mandal8
9Acknowledgments
‘Writing a book is a horrible, exhausting struggle, like a long bout with some painful illness. One would never undertake such a thing if one were not driven on by some demon whom one can neither resist nor understand.’
I am grateful to my teachers, my students and friends whose encouragement and emotional support make me courageous to do this task.
I am also grateful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and Mr Tarun Duneja (Director-Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for publishing this book. I would also like to thank all staff members of Kolkata production unit of Jaypee Brothers Medical Publishers (P) Ltd for their constant support and cooperation to complete this book.10