Mulholland & Greenfield’s Surgery: Scientific Principles and Practice

 

Description:

Newly streamlined and focused on quick-access, easy-to-digest content, Mulholland and Greenfield’s Surgery: Scientific Principles & Practice, 7th Edition, remains an invaluable resource for today’s residents and practicing surgeons. This gold standard text balances scientific advances with clinical practice, reflecting rapid changes, new technologies, and innovative techniques in today’s surgical care. New lead editor Dr. Justin Dimick and a team of expert editors and contributing authors bring a fresh perspective and vision to this classic reference.

 

 

Table of Contents:

 

1 Lifelong Learning

The Importance of Lifelong Learning

WHAT IS SELF-REGULATED LEARNING?

Fostering Self-Regulated Learning: Assessment Tools

FOSTERING SELF-REGULATED LEARNING: COACHING

FOSTERING SELF-REGULATED LEARNING: SELF-REGULATED READING

THE CHALLENGE OF SELF-REGULATED LEARNING DURING SURGICAL TRAINING

2 Substrate Metabolism in Surgery

CARBOHYDRATE METABOLISM

Glycogenesis and Glycogenolysis

Glycolysis

The Cori Cycle

Gluconeogenesis

Pentose Phosphate Pathway

LIPID METABOLISM

Lipolysis

Ketogenesis and Ketone Oxidation

Lipogenesis

Cholesterol Metabolism

Phospholipids

PROTEIN METABOLISM

THE UREA CYCLE

CELLULAR ENERGY GENERATION

Overview

Stage II: The Krebs Cycle—Integration of Metabolic Pathways and Oxidation of Acetyl CoA

Stages III and IV: Oxidative Phosphorylation

BIOTRANSFORMATION

Cytochromes P-450

Uridine Diphosphate-Glucuronyl Transferases

Glutathione S-transferases

Sulfotransferases

3 Surgical Nutrition and Metabolism

INTRODUCTION

BASIC METABOLIC PRINCIPLES

Body Composition

ENERGY AND SUBSTRATE METABOLISM

Measuring Energy Expenditure

NUTRITIONAL ASSESSMENT

OVERFEEDING AND MALNUTRITION

Overfeeding

Malnutrition

Substrate Metabolism Changes during Stress

Stressor-Dependent Adjustments to the Metabolic Response

NUTRITIONAL SUPPORT

Nutritional Support in Elective Surgery

Nutritional Support in Critical Care

Parenteral Nutrition Considerations

Enteral Nutrition Considerations

Macro- and Micronutrient Selection

Nutritional Access

NUTRITIONAL CONSIDERATIONS IN SPECIAL POPULATIONS

Sepsis and Septic Shock

Acute Respiratory Failure

Acute Renal Failure

Acute Liver Failure

Complications of Gastrointestinal Surgery

Burns

Acute Pancreatitis

Trauma

Solid Organ Transplant

Bariatric Surgery

Geriatrics

Obesity

4 The Pathogenesis of Obesity and Metabolic Disease

GENETICS OF OBESITY

Metabolic Thrift, Genetics, and Epigenetics

Human Metabolic Diversity and Environment

Physiology of Obesity

The Adipostat

Satiety and Hunger

Metabolic Rate

Adipocyte Physiology

The Microbiome

Bariatric Surgery and Weight Physiology

Summary

PATHOPHYSIOLOGY OF METABOLIC DISEASE

Obesity and Metabolic Disease

Nutrient Excess

Cellular Responses to Nutrient Excess

Adipose Tissue Failure

Adipose Tissue Overflow

SYSTEMIC METABOLIC DISEASE

Mediators of Metabolic Disease

Portal Overflow and Liver Disease

Diabetes

Cancer

CONCLUSION

5 Wound Healing

PHASES OF WOUND HEALING

Hemostasis

Inflammatory Phase

Proliferation Phase

Remodeling Phase

CLINICAL CONSIDERATIONS

Chronic versus Acute Wounds

MEDICATIONS AND DIETARY SUPPLEMENTS

Glucocorticoid Steroids

Radiation

6 Hemostasis

BASIC CONSIDERATIONS

NATURAL ANTICOAGULANT MECHANISMS

FIBRINOLYSIS

ENDOTHELIUM AND HEMOSTASIS

THROMBOSIS, INFLAMMATION, AND RESOLUTION

Cell Adhesion Molecules

Leukocytes and Thrombosis

ARTERIAL VERSUS VENOUS THROMBOSIS

PROCOAGULANT STATES

Acquired Procoagulant States

Inherited Procoagulant States

BLEEDING DISORDERS

Coagulation Factor Deficiency

Rare Factor Deficiencies

Platelet Disorders

Abnormalities in Fibrinolysis

7 Inflammation

INNATE VERSUS ADAPTIVE IMMUNITY

CELLULAR COMPONENTS

Neutrophils

Mononuclear Phagocytes

Lymphocytes

Eosinophils

Basophils and Mast Cells

Platelets

Myeloid-Derived Suppressor Cells

NONCELLULAR COMPONENTS

Cytokines

Early Cytokines/Innate Immunity

Late Cytokines/Adaptive Immunity

Cytokines that Stimulate Hematopoiesis

The Complement System

Lipid Mediators

Kinins

Neuropeptides

Nitric Oxide (NO)

Heme Oxygenase (HO)

Hydrogen Sulfide

RECOGNITION AND ACTIVATION PROCESSES

Exogenous and Endogenous Danger Recognition

Damage-Associated Molecular Patterns (DAMPs)

Receptors for Danger Recognition

CD14

AUTOPHAGY

THE STRESS RESPONSE

The Acute-Phase Response

Reperfusion Injury

Systemic Inflammatory Response Syndrome

Chronic Inflammation

8 Surgical Infections

INTRODUCTION

Early Use of Appropriate Broad-Spectrum Antimicrobial Therapy

Source Control

Pathogen Identification

INTRA-ABDOMINAL INFECTIONS

Classification

Diagnosis

Treatment

SPECIFIC INTRA-ABDOMINAL INFECTIONS

Appendicitis

Biliary Infections

Diverticulitis

Clostridium Difficile Colitis

Pancreatitis

SKIN AND SOFT TISSUE INFECTIONS

Classification of Skin and Soft Tissue Infections

Early Diagnosis and Differentiation of Necrotizing versus Nonnecrotizing SSTI

Early Initiation of Appropriate Empiric Broad-Spectrum Antimicrobial Therapy with Anti-MRSA Coverage and Consideration of Risk Factors for Specific Pathogens

Necrotizing Soft Tissue Infections

Pyomyositis

SURGICAL SITE INFECTIONS

Epidemiology

Definitions

Risk Factors for Surgical Site Infection

Surgical Site Infection Prevention

Additional Strategies for Surgical Site Infection Prevention

Surgical Site Infection and Colorectal Surgery

Treatment of Surgical Site Infection

Current Challenges in Surgical Site Infection

9 Shock

INTRODUCTION

EVALUATION OF SHOCK

TYPES OF SHOCK

Hypovolemic Shock

Cardiogenic Shock

Extracardiac Obstructive Shock

Distributive Shock

Septic Shock

Traumatic Shock

Neurogenic Shock

Physiologic Response to Hypovolemia

Acute Response

Sustained Response

ORGAN-SPECIFIC COMPENSATORY RESPONSES TO SHOCK

Cardiac and Microvascular Response

Neuroendocrine Response

Immunoinflammatory Response

Pulmonary Response

Renal Response

Hepatic Response

Genetic Regulation of the Response to Shock

LOSS OF COMPENSATORY RESPONSES TO SHOCK

COMPLICATIONS OF SHOCK

Ischemia–Reperfusion Injury

Multiple Organ Dysfunction Syndrome and CCI

Abdominal Compartment Syndrome

Hypothermia

Coagulopathy

TREATMENT

Fluid Therapy

Permissive Hypotension

Transfusion

Endpoints of Resuscitation

MONITORS

Central Venous Pressure

Pulmonary Artery Catheter

Minimally Invasive CO Monitors

Arterial Wave Contour Analysis

Bedside Ultrasound and Echocardiography

PHARMACEUTICAL SUPPORT

Inotropes and Vasopressors

Vasodilators

Miscellaneous Therapeutics

Future Therapies

10 Critical Care

INTRODUCTION

HEMODYNAMIC MONITORING

Oxygen Transport

Volume Assessment

Fluid Responsiveness

Cardiac Function

CARDIAC ARREST AND DYSRHYTHMIAS

PULMONARY GAS EXCHANGE

Oxygenation

Ventilation

VENTILATOR MODES

Pulmonary Mechanics

ACUTE RESPIRATORY FAILURE

Diagnosis

Ventilator Management

Ventilator-Associated Events

Liberation from Ventilation

VENOUS THROMBOEMBOLISM PROPHYLAXIS

Incidence

Risk Factor Scoring

Approaches to Prevention of VTE

TRANSFUSION

METABOLISM AND NUTRITION

Metabolic Requirements and Assessment

Nutritional Support

Routes of Nutritional Support

Timing of Nutritional Support

Organ Specific Nutritional Support

Immunonutrition

Stress-Related Mucosal Disease

ACUTE KIDNEY INJURY

Etiology

Severity

Treatment of Acute Kidney Injury

LIVER DYSFUNCTION

Variceal Bleeding

Hepatic Encephalopathy

Ascites and Spontaneous Bacterial Peritonitis

Hepatorenal Syndrome

Liver Failure

ENDOCRINE ISSUES

Glucose Control

Adrenal Insufficiency

Thyroid Abnormalities

INFECTIOUS DISEASE ISSUES

Sepsis Guidelines

Hospital Acquired Infections

NEUROLOGIC ISSUES

Analgesia and Sedation

Delirium

ORGANIZATIONAL STRUCTURE OF CRITICAL CARE

Evidence-Based Care

Severity of Illness

11 Fluids, Electrolytes, and Acid–Base Balance

INTRODUCTION

BODY FLUIDS

Total Body Water and Body Fluid Compartments

Composition of Body Fluids

Osmotic Activity of Body Fluids

Colloid Oncotic Pressure (Colloid Osmotic Pressure)

Osmoregulation

Tonicity of Body Fluids

FLUID BALANCE

Sodium Concentration and Water Balance

Volume Control

Normal Water and Electrolyte Exchange

NORMAL WATER EXCHANGE

FLUID AND ELECTROLYTE THERAPY

Parenteral Solutions

GOALS OF FLUID AND ELECTROLYTE THERAPY

Maintenance Fluid Therapy

Maintenance Electrolyte Therapy

Additional Electrolyte Therapy

CORRECTION OF VOLUME ABNORMALITIES

Volume Deficits

Volume Excess

REPLACEMENT OF ONGOING FLUID LOSSES

Intraoperative Fluid Therapy

Postoperative Fluid Therapy and Monitoring

ELECTROLYTES

Where Sodium Goes, Water Follows

Potassium

Calcium

Magnesium

ACID–BASE

Buffer Systems

Acid–Base Disturbances

Metabolic Acidosis

Metabolic Alkalosis

Respiratory Alkalosis

Respiratory Acidosis

Mixed Acid–Base Disorders

12 Burns: Medical, Surgical, Critical Care and Reconstruction of the Burn Patient

INTRODUCTION

EPIDEMIOLOGY

Children

Adults

Older Adults

Race and Ethnicity

Socioeconomic Status

ETIOLOGY

Flame Burns

Contact Injuries

Electrical Burns

Chemical Burns

Frostbite

PHYSIOLOGY OF BURNS

Burn Shock

Metabolic Response to Burn Injury

Immunologic Response to Burn Injury

EMERGENCY CARE

Airway Assessment

Fluid Resuscitation

Difficult to Resuscitate Patients

Burn Severity

CRITICAL CARE OF THE BURN PATIENT

Hemodynamic Monitoring

Ventilator Strategies

Electrolyte Abnormalities and Acute Renal Failure

Metabolic Response and Nutrition

WOUND MANAGEMENT

OPERATIVE INTERVENTIONS

Excision and Grafting

Order of Coverage

Extremity Treatment

Skin Alternatives

PAIN CONTROL

Acute Pain

Chronic Pain and Substance Abuse

INFECTIONS

Wound Infections

Vascular Catheter–Related Infections

Pneumonia

BURN RECONSTRUCTION

Optimizing Acute Treatment to Minimize the Need for Reconstruction

Hypertrophic Scarring

Tissue Expansion

Specific Anatomic Concerns

ASSOCIATED COMPLICATIONS OF BURN INJURIES

Muscle Catabolism and Wasting

Heterotopic Ossification

Majorlin Ulcer

CLINICAL RESEARCH

BASIC SCIENCE AND TRANSLATIONAL SCIENCE RESEARCH

CONCLUSION

13 Anesthesiology and Pain Management

INTRODUCTION

ANESTHETIC AGENTS AND THEIR PHYSIOLOGIC EFFECTS

Inhalation Agents

Intravenous Sedatives/Hypnotics

Muscle Relaxants

Opioids (Narcotics) and Other Intravenous Analgesics

Propofol

Ketamine

Amnesics and Anxiolytics

Local Anesthetics

NEURAXIAL BLOCKADE

PERIPHERAL NERVE BLOCKADE

SEDATION ANALGESIA FOR MINOR SURGICAL PROCEDURES

AIRWAY EVALUATION FOR THE NONANESTHESIOLOGIST

RISKS ASSOCIATED WITH ANESTHESIA

Cardiovascular Diseases

Pulmonary Disease

Obesity

Diabetes Mellitus

Renal Insufficiency and Failure

Obstructive Sleep Apnea

Risks Associated with Regional Techniques in Patients Being Treated with Anticoagulants

PREOPERATIVE EVALUATION

MONITORING THE SURGICAL PATIENT

Monitors of Oxygenation

Ventilation Monitors

Circulation Monitors

“Awareness” and Level of Consciousness Monitors

COMMON PROBLEMS IN THE POSTOPERATIVE PERIOD

ENHANCED RECOVERY PROTOCOLS

POSTOPERATIVE ACUTE PAIN MANAGEMENT

ACKNOWLEDGMENTS

14 Preoperative Risk Assessment

INTRODUCTION

SURGICAL MORTALITY, COMPLICATIONS, AND PATIENT-CENTERED OUTCOMES

RISK STRATIFICATION

Risk Calculators

GENERAL CONCEPTS OF PREOPERATIVE EVALUATION

Anesthesia

Surgical Procedure

Disparities

Age

Medical Comorbidity

Direction of Care

MEDICATION MANAGEMENT

SPECIFIC ORGAN SYSTEM GUIDELINES

Cardiovascular

Pulmonary

Hepatic

Renal

ADDITIONAL CONSIDERATIONS, FUTURE DIRECTIONS

15 Measuring the Quality of Surgical Care: Surgeons, Hospitals and Systems

INTRODUCTION

OVERVIEW OF CURRENT MEASURES

TRADITIONAL QUALITY MEASURES

Structure

Process of Care

Outcomes

CHOOSING THE RIGHT MEASURE

IMPROVING OUR ABILITY TO MEASURE

EMERGING NEED TO MEASURE AND IMPROVE SURGICAL CARE ACROSS HEALTHCARE SYSTEMS

16 Improving Surgical Quality

INTRODUCTION

QUALITY METRICS

QUALITY IMPROVEMENT PROCESSES

Outcome Based

Culture and Quality

QUALITY IMPROVEMENT POLICY AND REGULATION—THE MOVE TOWARD VALUE

17 Global Surgery

GLOBAL SURGERY DEFINED

HISTORY

CHALLENGES OF PROVIDING SURGICAL CARE

EPIDEMIOLOGY

COST-EFFECTIVENESS

SCALING UP SURGICAL CAPACITY

Workforce Shortages

Training and Education Models

LOGISTICS AND SPECIAL CONSIDERATIONS

Research

Humanitarian Surgery Considerations

GETTING INVOLVED

CONCLUSION

18 Patient Safety

INTRODUCTION TO PATIENT SAFETY

ADVERSE EVENTS AND ERRORS

MEASUREMENT CHALLENGES

SYSTEMS THINKING

DISTINCTION BETWEEN QUALITY AND SAFETY

CREATING A CULTURE OF SAFETY

MEASURING SAFETY CULTURE

Teamwork and Communication

MEASURING TEAMWORK

TOOLS FOR IMPROVING SAFETY CULTURE, TEAMWORK, AND COMMUNICATION

INVESTIGATING A SAFETY EVENT: ROOT CAUSE ANALYSIS

ESTABLISHING A COMPREHENSIVE SAFETY PROGRAM

CONCLUSIONS

Part Two Surgical Practice

SECTION A: TRAUMA

19 Trauma and Trauma Care: General Considerations

BURDEN OF DISEASE

EVOLVING MECHANISMS OF INJURIES WITH CHANGING POPULATION DEMOGRAPHICS

BIOMECHANICS OF INJURY

IMMEDIATE, EARLY, AND LATE DEATHS AFTER INJURY

FIELD TRIAGE DECISIONS AND EARLY PRIORITIES

EARLY HOSPITAL CARE AND PRIORITIES

LESSONS LEARNED FROM THE BATTLEFIELD

FUTURE DIRECTIONS

20 Prehospital and New Advances in Resuscitation

INTRODUCTION

PREHOSPITAL CARE

Personnel

Triage

Scoop and Run versus Stay and Play

SCENE ASSESSMENT AND MANAGEMENT

Airway

Breathing

Circulation

Resuscitation

CONTROVERSIES

Resuscitative Endovascular Balloon Occlusion of Aorta

LTOWB Rh-Positive Transfusion in Children and Women of Childbearing Potential

Rapid Sequence Intubation versus Non-RSI

CONCLUSION

21 Head Injuries

INTRODUCTION

EPIDEMIOLOGY

CLASSIFICATION

Clinical Scoring System

Neuroimaging Scales

PATHOPHYSIOLOGY OF TBI

Primary Brain Injury

Secondary Brain Injury

Molecular and Cellular Mechanisms in TBI

CLINICAL ASSESSMENT

RADIOLOGIC ASSESSMENT

MANAGEMENT OF BRAIN INJURIES

Broad Goals of Management

Initial Resuscitation

Neuromonitoring

Medical Management of ICP Elevation

Sedation and Analgesia

Therapeutic Intensity Level and Management Parameters to Control ICP

Management of Impending Cerebral Herniation

SURGICAL APPROACH

Skull Fracture

Epidural Hematoma

Subdural Hematoma

Parenchymal Contusions

Penetrating Injuries to the Brain

Role of Decompressive Craniectomy

PROGNOSIS

22 Injury and Violence Prevention: A Public Health Approach

HISTORY OF INJURY PREVENTION

EPIDEMIOLOGY OF INJURY: DEFINING THE PROBLEM

Unintentional Injury

Suicide and Self-Harm

Homicide and Assault

Mass Shootings

Legal Intervention

Intimate Partner Violence

Child Abuse

Firearm Injury

LANDMARK INJURY PREVENTION INITIATIVES

Violence as Public Health Problem

THE SOCIAL ECOLOGIC MODEL

THE SURGEON’S ROLE IN FIREARM-RELATED INJURY AND VIOLENCE PREVENTION

Primary Prevention

Secondary and Tertiary Prevention

23 Neck Injuries

INTRODUCTION

FUNCTIONAL ANATOMY

INITIAL MANAGEMENT

SELECTIVE VERSUS MANDATORY EXPLORATION

Overall Approach

Current Imaging Technology

Penetrating Neck Trauma

Blunt Neck Trauma

MANAGEMENT OF SPECIFIC INJURIES

Blunt Cerebrovascular Injury (BCVI)

OPERATIVE EXPLORATION

Penetrating Vascular Injury

Trachea and Larynx

Esophagus

COMPLICATIONS

24 Thoracic Trauma

INTRODUCTION

INITIAL IMAGING

COMMON INJURIES

Rib Fractures

Pneumothorax

Pulmonary Contusion

Hemothorax

Retained Hemothorax

Aortic Injury

Diaphragmatic Injuries

Cardiac

Blunt Cardiac Injury

Tracheobronchial Injury

Thoracic Esophageal Injury

RESUSCITATIVE THORACOTOMY

CONCLUSION

25 Abdominal Trauma

INTRODUCTION

BLUNT INITIAL EVALUATION AND DIAGNOSTICS

Resuscitation

Diagnostics

PENETRATING INJURY—INITIAL EVALUATION AND DIAGNOSTICS

General Approach to Penetrating Abdominal Injury

Indications and Contraindications to Selective Nonoperative Management

Diagnostics

THE TRAUMA LAPAROTOMY

DAMAGE CONTROL LAPAROTOMY

DIAPHRAGM

Anatomy

Epidemiology

Diagnostics

Treatment

LIVER AND BILIARY TRACT

Anatomy

Epidemiology

Diagnostics

Treatment

Extrahepatic Biliary Tract Injury

SPLEEN

Anatomy

Epidemiology

Diagnostics

Treatment

PANCREAS

Anatomy

Epidemiology

Diagnostics

Treatment

STOMACH

Anatomy

Diagnostics

Treatment

DUODENUM

Anatomy

Epidemiology

Treatment

COLON

Epidemiology

Diagnostics

Treatment

RECTUM

Anatomy

Epidemiology

Diagnostics

26 Genitourinary Trauma

KIDNEY

Evaluation

Treatment

Complications

URETER

Evaluation

Treatment

BLADDER

Evaluation

Treatment

URETHRA

Evaluation

Treatment

27 Vascular Trauma

BACKGROUND

EPIDEMIOLOGY AND MECHANISMS OF VASCULAR TRAUMA

Wartime Vascular Injury

Civilian Population Vascular Trauma

Mechanism of Vascular Trauma

DIAGNOSIS OF VASCULAR INJURY

Physical Examination

Adjuncts to the Physical Examination

Computed Tomography and Magnetic Resonance Imaging for Vascular Trauma

Contrast Angiography

MANAGEMENT OF THE PATIENT WITH VASCULAR TRAUMA

Trauma Patient Pathophysiology

Resuscitation of the Trauma Patient

General Intraoperative Considerations and Pearls

MANAGEMENT OF SPECIFIC INJURY PATTERNS—EXTREMITY

Upper Extremity

Lower Extremity

MANAGEMENT OF SPECIFIC INJURY PATTERNS—CERVICAL

MANAGEMENT OF SPECIFIC INJURY PATTERNS—TORSO

Thoracic Cavity

Abdomen and Retroperitoneum

ENDOVASCULAR MANAGEMENT OF TRAUMATIC VASCULAR INJURIES

CONCLUSION

28 The Principles of Orthopedic Surgery for Trauma

INTRODUCTION—AIMS AND PRIORITIES IN ORTHOPEDIC TRAUMA CARE

ORTHOPEDIC TRAUMA SURGERY TO SAVE LIFE

Hemorrhage

The Bleeding Pelvis

Pelvic Packing

COMPLICATED PELVIC INJURIES— OPEN FRACTURES OR ASSOCIATED VISCERAL INJURY

THE ORTHOPEDIC MANAGEMENT OF MAJOR POLYTRAUMA

Damage Control Surgery in Orthopedics

Special Polytrauma Situations—Head Injury

Special Polytrauma Situations—Chest Injury and Femur Fractures

SPECIFIC ORTHOPEDIC SCENARIOS

Major Wounds

ORTHOPEDIC TRAUMA SURGERY TO SAVE LIMBS

Open Fracture Principles

VASCULAR INJURIES

COMPARTMENT SYNDROME

INDICATIONS FOR AMPUTATION/FAILURE OF RECONSTRUCTION

ORTHOPEDIC TRAUMA SURGERY TO LIMIT DISABILITY—MANAGEMENT OF FRACTURES

Complex Articular Fractures

SPECIAL FRACTURE GROUPS—PROXIMAL FEMUR

COMPLICATIONS

Infection Nonunion and Malunion

Orthopedic Injury/Disaster Triage

29 Pediatric Trauma

INTRODUCTION AND EPIDEMIOLOGY

TRAUMA SYSTEMS

INITIAL ASSESSMENT, RESUSCITATION, AND STABILIZATION

Vital Signs

Fluid Resuscitation

SECONDARY SURVEY AND ADJUNCT DIAGNOSTIC MODALITIES

MANAGEMENT OF SPECIFIC INJURIES

Traumatic Brain Injury

Mild Traumatic Brain Injury

Spine Trauma

Thoracic Trauma

Abdominal Trauma

Pelvic Fracture and Extremity Trauma

Nonaccidental Trauma (Child Abuse)

Injury Prevention

Smoke Detectors and Carbon Monoxide Detectors

Drunken Driving Laws

Junior Driver Laws/Safe Driving Laws

Child Passenger Restraints

All-Terrain Vehicle Laws

GUN VIOLENCE PREVENTION

30 Geriatric Trauma

INTRODUCTION

PHYSIOLOGY, COMORBIDITY, AND PREINJURY MEDICATIONS

Cardiovascular

Pulmonary

Renal and Gastrointestinal

Medications

MECHANISM AND INJURIES

Elderly Abuse

Traumatic Brain Injury

Fractures

TRIAGE CRITERIA FOR OLDER PATIENTS

EVALUATION AND MANAGEMENT

Trauma Evaluation

Comprehensive Geriatric Assessment

Assessing Frailty

Patient Management

OUTCOMES

Mortality Outcomes

Functional Outcomes

PALLIATIVE AND END-OF-LIFE CARE IN THE GERIATRIC TRAUMA PATIENT

End-of-Life Care

Hospice

31 Trauma in Pregnancy

INTRODUCTION

EPIDEMIOLOGY

MECHANISMS OF INJURY

EVALUATION OF THE PREGNANT TRAUMA PATIENT

Airway

Pulmonary System

Cardiovascular System

Hematologic System

FETAL EVALUATION AND MONITORING

DIAGNOSTIC IMAGING

Pelvic Fractures

Abruptio Placentae

Uterine Rupture

Amniotic Fluid Embolism

Eclampsia

Disseminated Intravascular Coagulation

EMERGENCY CAESARIAN SECTION

SOCIAL CONSIDERATIONS

TEAM APPROACH TO TRAUMA IN THE PREGNANT PATIENT

32 Postinjury Management

32 Postinjury Management

INTRODUCTION

ACUTE TRAUMATIC COAGULOPATHY

DETECTION OF TRAUMATIC COAGULOPATHY

DAMAGE CONTROL RESUSCITATION

ENDPOINTS OF RESUSCITATION

ABDOMINAL COMPARTMENT SYNDROME

TRAUMATIC BRAIN INJURY

Secondary Brain Injury

Imaging in TBI

Coagulopathy in TBI

Antiplatelet and Anticoagulation Therapy in TBI

Seizure Prophylaxis after TBI

Penetrating Brain Injury

NUTRITIONAL AND METABOLIC SUPPORT

ORGAN DONATION

Rib Fractures

Blunt Cardiac Injury

33 Environmental Injuries

INTRODUCTION

ENVENOMATION

Snakebite

Venomous Lizards

Insect Bites and Stings

Spiders

Brown Recluse

Black Widow Spiders

HYMENOPTERA

Killer Bees

Fire Ants

Scorpions

Centipedes and Millipedes

Asp Caterpillars

Hypothermia

Cold Injury and Frostbite

Treatment

SECTION B: TRANSPLANTATION

34 Clinical Transplant Immunology

INTRODUCTION

SCIENTIFIC BASIS FOR MODERN CLINICAL IMMUNOSUPPRESSION

The Immune Response to a Solid Organ Transplant

REJECTION IN SOLID ORGAN TRANSPLANTATION

Hyperacute Rejection

Acute Rejection

Chronic Rejection

Antibody-Mediated Rejection

IMMUNOLOGIC PHARMACOTHERAPY IN SOLID ORGAN TRANSPLANTATION

Induction

CELL SURFACE RECEPTOR BLOCKADE

B7/CD28 CTLA4 Blockade

IL-2 Receptor Blockade

LEUKOCYTE DEPLETION

MAINTENANCE IMMUNOSUPPRESSION

Calcineurin Inhibitors

Steroids

mTOR Inhibitors

Antimetabolite Drugs

Infections after Transplant

Cancer

35 Organ Retrieval and Preservation

ORGAN DONATION

Living Donation

Deceased Donation

ORGAN SELECTION

Donor History of Cancer

Donor History of Infectious Disease

Organ-Specific Issues

THE ORGAN RETRIEVAL OPERATION

Heart and Lung Retrieval

Liver Retrieval

Kidney Retrieval

Pancreas Retrieval

NEW METHODS IN ORGAN OPTIMIZATION AND PRESERVATION

36 Kidney Transplantation

INTRODUCTION

IMMUNOLOGY OF RENAL TRANSPLANTATION

THE DONOR POOL: LIVING DONORS, DECEASED DONORS, AND DONATION AFTER CARDIAC DEATH

Living Donors

Deceased Donors

Further Strategies for Increasing the Number of Donor Kidneys

THE TRANSPLANT PROCEDURE

Recipient Preoperative Assessment

Living-Donor Nephrectomy: Open and Laparoscopic

Recipient Operative Procedure

COMPLICATIONS

Early Graft Dysfunction

Technical Complications

IMMUNOSUPPRESSION, REJECTION, AND IMMUNOSUPPRESSIVE COMPLICATIONS

Immunosuppression

Rejection

Immunosuppressive Complications

CURRENT RESULTS AND FUTURE TRENDS

37 Hepatic Transplantation

INDICATIONS FOR LIVER TRANSPLANTATION

Nonalcoholic Fatty Liver Disease

Alcohol-Related Liver Disease

Transplant for Malignancy

END-STAGE LIVER DISEASE AND EVALUATION FOR LIVER TRANSPLANTATION

Acute Liver Injury and Fulminant Hepatic Failure

Medical and Surgical Evaluation for Liver Transplantation

Waitlist Management and Organ Allocation

SURGICAL PROCEDURE: LIVER TRANSPLANTATION

Anesthetic Management

Intraoperative Management of Coagulopathy

Surgical Technique

Recipient Hepatectomy

Anhepatic Phase and Implantation of the Donor Liver

Post-revascularization Phase

Technique for Partial Liver Transplantation

Living Donor Liver Transplantation

POSTTRANSPLANT CARE AND COMPLICATIONS

Recipient Factors

Donor Factors

Technical Factors

Vascular Complications

Biliary Complications

Immunologic Complications

Antibody-Mediated Rejection

Cellular Rejection

Chronic Rejection

Immunosuppression Induction and Maintenance

Treatment of Acute Rejection

38 Cardiac Transplantation

HISTORICAL PERSPECTIVE

INDICATIONS FOR TRANSPLANTATION

PRETRANSPLANT MANAGEMENT

PRETRANSPLANT ASSESSMENT

ORGAN AVAILABILITY AND ALLOCATION

IMMUNOSUPPRESSION

DONOR SELECTION AND MANAGEMENT

Donor Selection

Heart Procurement

Key Concept

RECIPIENT MANAGEMENT AND PROCEDURE

CURRENT OUTCOMES

Survival

Complications

FUTURE DIRECTIONS

CONCLUSION

39 Lung Transplantation

INTRODUCTION

Early Years of Lung Transplantation

Current Status of Lung Transplants in the United States

THE FINAL RULE

Lung Allocation

INDICATIONS

Idiopathic Pulmonary Fibrosis

Chronic Obstructive Pulmonary Disease

Cystic Fibrosis

Pulmonary Hypertension

Contraindications to Lung Transplantation

OPERATIVE PROCEDURES

Donor Recovery Operation

Recipient Preparation

Single Lung Transplantation

Bilateral Lung Transplantation

OPERATIVE CONSIDERATIONS

Allograft Ischemic Time

Unilateral versus Bilateral Lung Transplant

Intraoperative Cardiopulmonary Support

Special Patient Populations

Surgical Complications

DONOR CONSIDERATIONS

Ex Vivo Lung Perfusion

EVLP Clinical Trials

Hepatitis C Virus-Infected Organs (HCV)

CONCLUSIONS

40 Pancreas and Islet Transplantation

INTRODUCTION

PATHOPHYSIOLOGY

SECONDARY COMPLICATIONS OF DIABETES

PANCREAS TRANSPLANTATION

Overview

Patient Selection

Simultaneous Kidney–Pancreas Transplantation

Pancreas after Kidney Transplantation

Simultaneous Living Donor Kidney–Deceased Donor Pancreas Transplantation

Living Donor Kidney–Pancreas Transplantation

Pancreas-Alone Transplantation

Evaluation and Screening

The Waiting List and Recipients

Deceased Donor Pancreas Allocation

Donor Evaluation

Recovery Technique

Back-Table Preparation of the Pancreas

Recipient Operation

Immunosuppression

Complications

Diagnosis and Treatment of Rejection

Recurrent Autoimmunity

Posttransplant Viral Infections

Results of Kidney–Pancreas Transplantation

Results of Solitary Pancreas Transplantation

Effect of Pancreas Transplantation on Secondary Complications of Diabetes Mellitus

ISLET TRANSPLANTATION

Overview

History

Islet Isolation

Patient Selection

Donor Selection/Recovery/Preservation

Transplant Techniques

Perioperative Care

Immunosuppression

Metabolic Control

Complications

Results

Graft Failure

THE FUTURE OF PANCREAS AND ISLET TRANSPLANTATION

SECTION C: HEAD AND NECK

41 Head and Neck

INTRODUCTION

PATIENT EVALUATION

History and Physical Examination

Workup

Airway Concerns

INFECTIOUS AND INFLAMMATORY DISEASE OF THE HEAD AND NECK

Neck Abscesses

Complications of Rhinosinusitis

Sialadenitis

NECK MASSES: CYSTIC NECK INFECTION OR MALIGNANCY?

HEAD AND NECK NEOPLASMS

Salivary Neoplasms

Sinonasal Neoplasms

HEAD AND NECK SQUAMOUS CELL CARCINOMA

Oral Cavity

Nasopharynx

Oropharynx

Hypopharynx

Larynx

NECK DISSECTION

COMPLICATIONS OF HEAD AND NECK SURGERY

SECTION D: ESOPHAGUS

42 Esophageal Anatomy and Physiology and Gastroesophageal Reflux Disease

ESOPHAGEAL ANATOMY AND FUNCTION

Cervical Esophagus

Thoracic Esophagus

Abdominal Esophagus

Structure of the Esophageal Wall and Mucosa

Blood Supply, Lymphatics, and Innervation

PHYSIOLOGY

The Swallowing Mechanism

The Gastroesophageal Barrier: Lower Esophageal Sphincter

EVALUATION OF ESOPHAGEAL FUNCTION

Upper Endoscopy

Radiologic Evaluation

Esophageal Manometry

Ambulatory pH Monitoring

Multichannel Impedance Testing

Impedance Planimetry

CONCLUSIONS

GASTROESOPHAGEAL REFLUX DISEASE

Definition and Epidemiology

Clinical Presentation

Physiology of the Antireflux Barrier

Transient Relaxation of the Lower Esophageal Sphincter

Structural Integrity of the Lower Esophageal Sphincter

Anatomic Alterations

Implications

Complications of Gastroesophageal Reflux Disease

Treatment of Gastroesophageal Reflux Disease

43 Esophageal Tumors and Injury

MALIGNANT ESOPHAGEAL NEOPLASMS

Epidemiology and Histology

Clinical Presentation and Diagnostic Evaluation

Staging

Treatment

Prognosis

ESOPHAGECTOMY

Techniques of Esophagectomy

Intraoperative Complications

Immediate and Long-term Outcomes Following Esophagectomy

Morbidity Following Esophagectomy

BENIGN ESOPHAGEAL NEOPLASMS

Leiomyoma

Fibrovascular Polyp

Schwannoma

Lymphangioma

ESOPHAGEAL INJURY

Esophageal Perforation

Caustic Injury

Esophageal Fistulas

Esophageal Foreign Body

SECTION E: STOMACH AND DUODENUM

44 Gastric Anatomy and Physiology

GROSS ANATOMY

MICROSCOPIC ANATOMY

GASTRIC PEPTIDES

Gastrin

Somatostatin

GASTRIC ACID SECRETION

Cellular Events

Regulation of Acid Secretion

PEPSIN

INTRINSIC FACTOR

GASTRIC BLOOD FLOW

GASTRIC MOTILITY

Gastric Smooth Muscle

Coordination of Contraction

45 Gastroduodenal Ulceration

EPIDEMIOLOGY

PATHOPHYSIOLOGY

Helicobacter pylori

Acid-Secretory Status

Mucosal Defense Against Peptic Injury

Environmental Factors

DIAGNOSIS

DRUG TREATMENT OF ULCER DISEASE

HISTAMINE-RECEPTOR ANTAGONISTS

PROTON PUMP BLOCKERS

OPERATIVE TREATMENT OF ULCER DISEASE

Surgical Goals

Operative Procedures

Hemorrhage

Perforation

Obstruction

GASTRIC ULCER

Endoscopic Diagnosis

Therapy

STRESS GASTRITIS

Diagnosis

Treatment and Prophylaxis

46 Management of Obesity

DIAGNOSIS AND EPIDEMIOLOGY

Obesity and Metabolic Disease

Diagnosis

Epidemiology, Disease Burden

MEDICAL MANAGEMENT

Treatment Strategies

SURGICAL MANAGEMENT

Bariatric Surgery—Beginnings

Gastric Bypass

Malabsorption Revisited

Pure Restriction

Epidemiology of Modern Bariatric Surgery

47 Gastric Neoplasms

ADENOCARCINOMA

Epidemiology

Premalignant Lesions

Gastritis

Helicobacter Pylori

Previous Gastric Surgery

Hereditary Syndromes

Clinical Features

Diagnosis and Staging

Staging Laparoscopy

Pathology

Curative-Intent Treatment

Endoscopic Resection

Surgical Resection

Neoadjuvant and Adjuvant Therapies

Palliative Surgical Treatment

OTHER GASTRIC NEOPLASMS

Gastric Lymphoma

Gastric Carcinoids

Gastrointestinal Stromal Tumors of the Stomach

SECTION F: SMALL INTESTINE

48 Anatomy and Physiology of the Small Intestine

GROSS ANATOMY AND EMBRYOLOGY

DUODENUM

VASCULAR AND LYMPHATIC SUPPLY

JEJUNUM AND ILEUM

VASCULAR AND LYMPHATIC SUPPLY

MICROSCOPIC ANATOMY

General Considerations

Mucosa

Submucosa

Physiology

Motility

IMMUNOLOGY

Principles of Gut Immunology

Nonaggregated and Aggregated Lymphoid Tissue

Immunoglobulin Secretion

Small Intestine Microbiota

DIGESTION AND ABSORPTION

Absorption of Water

Absorption of Electrolytes

Sodium

Chloride

Bicarbonate

Potassium

Carbohydrates

Nondigestible Carbohydrates (Dietary Fiber)

Protein

Fat

Bile Salts

Mineral

Vitamin Absorption

49 Ileus and Bowel Obstruction

INTRODUCTION

MECHANICAL OBSTRUCTION OF THE INTESTINE

Terminology and Classification

Pathophysiology of Intestinal Obstruction

Specific Types of Bowel Obstruction

Hernia

Gallstone Ileus

Intussusception

Crohn Disease

Malignant Obstruction

Volvulus

Radiation Enteritis

Open and Laparoscopic Operation in the Management of Small Bowel Obstruction

ILEUS AND PSEUDOOBSTRUCTION

Ileus

Colonic Pseudoobstruction (Ogilvie Syndrome)

50 Crohn Disease

INTRODUCTION

EPIDEMIOLOGY

ETIOLOGY

DIFFERENTIAL DIAGNOSIS

DIAGNOSTIC EVALUATION

CLINICAL EVALUATION

DIAGNOSTIC METHODS

Radiology

Endoscopy

Pathology

Laboratory Analysis

TREATMENT

Medical Management

OPERATIVE MANAGEMENT

Indications for Surgery

SPECIFIC CONSIDERATIONS

51 Small Intestinal Neoplasms

INTRODUCTION

EPIDEMIOLOGY

PATHOGENESIS

PREDISPOSITION TO SMALL BOWEL CANCER

Familial Adenomatous Polyposis

Crohn Disease

Celiac Disease

Peutz–Jeghers Syndrome

Lynch Syndrome

Other Familial Syndromes

Dietary and Lifestyle Predisposition

CLINICAL PRESENTATION

DIAGNOSIS

CAPSULE ENDOSCOPY

SMALL BOWEL ENTEROSCOPY

Double-Balloon Enteroscopy

Single-Balloon Enteroscopy

Spiral Enteroscopy

Exploratory Laparoscopy for Small Bowel Neoplasms

Imaging

MANAGEMENT

Benign

Malignant

METASTATIC TUMORS TO THE SMALL BOWEL

SECTION G: PANCREAS

52 Pancreas Anatomy and Physiology

INTRODUCTION

EMBRYOLOGY OF THE PANCREAS

VARIANT EMBRYOLOGIC ANATOMY

Pancreas Divisum

Annular Pancreas

Ectopic or Heterotopic Pancreas

CELLULAR ORGANIZATION OF THE PANCREAS

Exocrine Pancreas

Endocrine Pancreas

PHYSIOLOGY OF THE PANCREAS

Exocrine Physiology

Exocrine Insufficiency

Endocrine Physiology

PANCREATIC ANATOMY

53 Acute Pancreatitis

EPIDEMIOLOGY

AETIOLOGY

BILIARY PANCREATITIS

ALCOHOLIC PANCREATITIS

CLINICAL PRESENTATION

PHYSIOLOGY

SEVERITY CLASSIFICATION AND PREDICTION

Revised Atlanta Classification

Laboratory Test and Scores

Clinical-Based Classifications: Atlanta Classification and Determinant-Based Classification

TREATMENT

EARLY PHASE

FLUID RESUSCITATION

PAIN MANAGEMENT

ANTIBIOTICS AND PROBIOTICS AS PROPHYLAXIS

NUTRITION

Enteral Nutrition

PORTO-SPLENO-MESENTERIC THROMBOSIS IN AP

ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY IN ACUTE BILIARY PANCREATITIS

LOCAL COMPLICATIONS OF AP

MANAGEMENT OF LOCAL COMPLICATIONS

Peripancreatic Fluid Collections

MANAGEMENT OF PANCREATIC NECROSIS AND ITS COMPLICATIONS

STEP-UP APPROACH

MINIMALLY INVASIVE NECROSECTOMY

Endoscopic Necrosectomy

54 Chronic Pancreatitis

INTRODUCTION

EPIDEMIOLOGY

ETIOLOGY

PATHOPHYSIOLOGY

CLINICAL PRESENTATION

RADIOGRAPHIC EVALUATION

CONSIDERATIONS IN MANAGEMENT

ENDOSCOPIC MANAGEMENT

SURGICAL MANAGEMENT

Lateral Pancreaticojejunostomy

Localized Pancreatic Head Resection with Lateral Pancreaticojejunostomy

Pancreatic Head Resection

Distal Pancreatectomy

Total Pancreatectomy

Minimally Invasive Surgery for Chronic Pancreatitis

CONCLUSIONS

55 Neoplasms of Exocrine Pancreas

INTRODUCTION

EPIDEMIOLOGY AND RISK FACTORS

MOLECULAR GENETICS

PATHOLOGY

Solid Epithelial Tumors of the Pancreas

Cystic Epithelial Tumors of the Pancreas

CLINICOPATHOLOGIC STAGING

DIAGNOSIS

Clinical Presentation

Laboratory Studies

Radiologic Investigations

PREOPERATIVE STAGING

STAGING LAPAROSCOPY

RESECTION OF PANCREATIC CARCINOMA

Carcinoma of the Head, Neck, or Uncinate Process

Carcinoma of the Body and Tail

Postoperative Results

Long-Term Survival

ADJUVANT AND NEOADJUVANT THERAPY

UNRESECTABLE PANCREATIC CARCINOMA

PALLIATION

Biliary Obstruction

Duodenal Obstruction

PAIN

CONCLUSION

56 Neoplasms of the Endocrine Pancreas

INTRODUCTION

Epidemiology

Classification

MOLECULAR GENETICS

Whole-Exome Sequencing of PENs

Familial Syndromes

Molecular Targeting of PENs

DIAGNOSTIC EVALUATION

Presentation

Biochemical

Computed Tomography

Magnetic Resonance Imaging

Somatostatin Receptor Scintigraphy

Endoscopic Ultrasound

Venous Sampling

SURGICAL EXPLORATION

NONFUNCTIONAL PANCREATIC ENDOCRINE NEOPLASMS

Surgical Resection

Lymphadenectomy

INSULINOMA

GASTRINOMA (ZOLLINGER–ELLISON SYNDROME)

VIPOMA (VERNER–MORRISON SYNDROME)

GLUCAGONOMA

SOMATOSTATINOMA

METASTATIC PANCREATIC ENDOCRINE TUMORS

Liver-Directed Therapies

Somatostatin Analogs

Systemic Therapies

SECTION H: HEPATOBILIARY AND PORTAL VENOUS SYSTEM

57 Hepatobiliary Anatomy

TOPOGRAPHIC AND SURFACE ANATOMY

MORPHOLOGIC AND FUNCTIONAL ANATOMY

Hepatic Arteries

Portal Veins

Biliary System and Gallbladder

Hepatic Veins

LIVER IMAGING

Computed Tomography

Magnetic Resonance Imaging/Magnetic Resonance Cholangiopancreatography

ULTRASOUND AND INTRAOPERATIVE LIVER ASSESSMENT

PREOPERATIVE EVALUATION OF HEPATIC RESERVE

INDICATIONS FOR LIVER RESECTION AND ONCOLOGIC CONSIDERATIONS

NOMENCLATURE FOR HEPATECTOMIES

INTRAOPERATIVE CONSIDERATIONS

58 Hepatic Infection and Acute Liver Failure

PYOGENIC LIVER ABSCESS

Prevalence and Pathogenesis

Risk Factors

Clinical Manifestations

Diagnosis

Microbiology

Treatment

AMEBIC LIVER ABSCESS

Prevalence and Pathogenesis

Risk Factors

Clinical Manifestations

Diagnosis

Treatment

ECHINOCOCCUS (HYDATID DISEASE)

Prevalence and Pathogenesis

Risk Factors

Clinical Manifestations

Diagnosis

Treatment

SCHISTOSOMA

Prevalence and Pathogenesis

Risk Factors

Clinical Manifestations

Diagnosis

Treatment

Viral Hepatitis

HEPATITIS A VIRUS

Epidemiology/Risk Factors for Transmission

Clinical Features

Treatment

HEPATITIS B VIRUS

Epidemiology/Risk Factors for Transmission

Clinical Features

Treatment

HEPATITIS C VIRUS

Epidemiology/Risk Factors for Transmission

Clinical Features

Treatment

HEPATITIS D VIRUS

Epidemiology/Risk Factors for Transmission

Clinical Features

Treatment

HEPATITIS E VIRUS

Epidemiology/Risk Factors for Transmission

Clinical Features

Treatment

Cytomegalovirus

Epstein–Barr Virus

Herpes Simplex Virus

Varicella Zoster Virus

ACUTE LIVER FAILURE

Definition

Diagnosis

Etiology

Clinical Features, Management, and Treatment

Liver Transplantation

Life Support Systems

Prognosis

59 Cirrhosis and Portal Hypertension

CIRRHOSIS

Background and Definition

Pathophysiology

Etiology

Diagnosis

Complications

PORTAL HYPERTENSION

Anatomy

Pathophysiology

Etiology

Complications of Portal Hypertension

60 Hepatic Neoplasms

INTRODUCTION

DIFFERENTIAL DIAGNOSIS

Workup

Diagnostic Principles

GENERAL TREATMENT GUIDELINES

BENIGN/PREMALIGNANT LESIONS

Hemangioma

Focal Nodular Hyperplasia

Hepatocellular Adenoma

Simple Cysts

Mucinous Cysts (MCN and IPMN-B)

MALIGNANT LESIONS

Oncologic Appropriateness

Host Condition

Technical Resectability

ONCOLOGIC APPROPRIATENESS

Preoperative Evaluation

Hepatocellular Carcinoma

Intrahepatic Cholangiocarcinoma

Colorectal Liver Metastases

Neuroendocrine Liver Metastases

Noncolorectal, Nonneuroendocrine Liver Metastases

HOST CONDITION

TECHNICAL RESECTABILITY

Vascular Inflow/Outflow and Biliary Drainage

FLR QUANTITY AND QUALITY

Volumetric Assessment of the Liver

Functional Assessment of the Liver

INCREASING TECHNICAL RESECTABILITY

Portal Vein Embolization

Two-Stage Hepatectomy

Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy

ANATOMY AND CLASSIFICATION

OPERATIVE PROCEDURES

Patient Positioning and Incision

Exposure, Mobilization, and Assessment

Intraoperative Ultrasound

GENERAL PRINCIPLES OF HEPATIC RESECTIONS

Inflow Control and Preservation of the Integrity of the Biliary Tree

Outflow Control

Parenchymal Transection

CONCLUSION

61 Calculous Biliary Disease

INTRODUCTION

RISK FACTORS FOR GALLSTONE FORMATION

NATURAL HISTORY OF GALLSTONES

GALLSTONES AND GALLBLADDER CANCER

CHOLECYSTITIS

Acute Cholecystitis

Clinical Manifestations

Imaging

Diagnosis

Treatment

CHRONIC CHOLECYSTITIS

ACUTE ACALCULOUS CHOLECYSTITIS

OTHER CONDITIONS

Gangrenous Cholecystitis

Emphysematous Cholecystitis

Mirizzi Syndrome

Cholecystoenteric Fistulae

CHOLECYSTECTOMY

TECHNIQUE—LAPAROSCOPIC CHOLECYSTECTOMY

Intraoperative Cholangiogram

OTHER APPROACHES TO CHOLECYSTECTOMY

Single-Incision Laparoscopic Approach

Robotic Cholecystectomy

Open Cholecystectomy

SUBTOTAL CHOLECYSTECTOMY

Percutaneous Drains after Cholecystectomy

COMPLICATIONS OF CHOLECYSTECTOMY

PROPHYLACTIC CHOLECYSTECTOMY

PERCUTANEOUS CHOLECYSTOSTOMY

Other Therapies

SPECIAL CONSIDERATIONS

Gallstone Pancreatitis

Gallbladder Cancer

Cholecystitis during Pregnancy

Cholecystitis and Cirrhosis

CHOLEDOCHOLITHIASIS

Clinical Presentation

Diagnosis

Management

Endoscopic Approach

Percutaneous Approach

Surgical Techniques for Choledocholithiasis

Laparoscopic Surgical Approach

Open Surgical Approach

T-TUBES

INTRAHEPATIC STONES

62 Biliary Injury, Strictures, and Sclerosing Cholangitis

BILE DUCT INJURY

Clinical Presentation

Evaluation

Treatment

Outcomes

Follow-Up

BILIARY STRICTURE

Clinical Presentation

Evaluation

Treatment

Outcomes

Follow-Up

SCLEROSING CHOLANGITIS

Clinical Presentation

Evaluation

Treatment

63 Biliary Neoplasms

INTRODUCTION

GALLBLADDER CARCINOMA

Incidence

Pathology and Staging

Clinical Findings and Diagnosis

Surgery

Neoadjuvant and Adjuvant Therapy

Prognosis

Follow-up after Resection for Gallbladder Cancer

Issues for the Future

BILE DUCT CARCINOMA

INCIDENCE

Pathology and Staging

Clinical Findings and Diagnosis

Surgery

Adjuvant Therapy

Follow-up after Resection of Cholangiocarcinoma

Issues for the Future

BENIGN GALLBLADDER NEOPLASMS

Incidence

Pathology

Clinical Findings

Diagnosis

Treatment

BENIGN BILE DUCT NEOPLASMS

Incidence

Clinical Findings

Diagnosis

Treatment

SECTION I: COLON AND RECTUM

64 Anatomy and Physiology of the Colon, Rectum, and Anus

INTRODUCTION

EMBRYOLOGY

GROSS ANATOMY

Pelvic Floor

Anorectal Spaces

Arterial Blood Supply

Venous Drainage

Lymphatic Drainage

Neural Components

PHYSIOLOGY

Colonic Flora

Colonic Motility

Defecation

Anal Continence

CONCLUSIONS

65 Gastrointestinal Bleeding

NOMENCLATURE

EPIDEMIOLOGY

CLINICAL PRESENTATION

Site and Cause of Bleeding

Risk Factors for GI Bleeding

Severity of Bleeding

RISK ASSESSMENT AND TRIAGE

Risk Assessment Tools for Upper GI Bleeding

Risk Assessment Tools for Lower GI Bleeding

RESUSCITATION

Airway Management

Volume Resuscitation

Hemodynamic Monitoring

Nasogastric Lavage

Management of Antithrombotic Drugs

DIAGNOSTIC ALGORITHMS

Upper GI Bleeding

Lower GI Bleeding

UPPER GASTROINTESTINAL BLEEDING

Peptic Ulcer Disease

Stress Ulceration

Esophagitis

Mallory–Weiss Syndrome

Dieulafoy Lesion

Gastroesophageal Varices

Clinical Outcomes for Upper GI Bleeding

LOWER GASTROINTESTINAL BLEEDING

Diverticular Disease

Internal Hemorrhoids

Colon Ischemia

Inflammatory Bowel Disease

Infectious Colitis

MID-GASTROINTESTINAL BLEEDING

Angioectasia

Meckel Diverticulum

Small Bowel Diverticula

Aortoenteric Fistula

Gastrointestinal Stromal Tumors

66 Ulcerative Colitis

INTRODUCTION

EPIDEMIOLOGY

ETIOLOGY AND RISK FACTORS

Genetics

Environment

Microbiome

CLINICAL FEATURES

Extraintestinal Disease

DIAGNOSIS

Laboratory Testing

Imaging

Endoscopy

Pathology

MANAGEMENT

Medical Management

SURGERY

Indications

Surgical Management

67 Colonic Polyps and Polyposis Syndromes

COLONIC POLYPS

Adenomatous Polyps

Epidemiology

Histology

Etiology/Molecular Pathways

Clinical Features

Serrated Polyps

Hyperplasic Polyps

Hamartomatous Polyps

Inflammatory Polyps

SCREENING AND SURVEILLANCE MODALITIES FOR COLONIC POLYPS

Flexible Sigmoidoscopy

Colonoscopy

CT Colonography

Stool-Based Tests

POLYPOSIS SYNDROMES

Adenomatous Polyposis Syndromes

Hamartomatous Polyposis Syndromes

CONCLUSIONS

68 Colorectal Cancer

INTRODUCTION

EPIDEMIOLOGY

RISK FACTORS

MOLECULAR CHARACTERISTICS

HISTOPATHOLOGY AND PROGRESSION

STAGING AND PROGNOSIS

SCREENING AND PREVENTION

Screening Tests

Risk Categories

Consequences of Screening

Implementation of Guidelines

DIAGNOSIS

Symptoms and Signs

Diagnostic Evaluation

TREATMENT

Preoperative Preparation

Principles of Surgical Treatment

TREATMENT OF LOCALIZED COLON CANCER

Malignant Colonic Polyps

Surgery for Localized Colon Cancer

Postoperative Adjuvant Therapy for Localized Colon Cancer

TREATMENT OF LOCALIZED RECTAL CANCER

Anatomy of the Rectum

Clinical Staging of Rectal Cancer

Local Excision for Early-Stage Rectal Cancer

Transabdominal Resection for Rectal Cancer

Adjuvant and Neoadjuvant Radiation and Chemotherapy for Locally Advanced Rectal Cancer

Chemotherapy for Locally Advanced Rectal Cancer

Outcomes of Multimodality Treatment in Patients with Locally Advanced Rectal Cancer

Treatment Selection in Patients with Localized Rectal Cancer

Watch and Wait

TUMOR-RELATED EMERGENCIES

SURVEILLANCE AFTER CURATIVE RESECTION FOR COLON AND RECTAL CANCER

TREATMENT OF STAGE IV COLON AND RECTAL CANCER

Treatment of the Primary Tumor in Stage IV CRC

Surgical Treatment of Colorectal Metastases

Chemotherapy for Metastatic Disease

TREATMENT OF LOCALLY RECURRENT CRC

69 Diverticular Disease

INTRODUCTION

TERMINOLOGY AND ANATOMY

EPIDEMIOLOGY

North America and Europe

Africa

Asia

ETIOLOGY

Inherent Risk Factors: Genetic Background

Inherent Risk Factors: Changes in Colonic Structure and Function

Environmental Risk Factors: Diet and Lifestyle

Environmental Risk Factors: Microbiome

ACUTE DIVERTICULITIS

Presentation and Differential Diagnosis

Diagnosis

TREATMENT

Acute Uncomplicated Diverticulitis

Acute Complicated Diverticulitis

Perforated Diverticulitis with Peritonitis

DIVERTICULITIS—RECURRENT AND CHRONIC INFLAMMATORY PRESENTATIONS

Recurrent Diverticulitis

Fistula, Stenosis, and Obstruction

Less Common Presentations of Diverticular Disease

70 Anorectal Disorders

ANATOMY AND PHYSIOLOGY

The Rectum

The Anal Canal and Pelvic Floor

Physiology

DIAGNOSTIC EVALUATION OF THE ANUS

BENIGN ANORECTAL DISEASE

Hemorrhoids

Anal Fissure

Anorectal Abscess

Anal Fistula

Pilonidal Disease

Fecal Incontinence

Rectal Prolapse

SEXUALLY TRANSMITTED DISEASES OF THE ANORECTUM

Gonorrhea

Chlamydia/Lymphogranuloma Venereum

Herpes Simplex Virus

HIV and AIDS

Condyloma Acuminata and Squamous Intraepithelial Lesions

NEOPLASTIC ANORECTAL DISEASE

Squamous Cell Carcinoma

ADENOCARCINOMA

Paget Disease

Anal Canal Adenocarcinoma

Basal Cell Carcinoma

Melanoma

71 Appendiceal Diseases

ANATOMY AND PHYSIOLOGY

APPENDICITIS

Etiology and Pathophysiology

Diagnosis

Management

Special Populations

APPENDICEAL NEOPLASMS

Neuroendocrine Tumors

Appendiceal Mucinous Neoplasms

Adenocarcinomas

SECTION J: HERNIA AND SPLEEN

72 Abdominal Wall Hernias

INTRODUCTION

ANATOMY OF THE ABDOMINAL CORE

Diaphragm

Anterior Abdominal Wall and Flanks

Posterolateral (Lumbar) Abdominal Wall

Vasculature of the Abdominal Wall and Deep Inguinal Region

Pelvic Floor and Obturator Muscles

WHY DO HUMAN BEINGS DEVELOP ABDOMINAL WALL HERNIAS?

COMPLICATIONS OF HERNIAS

Hernia Accident

Incarceration

Intestinal Obstruction

Strangulation

Richter Hernia

GROIN HERNIAS

Epidemiology

Classification

Clinical Diagnosis

Differential Diagnosis

Preoperative Considerations

Surgical Treatment of Groin Hernias

Femoral Hernias

SPORTS HERNIA/ATHLETIC PUBALGIA

Complications of Inguinal Hernia Repair

VENTRAL ABDOMINAL WALL HERNIAS

UMBILICAL AND PERIUMBILICAL HERNIAS

EPIGASTRIC HERNIAS

INCISIONAL HERNIAS

Treatment of Ventral Hernias

Preoperative Preparation

Surgical Techniques

Massive Hernia with Loss of Domain

Parastomal Hernias

Prophylactic Mesh Placement

UNUSUAL HERNIAS

Spigelian Hernia

Lumbar and Flank Hernias

Obturator Hernia

Sciatic Hernia

Supravesical Hernia

Interparietal Hernia

Littre Hernia

Perineal Hernia

Perivascular Hernia

COMPLICATIONS OF VENTRAL HERNIA REPAIR

General Complications

Surgical Site Infection

Surgical Site Occurrence

Mesh-Related Complications

73 The Spleen

INTRODUCTION

HISTORY

EMBRYOLOGY AND ANATOMY

PHYSIOLOGY

Hematologic Function of the Spleen

Immunologic Function of the Spleen

PATHOPHYSIOLOGY

Hyposplenism

Hypersplenism

SURGICAL TREATMENT FOR DISEASES RELATING TO THE SPLEEN

Trauma to the Spleen

Autoimmune and Erythrocyte Disorders

Hypersplenism

INCIDENTAL SPLENECTOMY

IATROGENIC SPLENECTOMY

DIAGNOSTIC SPLENECTOMY

VASCULAR DISORDERS OF THE SPLEEN

Splenic Vein Thrombosis

Splenic Artery Aneurysm

MISCELLANEOUS INDICATIONS FOR SPLENECTOMY

Cysts of the Spleen

Abscess of the Spleen

Ectopic Spleen (Wandering Spleen)

SPLENECTOMY: OPERATIVE TECHNIQUE

Preoperative Evaluation

Description of Procedure

SEQUELAE OF SPLENECTOMY AND HYPOSPLENISM

Postsplenectomy Sepsis

Vascular Complications Following Splenectomy

SECTION K: SURGICAL ENDOCRINOLOGY

74 Breast Disease

ANATOMY

Surgical Anatomy of the Breast

Lymphatic Drainage

BREAST PHYSIOLOGY

Breast Development

Pregnancy and Lactation

Menopause

CLINICAL EVALUATION OF THE PATIENT WITH BREAST DISEASE

Clinical Breast Examination

Diagnostic Mammography and Breast Ultrasound

Diagnostic MRI

Biopsy Procedures

COMMON CLINICAL PROBLEMS AND MANAGEMENT ALGORITHMS

Breast Mass

Breast Pain

Nipple Discharge

Breast Infections

BENIGN BREAST DISEASE

Nonproliferative Breast Lesions

Proliferative Breast Lesions without Atypia

Proliferative Breast Lesions with Atypia

Lobular Carcinoma In Situ (LCIS)

MANAGEMENT OF PATIENTS AT HIGH RISK FOR BREAST CANCER

Risk Factors

Clinical Risk Assessment

Management

DUCTAL CARCINOMA IN SITU (DCIS)

EVALUATION OF THE PATIENT WITH BREAST CANCER

AJCC TNM Staging

Histologic Subtype and Tumor Grade

Biomarker Profile (ER, PR, HER2)

Molecular Subtyping

Breast MRI

Sentinel Lymph Node Biopsy

TREATMENT OF THE PATIENT WITH BREAST CANCER

Overview

Surgical Therapy

Radiation Therapy

Chemotherapy

Endocrine Therapy

Targeted Therapy

Special Issues in Breast Cancer Treatment

Breast Cancer in the Elderly

Breast Cancer during Pregnancy

Breast Cancer in Men

Locoregional Breast Cancer Recurrence

Paget Disease of the Breast

Phyllodes Tumor

75 The Thyroid Gland

INTRODUCTION

EMBRYOLOGY

ANATOMY OF THE THYROID

Vasculature

Lymphatics

Nerves

Parathyroid Glands

THYROID PHYSIOLOGY

CLINICAL EVALUATION OF THE PATIENT WITH A THYROID DISORDER

LABORATORY ASSESSMENT OF THYROID ABNORMALITIES

Thyroid-Stimulating Hormone (Thyrotropin, TSH)

Free versus Total Thyroxine (T4) and Triiodothyronine (T3)

Thyroglobulin and Thyroglobulin Antibodies

Thyroid Autoantibodies

Calcitonin

RADIOGRAPHIC ASSESSMENT OF THYROID ABNORMALITIES

Ultrasound

Radionuclide Imaging

Positron Emission Tomography

Computed Tomography and/or Magnetic Resonance Imaging

THYROID DISORDERS CHARACTERIZED BY HYPERTHYROIDISM

Toxic Adenoma

Toxic Multinodular Goiter

Graves Disease

Thyroid Storm

THYROID DISORDERS ASSOCIATED WITH HYPOTHYROIDISM

THYROIDITIS

Hashimoto Thyroiditis

Postpartum Thyroiditis and Painless Sporadic Thyroiditis

Subacute Thyroiditis

Amiodarone-Induced Thyrotoxicosis or Thyroiditis

Acute Thyroiditis

Riedel Thyroiditis

NODULAR THYROID DISEASE

Multinodular Goiter

Uninodular Disease

Substernal or Intrathoracic Thyroid Nodular Disease

Thyroid Cytopathology

Bethesda Classification

Molecular Evaluation

DIFFERENTIATED THYROID CANCER

Papillary Thyroid Cancer

Papillary Thyroid Cancer: Nonoperative Management

Follicular Thyroid Cancer

Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features

Hurthle Cell Cancer

MEDULLARY THYROID CANCER

ANAPLASTIC THYROID CANCER

OTHER THYROID MALIGNANCIES

STAGING OF DIFFERENTIATED, MEDULLARY, AND ANAPLASTIC THYROID CANCER

NONSURGICAL THERAPEUTIC ADJUNCTS FOR THYROID CANCER

TSH Suppression

Radioiodine Therapy

External-Beam Radiation Therapy

Metastatic Disease and Systemic Therapy

THYROID SURGERY

Technique

Surgical Energy Devices

Intraoperative Nerve Monitoring

Extent of Operation

Lymph Node Dissection

COMPLICATIONS

Hypoparathyroidism

Recurrent Laryngeal Nerve Injury

Hematoma

76 Parathyroid Glands

ANATOMY

PHYSIOLOGY

Calcium

Phosphate

Regulation of Calcium and Phosphate Metabolism

Pathophysiology

HYPERCALCEMIA

Clinical Manifestations

Differential Diagnosis

Etiology

Medical Treatment

HYPOCALCEMIA

Clinical Features

Etiology

Treatment

HYPERPARATHYROIDISM

Definitions

Incidence

Etiology

Pathology

Systemic Effects

Treatment

Principles of Surgical Correction

Limited Surgical Exploration

Special Situations

MULTIPLE ENDOCRINE NEOPLASIA

Pathogenesis

Clinical Features and Management of Multiple Endocrine Neoplasia Type 1

Clinical Features and Management of Multiple Endocrine Neoplasia Type 2

Nonendocrine Manifestations of Multiple Endocrine Neoplasia Type 2B

77 Adrenal Gland

ANATOMY

BIOCHEMISTRY AND PHYSIOLOGY

Adrenal Cortex

Adrenal Medulla

ADRENAL NEOPLASMS AND DISEASES

Incidental Adrenal Mass

DISEASES OF THE ADRENAL CORTEX

Hypercortisolism

Hyperaldosteronism

Treatment

Adrenocortical Carcinoma

DISEASES OF THE ADRENAL MEDULLA

Pheochromocytoma/Paraganglioma

Metastasis to the Adrenal Glands

ADRENALECTOMY

Laparoscopic Transabdominal Adrenalectomy

Posterior Retroperitoneoscopic Adrenalectomy

Anterior Open Approach

Thoracoabdominal Approach

ADRENAL INSUFFICIENCY

Signs and Symptoms

Diagnosis

Treatment

78 Pituitary Surgery

INTRODUCTION

ANATOMY

PATHOLOGY OF SELLAR LESIONS

Pituitary Adenomas

Nonadenomatous Lesions of the Sella

MOLECULAR PATHOGENESIS

ENDOCRINE EVALUATION

Pituitary Hypofunction (Hypopituitarism)

Hypersecretory Syndromes

Endocrine Evaluation of a Pituitary “Incidentaloma”

NEUROLOGIC EVALUATION IN PITUITARY ADENOMAS

IMAGING OF PITUITARY ADENOMAS

Magnetic Resonance Imaging

Computerized Tomography

MRI Characteristics of Pituitary Tumors and Other Sellar Lesions

SURGICAL TECHNIQUE

Approach

Navigation

VISUALIZATION

Determining the Adequacy of Resection

Surgical Technique

Postoperative Management

RESULTS AND COMPLICATIONS

Prolactinomas

Acromegaly

Cushing Disease

MANAGEMENT OF PITUITARY ADENOMAS BY SYNDROME

Prolactinomas

Acromegaly

Cushing Disease

Nonfunctioning Tumors

Thyrotropin-Secreting Pituitary Adenomas

SOCIOECONOMIC CONSIDERATIONS

SECTION L: LUNG

79 Lung Neoplasms

INTRODUCTION

EPIDEMIOLOGY

MOLECULAR TUMOR GENOMICS

Non–S mall Cell Lung Carcinoma

Overview

Diagnosis for Non–Small Cell Lung Carcinoma

Staging of Non–Small Cell Lung Carcinoma

Treatment

PULMONARY CARCINOID TUMORS

LARGE CELL NEUROENDOCROINE CARCINOMA

SMALL CELL LUNG CARCINOMA

ADENOID CYSTIC CARCINOMA

MUCOEPIDERMOID CARCINOMA

Hamartoma

80 Nonneoplastic Thoracic Disease

INTRODUCTION

CHEST WALL ANATOMY

CHEST WALL NEOPLASMS

BENIGN SOFT TISSUE TUMORS

BENIGN BONY/CARTILAGINOUS TUMORS

MALIGNANT SOFT TISSUE TUMORS

MALIGNANT BONY/CARTILAGINOUS TUMORS

METASTATIC TUMORS

CHEST WALL RECONSTRUCTION

CHEST WALL CONGENITAL ABNORMALITIES AND THORACIC OUTLET SYNDROME

Pectus Excavatum and Pectus Carinatum

Sternal Clefts

Poland Syndrome

Thoracic Outlet Syndrome

NONNEOPLASTIC LUNG DISEASE

Lung Abscess and Bronchiectasis

Hemoptysis

COPD and Lung Volume Reduction

Tracheobronchial Foreign-Body Aspiration

Pneumothorax

Congenital Lung Disease

Pulmonary Sequestrations

Congenital Lobar Emphysema

Congenital Cystic Adenomatoid Malformation

Bronchogenic Cysts

Pleural Disease

PLEURAL EFFUSIONS

Empyema

Mesothelioma

Trachea

Anatomy

Surgical Airways

Tracheal Tumors

Tracheomalacia and Airway Stents

Mediastinum

Anterior Mediastinum

Middle and Posterior Mediastinum

Pediatric Mediastinum

Mediastinitis

Superior Vena Cava Syndrome

SECTION M: VASCULAR DISEASE

81 Congenital Heart Disease

INTRODUCTION

HISTORY

ATRIAL SEPTAL DEFECT

Embryology

Anatomy and Pathophysiology

Diagnostic Findings

Indications for Intervention and Treatment Options

VENTRICULAR SEPTAL DEFECT

Embryology

Anatomy and Pathophysiology

Diagnostic Findings

Indications for Intervention and Treatment Options

ATRIOVENTRICULAR SEPTAL DEFECT

Embryology

Anatomy and Pathophysiology

Diagnostic Findings

Indications for Intervention and Treatment Options

TETRALOGY OF FALLOT

Embryology

Anatomy and Pathophysiology

Diagnostic Findings

Indications for Intervention and  Treatment Options

TRANSPOSITION OF THE GREAT ARTERIES

Embryology

Anatomy and Pathophysiology

Indications for Intervention and Treatment Options

TRUNCUS ARTERIOSUS

Embryology

Anatomy and Pathophysiology

Diagnostic Findings

Indications for Intervention and Treatment Options

HYPOPLASTIC LEFT HEART SYNDROME

Embryology

Anatomy and Pathophysiology

Diagnostic Findings

Indications for Intervention and Treatment Options

AORTIC STENOSIS

Embryology

Anatomy and Pathophysiology of Valvar Aortic Stenosis

Diagnostic Findings of Valvar AS in the Neonate or Infant

Indications for Intervention and Treatment Options for Valvar AS in the Neonate or Infant

Diagnostic Findings of Valvar AS in the Older Child

Indications for Intervention and Treatment Options for Valvar AS in the Older Patient

Anatomy and Pathophysiology of Subvalvar Aortic Stenosis

Diagnostic Findings of Subvalvar AS

Indications for Intervention and Treatment Options for Subvalvar AS

Anatomy and Pathophysiology of Supravalvar Aortic Stenosis

Diagnostic Findings of Supravalvar AS

Indications for Intervention and Treatment Options for Supravalvar AS

COARCTATION OF THE AORTA

Embryology

Anatomy and Pathophysiology

Diagnostic Findings

Indications for Intervention and Treatment Options

PATENT DUCTUS ARTERIOSUS

Embryology

Anatomy and Pathophysiology

Diagnostic Findings

Indications for Intervention and Treatment Options

VASCULAR RINGS

Embryology

Anatomy and Pathophysiology

Diagnostic Findings

Indications for Intervention and Treatment Options

CORONARY ARTERY ANOMALIES

Embryology

Background

Coronary Arteriovenous Fistula

Coronary Artery Origin from the Pulmonary Artery

Anomalous Aortic Origin of Coronary Artery

Myocardial Bridging

Coronary Artery Aneurysms

82 Valvular Heart Disease

VALVULAR ANATOMY

AORTIC STENOSIS

Prevalence and Etiology

Pathophysiology

Diagnosis

Electrocardiogram and Imaging

Natural History

Treatment

AORTIC REGURGITATION

Prevalence and Etiology

Pathophysiology

Diagnosis

Imaging

Natural History

Treatment

MITRAL STENOSIS

Prevalence and Etiology

Pathophysiology

Diagnosis

Imaging

Natural History

Treatment

MITRAL REGURGITATION

Prevalence and Etiology

Pathophysiology

Diagnosis

Imaging

Natural History

Treatment

TRICUSPID VALVE DISEASE

Valve Prostheses

83 Mechanical Circulatory Support

INTRODUCTION

INDICATIONS FOR MCS

TIMING OF MCS INTERVENTION

Cardiogenic Shock and Acute Heart Failure

Chronic Heart Failure

PATIENT SELECTION AND INFLUENCE OF COMORBIDITIES ON OUTCOMES

Renal Function

Pulmonary Function

Liver Function

Right Ventricular Heart Failure

Nutrition

OTHER IMPORTANT MEDICAL CONSIDERATIONS WHEN INITIATING MCS

Valvular Heart Disease

Coronary Artery Disease

Arrhythmias

Intracardiac Shunts

PATIENT OUTCOMES AND MAJOR ADVERSE EVENTS FOLLOWING INITIATION OF MCS

Bleeding

RV Failure

Intracranial Bleeding and Thromboembolism

Infection

Device Malfunction and Thrombosis

WEANING PATIENTS FROM MCS

Weaning Short-Term MCS

Weaning Long-Term MCS

MCS DEVICES

Devices Intended for Short-Term MCS (Temporary Devices)

Implantable Devices Intended for Durable MCS

Total Artificial Heart

FUTURE DIRECTIONS

84 Pericardium

INTRODUCTION

HISTORY

EMBRYOLOGY AND ANATOMY

NORMAL PHYSIOLOGY

DIAGNOSTIC STUDIES

CONGENITAL ABNORMALITIES

ACUTE PERICARDITIS

Idiopathic and Viral Pericarditis

Acquired Immunodeficiency Syndrome

Tuberculous Pericarditis

Purulent Pericarditis

Uremic Pericarditis

Vasculitis, Connective Tissue Disease, and Drugs

Dressler and Postpericardiotomy Syndrome

Radiation-Induced Pericarditis

PERICARDIAL EFFUSION AND TAMPONADE

Postoperative Cardiac Tamponade

PERICARDIAL CONSTRICTION

NEOPLASTIC PERICARDIAL DISEASE

PERICARDIOCENTESIS

PERICARDIAL BIOPSY AND SURGICAL DRAINAGE

RECONSTRUCTION OF THE PERICARDIUM

PERICARDIECTOMY

85 Vascular Diagnostics: The Noninvasive Vascular Laboratory

INTRODUCTION

PLETHYSMOGRAPHY

ULTRASOUND

BASICS OF DUPLEX ULTRASOUND

B-Mode Ultrasound

Doppler Ultrasound

Color Flow

Carotid and Vertebral Arteries

Common Carotid Artery Waveforms

ICA Waveforms

Vertebral Artery

External Carotid Artery

Classifying Carotid Stenosis

Current Criteria for ICA Stenosis

BILATERAL HIGH-GRADE ICA STENOSIS

Stented Carotid Arteries

CCA and ECA Stenosis

LOWER EXTREMITY ARTERIAL DISEASE

PLETHYSMOGRAPHIC TECHNIQUES

Volume Flow

Pulse Volume Recordings

ULTRASOUND TECHNIQUES

Ankle–Brachial Index

Segmental Limb Pressures

Exercise Testing

Doppler Analog Waveform Analysis

Peripheral Artery Duplex Scanning

Upper Extremity Arterial Evaluation

SEGMENTAL ARM PRESSURES

DIGITAL PRESSURES AND PLETHYSMOGRAPHY

COLD CHALLENGE TESTING

UPPER EXTREMITY DUPLEX SCANNING

VISCERAL ARTERIES

Mesenteric Arteries

RENAL ARTERIES

Indirect Assessment of Renal Artery Stenosis

Direct Assessment of Renal Artery Stenosis

Predicting Success of Renal Artery Interventions

VENOUS DISEASE

Acute Deep Venous Thrombosis

Chronic Venous Insufficiency

SELECTED MISCELLANEOUS EXAMINATIONS

Evaluation for Abdominal Aortic Aneurysm

Evaluation of Aortic Endografts

Evaluation and Treatment of Groin Pseudoaneurysms

Transcutaneous Oxygen Measurements

86 Vascular Infection

INTRODUCTION

DEFINITIONS AND PATHOGENESIS

Pathogenesis of Primary Arterial Infections

Pathogenesis of Arterial Graft Infections

MICROBIOLOGY

Primary Arterial Infections

Arterial Graft Infections

CLASSIFICATION OF ARTERIAL GRAFT INFECTIONS

DIAGNOSIS

Common Clinical Presentations

Imaging for Vascular Infection

CONSERVATIVE MANAGEMENT

Primary Arterial Infections

Arterial Graft Infections

SURGICAL MANAGEMENT OF AORTIC ARTERIAL AND GRAFT INFECTIONS

Aortic Infections Presenting with Hemorrhage or Sepsis

Aortic Infections in the Stable Patient

NONAORTIC ARTERIAL AND GRAFT INFECTIONS

Lower Extremity Arterial Infections

Arterial Infections in Other Sites

ANTIBIOTIC THERAPY

PREVENTION OF SECONDARY ARTERIAL INFECTIONS

CONCLUSIONS

87 Cerebrovascular Disease

INTRODUCTION

ATHEROSCLEROTIC CAROTID ARTERY DISEASE

Epidemiology

Pathogenesis of Stroke

Clinical Syndromes

Initial Diagnostic Evaluation

Treatment of Atherosclerotic Carotid Artery Disease

Symptomatic

Asymptomatic

CAROTID ENDARTERECTOMY

Technique

Complications

Transfemoral Carotid Artery stenting

Complications

Results

TRANSCAROTID ARTERY REVASCULARIZATION

Technique

Complications

Results

CAROTID ENDARTERECTOMY VERSUS TRANSFEMORAL CAROTID STENTING VERSUS TRANSCAROTID REVASCULARIZATION

NONATHEROSCLEROTIC CAROTID ARTERY DISEASE

Carotid Artery Dissection

Carotid Artery Fibromuscular Dysplasia

Carotid Artery Aneurysms

Carotid Body Tumors

Carotid Trauma

VERTEBROBASILAR INSUFFICIENCY

Introduction

Clinical Findings

Pathogenesis

Initial Diagnostic Evaluation

Treatment

ATHEROSCLEROTIC BRACHIOCEPHALIC DISEASE

Introduction

Clinical Findings

Diagnostic Evaluation

Indications for Repair

Surgical Treatment

88 Upper Extremity Arterial Disease

INTRODUCTION

PRESENTATION

ETIOLOGY

HISTORY AND PHYSICAL EXAMINATION

LABORATORY AND NONINVASIVE TESTING

ANGIOGRAPHY

MANAGEMENT

CONCLUSIONS

89 Renal and Splanchnic Vascular Disease

SPLANCHNIC VASCULAR OCCLUSIVE AND ANEURYSMAL DISEASE

Introduction

Anatomy and Physiology

Acute Mesenteric Ischemia

Management of AMI

Chronic Mesenteric Ischemia

Management of CMI

Splanchnic Artery Aneurysms

RENAL ARTERY OCCLUSIVE AND ANEURYSMAL DISEASE

Introduction

Pathophysiology of Renovascular Hypertension

Renal Artery Occlusive Disease

Medical Management of Renovascular Hypertension

Surgical and Endovascular Management of Renal Artery Occlusive Disease

Renal Artery Aneurysm

90 Aortoiliac Occlusive Disease

INTRODUCTION

ETIOLOGY

Anatomy and Pathophysiology

PRESENTATION

Clinical Pathologic Types of Aortoiliac Disease

DIAGNOSIS

Noninvasive Vascular Testing

Differential Diagnosis

TREATMENT

Medical Therapy (Table 90.4)

Indications for Revascularization

Preintervention Imaging Studies

Preoperative Evaluation

Choice of Revascularization Technique

91 Peripheral Arterial Disease

INTRODUCTION AND EPIDEMIOLOGY

INFRAINGUINAL ARTERIAL OCCLUSIVE DISEASE

Risk Factors

Presentation and Natural History

Diagnosis

Medical Treatment

Indications for Revascularization

Approach to Revascularization

Endovascular Therapy

Operative Management

Autogenous Vein Bypass

Nonreversed Saphenous Vein Grafts

Prosthetic Bypass

Reoperative Bypass Surgery

Postreconstruction Management

Graft Failure and Surveillance

Complications

ACKNOWLEDGMENT

92 Lower Extremity Amputation

INTRODUCTION

INDICATIONS

EVALUATION FOR REVASCULARIZATION

CHOICE OF AMPUTATION LEVEL

General

Specific Situations

Energy Requirement

Clinical Assessment

OPERATIVE TECHNIQUE

General Considerations

Digital and Ray Amputations

Transmetatarsal Amputation

Syme Amputation

Below-Knee Amputation

Above-Knee Amputation

Hip Disarticulation

Cryoamputation

Other Lower Extremity Amputations

Wound Dressings

Complications

REHABILITATION AND PROSTHETIC MANAGEMENT

General Considerations

Specific Considerations

93 Thoracic and Thoracoabdominal Aorta: Aneurysm and Dissection

BACKGROUND

EPIDEMIOLOGY

PATHOGENESIS

CLINICAL MANIFESTATIONS

DIAGNOSTIC IMAGING

PREOPERATIVE EVALUATION

OPERATIVE TECHNIQUES

Elephant Trunk Technique for Extensive Aortic Aneurysms

POSTOPERATIVE MANAGEMENT

SURGICAL OUTCOMES

Neurologic Outcomes

Delayed Neurologic Deficits

Renal Failure

COMPLICATIONS

Elephant Trunk Technique

IMPACT OF AORTIC DISSECTION

ENDOVASCULAR REPAIR

Hybrid Repair

Parallel Grafts

Total Endovascular Repair

94 Abdominal Aortic Aneurysms

INTRODUCTION

DEFINITIONS AND CLASSIFICATIONS

MAGNITUDE OF THE PROBLEM

PATHOGENESIS AND RISK FACTORS

PRINCIPLES OF MANAGEMENT

CLINICAL PRESENTATION AND DIAGNOSIS

OPERATIVE INDICATIONS

CHOICE OF OPEN OR ENDOVASCULAR REPAIR

OPERATIVE REPAIR

Preoperative Evaluation

Open Repair of Intact Abdominal Aortic Aneurysms

Endovascular Repair of Intact Abdominal Aortic Aneurysms

REPAIR OF RUPTURED ABDOMINAL AORTIC ANEURYSMS

Open Repair

ENDOVASCULAR REPAIR FOR RUPTURE

ADDITIONAL CONSIDERATIONS

Isolated Iliac Artery Aneurysms

INFLAMMATORY ABDOMINAL AORTIC ANEURYSMS

Juxtarenal and Suprarenal Abdominal Aortic Aneurysms

Infected Abdominal Aortic Aneurysms

Aortoenteric Fistulae

Venous Anomalies Relevant to Aortic Surgery

Renal Anomalies

Coexistent Renal or Visceral Artery Occlusive Disease

Additional Concurrent Intra-Abdominal Disease

95 Lower Extremity Aneurysms

PERIPHERAL ANEURYSMS

Incidence

Pathogenesis

Clinical Manifestations

FEMORAL ARTERY ANEURYSMS

Degenerative (Atherosclerotic) Aneurysms

Anastomotic Pseudoaneurysms

Femoral Pseudoaneurysms

Mycotic Aneurysms

POPLITEAL ARTERY ANEURYSMS

Incidence

Pattern of Disease

Clinical Manifestations

Natural History

Diagnosis

Treatment

Surgical Technique

Results

96 Venous Disease

VENOUS THROMBOEMBOLISM

Incidence, Risk Factors, and Categories

Venous Thromboembolism Diagnosis

Pulmonary Embolism

Axillary/Subclavian Vein Thrombosis

Standard Therapy for VTE

Duration of Anticoagulation

Emerging Medical Treatments and Trends in VTE Managements

Calf Vein DVT

Nonpharmacologic Treatments

IVC Filters

Thrombolytic and Surgical Procedures for Deep VTE

Pulmonary Embolectomy

Superficial Thrombophlebitis

CHRONIC VENOUS DISEASE

Normal Venous Anatomy

Normal Venous Physiology

Prevalence and Impact

Pathophysiology and Etiology

Clinical Signs and Symptoms

Diagnostic Evaluation

Treatment Options and Results

SECTION N: PEDIATRIC SURGERY

97 Fetal, Pediatric, and Neonatal Physiology

INTRODUCTION

Fetal and Transitional Physiology

Neonatal Physiology

Pediatric Physiology

98 Fetal Intervention

INTRODUCTION

The Development of a New Surgical Subspecialty

CORE PRINCIPLES

FETAL SURGERY—KEY ELEMENTS LEADING TO SUCCESS OF FETAL SURGERY

Fetal Imaging

Prenatal Genetic Diagnosis

MATERNAL–FETAL RISKS

CURRENT FETAL CONDITIONS AMENABLE TO FETAL INTERVENTION

Twin-to-Twin Transfusion Syndrome

Rationale for Prenatal Treatment

Myelomeningocele aka Spina Bifida

Rationale for Prenatal Surgery

Congenital Diaphragmatic Hernia

Treatment Methods

Congenital Cardiac Lesions/Congenital Heart Defects

Rationale for Prenatal Intervention— Treatment Methods

Congenital Lung Lesions

Treatment Methods

Sacrococcygeal Teratoma

Rationale for Prenatal Surgery— Treatment Methods

Gastroschisis

Lower Urinary Tract Obstruction

Rationale for Fetal Treatment

Cervical Teratoma, Airways Masses, and EXIT Procedures

FUTURE DIRECTIONS

Fetal Molecular Therapies

In Utero Gene Therapy

In Utero Stem Cell Transplantation

Tissue Engineering

ACKNOWLEDGMENTS

99 Pediatric Head and Neck

INTRODUCTION

Imaging

Congenital

Infectious

Vascular Malformations

Airway

SUMMARY

100 Pediatric Chest

CHEST WALL DEFORMITIES

Embryology, Development, and Etiology of Chest Wall Deformities

Pectus Excavatum

Surgical Correction of the Pectus Excavatum

“Open” Operations

Minimally Invasive Repair/Nuss Procedure

Other Techniques

Pectus Carinatum

Poland Syndrome

Sternal Clefts

Jeune Asphyxiating Thoracic Dystrophy

The “Slipping Rib” Syndrome

“Flaring” of the Costal Margin

Costochondral “Tumor”

CONGENITAL LUNG LESIONS

Pulmonary Sequestration

Congenital Pulmonary Airway Malformations

Bronchogenic Cysts

Congenital Lobar Overinflation

Diagnosis

Cysts of the Mediastinum

Thymic Cysts

Enteric Duplication Cysts/Enterogenous Cysts

Lymphatic Malformations

Pericardial Cysts

THORACIC TUMORS IN CHILDREN

Metastatic Lung Tumors

Osteogenic Sarcoma

Soft Tissue Sarcomas

Wilms Tumor

Primary Lung Tumors

Bronchial Adenomas

Bronchogenic Carcinoma

Pleuropulmonary Blastoma

Other Malignant Tumors

Hamartoma

Mediastinal Tumors

Chest Wall Tumors

Respiratory Papillomatosis

ESOPHAGEAL ATRESIA/TRACHEOESOPHAGEAL FISTULA

Embryology

Classification

Incidence and Epidemiology

Clinical Findings, Diagnosis, and Pathophysiology

Associated Anomalies

Preoperative Management

Surgical Technique

Results, Complications, and Outcomes

OTHER CONGENITAL ANOMALIES OF THE TRACHEA AND ESOPHAGUS

Laryngotracheoesophageal Cleft and Tracheal Agenesis

Congenital Esophageal Stenosis

Esophageal Duplication

Vascular Rings

Congenital Tracheal Stenosis

FOREIGN BODIES OF THE TRACHEOBRONCHIAL TREE

Pathophysiology

Clinical Presentation

Management

CONGENITAL ABNORMALITIES OF THE DIAPHRAGM

Embryology of the Diaphragm

Congenital Diaphragmatic Hernia Pathology and Pathophysiology

Diagnosis

Prognostic Factors

Treatment

Surgery

Outcome

Evolving Therapies

Foramen of Morgagni Hernia

Eventration of the Diaphragm

Diaphragmatic Pacing

PLEURAL DISEASES

Empyema

Pneumothorax

Chylothorax

101 Pediatric Abdomen

ABDOMINAL WALL DEFECTS

Gastroschisis

Omphalocele

Umbilical Hernia

Inguinal Hernia and Hydrocele

Operative Considerations and Outcome

Hydrocele

GASTROINTESTINAL DISORDERS

Neonatal Intestinal Obstruction

Intestinal Atresia or Stenosis

Congenital Duodenal Obstruction

Anorectal Malformations (Imperforate Anus)

Necrotizing Enterocolitis

Complications, Results, and Outcome

Meconium Ileus

Meconium Plug Syndrome

Malrotation

Congenital Aganglionosis (Hirschsprung Disease)

OTHER CHILDHOOD GASTROINTESTINAL DISORDERS

Infantile Hypertrophic Pyloric Stenosis

Intussusception

Meckel Diverticulum and Related Disorders

Mesenteric and Omental Cysts

Primary Peritonitis

Ascites

Rectal Prolapse

PEDIATRIC LIVER

Tumors of the Liver

Liver Resection

Hepatic Infections

PEDIATRIC BILIARY TRACT

Embryology

Biliary Atresia

Congenital Choledochal Cystic Disease of the Biliary Tract

Pathophysiology

PEDIATRIC PANCREAS

Acute Pancreatitis

Pancreas Divisum

Pancreatic Cysts

Pancreatic Neoplasms

Endocrine Lesions of the Pancreas

102 Pediatric Genitourinary System

Fetal Development of Genitourinary System

ANOMALIES OF THE KIDNEY

Cystic Conditions of the Kidney

Solitary Kidney

3,4Anomalies of the Ureter

Ureteropelvic Junction Obstruction

Ureteral Duplication

Ectopic Ureter

Ureterocele

Megaureter

Vesicoureteral Reflux

BLADDER ANOMALIES

Urachal Abnormality

Exstrophy–Epispadias Complex

Anomalies of the Urethra

Posterior Urethral Valves

Hypospadias

Differences in Sex Development

Anomalies of the Penis and Prepuce

Anomalies of the Testicle and Scrotum

Undescended Testicle or Cryptorchidism

Torsion of Testicle and Appendages

Prepubertal Testicular Tumors

Varicocele

VAGINAL ANOMALIES

Labial Adhesions

Imperforate Hymen

Urogenital Sinus Anomalies

Prune-Belly Syndrome

Neurogenic Bladder

ACKNOWLEDGMENT

103 Childhood Tumors

INTRODUCTION

INCIDENCE OF CHILDHOOD SOLID TUMORS

NEUROBLASTOMA

Epidemiology and Genetic Risk

Pathology and Biologic Features

Presentation, Diagnosis, and Staging

Perinatal Neuroblastoma

Treatment

Future Directions

WILMS TUMOR

Epidemiology and Genetic Risk

Pathology and Biologic Features

Presentation, Diagnosis, and Staging

Treatment

Surgical Considerations

Renal Vein/Inferior Vena Cava

Bilateral Wilms Tumor

Partial Nephrectomy

Future Directions

NON-WILMS RENAL TUMORS

Congenital Mesoblastic Nephroma

Clear Cell Sarcoma

Rhabdoid Tumor of the Kidney

Renal Cell Carcinoma

RHABDOMYOSARCOMA

Epidemiology and Genetic Risk

Pathology and Biologic Features

Presentation and Diagnosis

Staging

Clinical Group Assessment and Risk Status

Treatment

Future Directions

NONRHABDOMYOSARCOMA SOFT TISSUE SARCOMA

Epidemiology

Pathology and Biologic Features

Presentation, Diagnosis, and Staging

Treatment

HEPATIC TUMORS

Hepatoblastoma

Hepatocellular Carcinoma

104 The Pregnant Patient

DEVELOPMENT OF THE FETUS

ANATOMY OF THE CHANGING UTERUS

PREMATURE ONSET OF LABOR

Tocolysis

MONITORING OF THE FETUS

Fetal Heart Rate

IMAGING THE PREGNANT PATIENT

Ionizing Radiation

Ultrasound

Computed Tomography

Magnetic Resonance Imaging

APPENDICITIS IN THE PREGNANT PATIENT

Imaging Modalities

Diagnostic Laparoscopy

Appendectomy

BILIARY TRACT DISEASE IN PREGNANCY

Choledocholithiasis

BREAST CANCER IN THE PREGNANT PATIENT

Surgical Management

Systemic Therapy

MANAGEMENT OF THE PREGNANT PATIENT WITH TRAUMA

Primary and Secondary Survey

Radiographic Assessment

Fetal Monitoring and Emergency Delivery

SECTION O: SKIN AND SOFT TISSUE

105 Cutaneous Malignancies

INTRODUCTION

MELANOMA

Etiology and Risk Factors

Clinical Diagnosis and Classification

Staging and Prognostic Factors

Microstaging

Clinical and Pathologic Staging

Other Prognostic Factors

Treatment of Primary Melanoma

Staging Workup

Excision of Primary Melanoma

Sentinel Lymph Node Biopsy

Treatment of Regional Metastatic Melanoma

Adjuvant Therapy

Treatment of In-Transit Disease

Treatment of Disseminated Melanoma

Surgery

Chemotherapy

High-Dose Interleukin-2

Immune Checkpoint Inhibitors

BRAF and MEK Inhibitors

The Impact of Treatment on Unresectable Metastatic Melanoma

NONMELANOMA SKIN CANCERS

Etiology

Basal Cell Carcinoma

Cutaneous Squamous Cell Carcinoma

Surgical Treatment of the Common Nonmelanoma Skin Cancers

Mohs Surgery

Adjuvant and Primary Radiation Therapy

Locally Advanced and Metastatic BCC

Locally Advanced and Metastatic SCC

Other Cutaneous Malignancies of Interest

106 Sarcomas of Soft Tissue and Bone

INTRODUCTION

EPIDEMIOLOGY

GENETIC CANCER SYNDROMES

SOFT TISSUE SARCOMAS

Clinical Presentation

Diagnosis

PATHOLOGIC CLASSIFICATION

Staging

TREATMENT

Principles of Surgery

Adjuvant and Neoadjuvant Therapy

Retroperitoneal and Intra-Abdominal Sarcomas

Recurrent or Metastatic Disease

Gastrointestinal Stromal Tumors

Desmoid Tumors/Desmoid Fibromatosis

CONCLUSIONS

107 Plastic and Reconstructive Surgery

MANAGEMENT OF THE PROBLEM WOUND

Wound Evaluation

The Treatment Paradigm for Wound Management

PEDIATRIC PLASTIC SURGERY

Congenital Anomalies

HAND AND UPPER EXTREMITY SURGERY

Nomenclature

Anatomy and Examination

Infection

Trauma

Complex Hand and Forearm Reconstruction

Congenital Anomalies

Acquired Conditions

PLASTIC SURGERY OF THE BREAST

Breast Characteristics

Reduction Mammoplasty

Preoperative Evaluation

Surgical Approaches

Mastopexy

Augmentation Mammoplasty

Preoperative Evaluation

Surgical Approaches

Postoperative Follow-Up

Gynecomastia Reduction

Preoperative Evaluation

Surgical Approaches

Postoperative Follow-Up

Breast Reconstruction

Preoperative Evaluation

Surgical Approaches

Postoperative Follow-Up

Transgender Surgery

Breast Implants

AESTHETIC SURGERY

Cosmetic Procedures for the Head and Neck

Cosmetic Procedures of the Trunk and Extremities (Body Sculpting)

NONSURGICAL AESTHETIC PROCEDURES

Minimally Invasive Procedures

Index

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An aparitie	01/07/2021
Autor	Justin B. Dimick MD
Dimensiuni	213 x 276 x 70 mm
Editura	LWW
Format	Hardcover
ISBN	9781975143169
Limba	Engleza
Nr pag	1984