Table Of ContentClinical Sciences Review for Medical Licensure
Developed at
The University ofOklahoma College of Medicine
Ronald S. Krug, Series Editor
Suitable Review for:
United States Medical Licensing Examination
(USMLE), Step 2
Springer
NewYork
Berlin
Heidelberg
Barcelona
Budapest
HongKong
London
Milan
Paris
Santa Clara
Singapore
Tokyo
General
Surgery
Second Edition
M. Alex Jacocks
Rita R. Claudet
Technical Editor
Springer
M. AlexJacocks, M.D.
Department ofSurgery
Health SciencesCenter
The UniversityofOklahoma College ofMedicine
Oklahoma City, OK 73190
USA
LibraryofCongressCataloging-in-Publication
Jacocks, M. Alex.
Generalsurgery/M. Alex Jacocks. - 2nded.
p. em. - (Oklahoma notes)
Includesbibliographical references.
ISBN-13:978-0-387-94637-5 e-ISBN-13:978-1-4612-2372-6
DOl:10.1007/978-1-4612-2372-6
1. Surgery-Outlines, syllabi, etc. 2. Surgery-Examinations,
questions, etc. I. Title. II. Series.
[DNLM: 1. Surgery-outlines. 2. Surgery-examinationquestions.
WO 18.2J17g 1996]
RD37.3.J3 1996
617.9-dc20
DNLMIDLC
for LibraryofCongress 96-13052
Printedonacid-free paper.
© 1996,1993 Springer-Verlag New York, Inc.
All rights reserved. This work may not betranslated orcopied in whole or in part without
thewrittenpermissionofthe publisher(Springer-Verlag NewYork, Inc., 175FifthAvenue,
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scholarly analysis. Use in connection with any form of information storage and retrieval,
electronic adaptation, computer software, or by similar or dissimilar methodology now
known orhereafterdeveloped isforbidden.
The use of general descriptive names, trade names, trademarks, etc., in this publication,
even if the former are not especially identified, are not to be taken as a sign that such
names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly
be used freelybyanyone.
While the advice and information in this book is believed to be true and accurate at the
date ofgoingto press, neitherthe authors northe editors northepublishercan acceptany
legal responsibilityfor anyerrors oromissionsthatmaybe made. The publisher makes no
warranty, expressorimplied,with respecttothe materialcontainedherein.
ProductionmanagedbyRobertWexler; manufacturingsupervisedbyJoe Quatela.
Camera-readycopypreparedbytheauthor.
9 8 7 654 3 2 1
ISBN-13:978-0-387-94637-5 Springer-Verlag NewYork Berlin Heidelberg SPIN 10522842
Preface to the Oklahoma Notes
The intent of the Oklahoma Notes is to provide students with a set of texts that
present the basic information ofthe general medical school curriculum in such a
manner that the content is clear, concise and canbe readily absorbed.
The basic outline format that has made the Oklahoma Notes extremely popular
when preparing for standardized examinations has been retained in all the texts.
The educational goals for these materials are first to help organizethinking about
given categories of information, and second, to present the information in a for
matthatassistsinlearning. Theinformationthatstudents retainbestis that which
has been repeated often, and has been actively recalled. The outline format has
always been used in the Oklahoma Notes because students have reported to us
that it allows them to cover subsequent parts of the outline, and use the topic
heading as a trigger to recall the information under the heading. They then can
uncover the material and ascertain whether they have recalled the information
correctly.
This second edition of the Clinical Series of the Oklahoma Notes represents a
major refinement ofthe first editions. A number ofissues have been addressed to
make the texts more efficient, effective and "userfriendly." These include:
• Correction oftechnical errors.
• Addition of new material that has been reported since the first editions were
published.
• Standardpresentationofmaterials in alltextsto make information moreacces
sibleto the student.
• Review questions written in standardized format. These questions reflect the
majorissues ofthe sections ofthe texts.
We hope these are helpfulto you in your educational progress and preparation for
required examinations.
Ronald S. Krug, Ph.D.
Series Editor
Preface for Second Edition
Each chapter of this revision has been carefully reviewed for accuracy and up
dated as new information has been woven into clinical practice. While doing so,
we have tried to maintain brevity and relevance. It covers concepts and details
that most educators and practicing physicians feel finishing medical students
should grasp. Additionally, study questions have been added to help the student
assesshis own masteryofthe material.
As in the previous edition. this text is intended to help you study for boards and
as such is not a comprehensive textbook of surgery. We have again used the
relevantlearning objectives ofthe Association ofSurgical Education as a basis for
the materialcovered. Wehope itwillhelpguide your review ofpreviouslylearned
material.
Acknowledgments
I would like to acknowledge the tremendous amount of work put into this effort
by other peopleonthe staffat the University ofOklahomaCollege ofMedicine, in
particular, Ms. Judy Wheeler for her tremendous hours at organizing and typing
this material. Dr. Rita Claudet has provided editing expertise, as well as inspira
tion toward completion of this revision, that have added to its accuracy and
versatility.
Contents
Prefaceto the Oklahoma Notes . v
Preface for Second Edition .. vii
Acknowledgments . ix
Chapter1 Fluids, Electrolytes, Nutrition . 1
Basic principles . 1
The normal fluids and electrolytes and their maintenance . 1
Abnormalities . 4
Nutrition . 10
Chapter2 Shock . 13
Introduction . 13
Hypovolemic shock . 14
Cardiogenic shock . 15
Septic shock . 16
Neurogenic shock . 17
Chapter3 Clotting Disorders and UseofBlood Products . 19
Clotting disorders .. 19
Blood replacement therapy . 22
Chapter4 Surgical Infections .. 25
Classification ofsurgical wounds .. 25
Pathogenesis ofinfection . 25
Prevention ofsurgical infection . 25
Communityacquired infections . 26
Hospital acquired infection . 28
Chapter5 MultipleTrauma . 31
Primarysurvey-ABCDE . 31
Secondarysurvey .. 32
Chapter6 Burns . 39
Types and classification ofburn injuries . 39
Treatment . 40
Chapter 7 Wound Healing . 42
Pathophysiology . 42
Classification ofwounds 44
xii Contents
Use ofprophylactic antibiotics 45
Wound care 45
Chapter8 Acute Abdominal Pain 48
General aspects 48
Acuteappendicitis 48
Pelvic inflammatory disease 49
Ectopic pregnancy 49
Biliarydisease 49
Acute pancreatitis 51
Perforated duodenal ulcer 51
Acute diverticulitis 52
Smallbowelobstruction (SBO) 52
Genitourinary problems 53
Chapter9 Esophagus 54
Anatomic points ofinterest 54
Physiology 54
Pathology 55
Chapter10 Stomach 58
Anatomy 58
Physiology 58
Diagnostic tools 59
Peptic ulcerdisease 60
Gastric ulcer disease 61
Post-gastrectomy syndromes 62
Gastric cancer 63
Chapter11 Small Bowel 65
Anatomy 65
Physiology 65
Crohn's Disease 66
Smallbowel obstruction 68
Diverticulardisease 69
Smallbowel neoplasms 70
Chapter12 Appendix 71
Inflammation 71
Neoplasias 72
Chaper13 Colon 74
Introduction 74
Neoplastic diseases 74
Diverticular disease 77
Inflammatoryboweldisease 77
Large bowel obstruction 79
LowerGI hemorrhage 79
Chapter14 Rectum and Anus 81
Rectum andanus 81
Anus 81
Chapter15 Gallbladderand Biliary System 84
Anatomy 84
Contents xiii
Physiology 84
Congential problems 84
Calculus associated illnesses 85
Cancer 88
Chapter16 Liver 90
Anatomy 90
Physiology 90
Congenitalabnormalities 90
Inflammatory problems 91
Portalhypertension 92
Neoplasias 94
Chapter17 Pancreas 96
Anatomy 96
Physiology 96
Inflammatory conditions 96
Neoplasia 98
Chapter18 Spleen 101
Anatomy...................... 101
Function 101
Splenic removal 102
Other 103
Chapter19 Gastrointestinal Hemorrhage 104
UpperGI bleeding 104
LowerGI bleeding 106
GI hemorrhage in infants and children 108
Chapter20 Hernias 109
Groin hernias 109
Otherhernias 110
Chapter21 Breast 112
Anatomy/Physiology . 112
Evaluation 112
Benignconditions 113
Malignantconditions .. 114
Chapter22 VascularSystem 118
Atherosclerotic peripheralarterialdisease 118
Venous Disease 125
Lymphatic disorders 126
Chapter23 Heart 128
Congenital disease 128
Acquiredcardiac disease 132
Pacemakers 135
Chapter24 Lung and Mediastinum 136
Pulmonary functions 136
Lungcancer 138
