Table Of ContentSurgery at a Glance
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Surgery at a Glance
Pierce A. Grace
MA, MCh, FRCSI, FRCS
Professor of Surgical Science
Graduate Entry Medical School
University Hospital Limerick
Limerick, Ireland
Neil R. Borley
FRCS, FRCS (Ed), MS
Consultant Colorectal Surgeon
Cheltenham General Hospital
Cheltenham, UK
Fifth edition
A John Wiley & Sons, Ltd., Publication
This edition first published 2013 © 2013 by John Wiley & Sons, Ltd.
Previous editions 1999, 2002, 2006, 2009
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Library of Congress Cataloging-in-Publication Data
Grace, P.A. (Pierce A.)
Surgery at a glance / Pierce Grace, Neil R.Borley. – 5th ed.
p. ; cm.
Includes bibliographic references and index.
ISBN 978-1-118-27220-6 (pbk.: alk.paper)
1. Borley, Neil R. 11. Title. [DNLM. 1. Surgical Procedures, Operative–Handbooks.
2. Diagnostic
Techniques and Procedures – Handbooks. WO 39]
617'.9—dc23
2012032718
Cover image: SCIENCE PHOTO LIBRARY © MAURO FERMARIELLO
Cover design by Meaden Creative
A catalogue record for this book is available from the British Library.
Set in Times 9/11.5 pt by Toppan Best-set Premedia Limited
1 2013
Contents
Preface 6 43 Gastro-oesophageal reflux disease 106
List of abbreviations 7 44 Oesophageal carcinoma 108
45 Peptic ulcer disease 110
Part 1 Clinical presentations at a glance 46 Gastric carcinoma 112
1 Neck lump 10 47 Malabsorption 114
2 Dysphagia 12 48 Crohn’s disease 116
3 Haemoptysis 14 49 Acute appendicitis 118
4 Breast lump 16 50 Diverticular disease 120
5 Breast pain 18 51 Ulcerative colitis 122
6 Nipple discharge 20 52 Colorectal carcinoma 124
7 Gastrointestinal bleeding 22 53 Benign anal and perianal disorders 126
8 Dyspepsia 26 54 Intestinal obstruction 128
9 Vomiting 28 55 Abdominal hernias 130
10 Acute abdominal pain 30 56 Gallstone disease 132
11 Chronic abdominal pain 32 57 Pancreatitis 136
12 Abdominal swellings (general) 34 58 Pancreatic tumours 138
13 Abdominal swellings (localized) – upper abdominal 36 59 Benign breast disease 140
14 Abdominal swellings (localized) – lower abdominal 40 60 Breast cancer 142
15 Jaundice 42 61 Goitre 144
16 Diarrhoea 44 62 Thyroid malignancies 146
17 Altered bowel habit/constipation 46 63 Parathyroid disease 148
18 Groin swellings 48 64 Pituitary disorders 150
19 Claudication 50 65 Adrenal disorders 152
20 Acute warm painful leg 52 66 Skin cancer 154
21 Acute ‘cold’ leg 54 67 Ischaemic heart disease 157
22 Leg ulceration 56 68 Valvular heart disease 160
23 Dysuria 58 69 Peripheral arterial disease 162
24 Urinary retention 60 70 The diabetic foot 164
25 Haematuria 62 71 Aneurysms 166
26 Scrotal swellings 64 72 Extracranial arterial disease 168
27 Stomas and incisions 66 73 Venous thromboembolism 170
74 Varicose veins 173
Part 2 Surgical diseases at a glance 75 Lymphoedema 176
28 Anaesthesia 68 76 Postoperative pulmonary complications 178
29 Hypoxia 72 77 Lung cancer 180
30 Surgical infection 74 78 Urinary tract infection 182
31 Sepsis 78 79 Benign prostatic hypertrophy 184
32 Systemic inflammatory response syndrome 80 80 Renal (urinary) calculi 186
33 Shock 82 81 Renal cell carcinoma 188
34 Acute renal failure 84 82 Carcinoma of the bladder 190
35 Fractures 86 83 Carcinoma of the prostate 192
36 Orthopaedics – congenital and childhood disorders 88 84 Testicular cancer 194
37 Orthopaedics – metabolic and infective disorders 90 85 Urinary incontinence 196
38 Arthritis 92 86 Solid organ transplantation 198
39 Musculoskeletal tumours 95 87 Paediatric ‘general’ surgery 200
40 Burns 98
41 Major trauma – basic principles 100 Index 204
42 Traumatic brain injury (head injury) 102
Companion website
Includes a companion website at:
www.testgeneralsurgery.com
Featuring:
– MCQs
– Short answer questions.
Contents 5
Preface
Surgery at a Glance continues to be a very popular text with medical from several people in putting this book together. We would like to
students and others who study surgery. In full colour, the book, in thank the many medical students and colleagues who have read the
keeping with the At a Glance series in general, has a very user-friendly book and given us good advice. Students seem to like this book par-
layout and is easy to read. A key feature of Surgery at a Glance is its ticularly for revision in preparation for exams. We especially thank
division into clinical presentations and surgical diseases. Thus, in one the publishing team and illustrators at Wiley-Blackwell for their hard
volume is combined the ways that patients present with surgical prob- work in bringing this beautifully presented book to completion. We
lems and the surgical diseases that underlie those presentations. Four- believe that the fifth edition of Surgery at a Glance is an excellent
teen years on we are delighted to present the revised and updated fifth book and we hope that this text will continue to help students under-
edition of Surgery at a Glance. The new edition contains some addi- stand surgery.
tions. In response to feedback from medical students we have added
four new chapters on orthopaedics as well as updating the text and Pierce A. Grace
illustrations throughout the book. The book retains its colour profile Neil R. Borley
and beautiful illustrations. We have had lots of help and suggestions 2013
6 Preface
List of abbreviations
AAA abdominal aortic aneurysm CEA carcinoembryonic antigen
AAT aspartate amino transferase CEA carotid endarterectomy
ABI ankle–brachial pressure index cfu colony forming units
Abs antibiotics CgA chromogranin A
ACE angiotensin converting enzyme CK creatinine kinase
Ach acetylcholine CLO Campylobacter-like organism
ACN acute cortical necrosis CMV cisplatin, methotrexate, vinblastine
ACS acute coronary syndrome CMV cytomegalovirus
ACTH adrenocorticotrophic hormone CNS central nervous system
ADH antidiuretic hormone COCP combined oral contraceptive pill
AF atrial fibrillation COPD chronic obstructive pulmonary disease
AFP α-fetoprotein COX cyclo-oxygenase
Ag antigen CPK-MB creatine phosphokinase (cardiac type)
AJCC American Joint Committee on Cancer CRC colorectal carcinoma
AKI acute kidney injury CRF chronic renal failure
Alb albumin CRP C-reactive protein
ALI acute lung injury CSF cerebrospinal fluid
ALND axillary lymph node dissection CT computed tomography
ANCA antineutrophil cytoplasmic antibody CTA computed tomographic angiogram
ANDI abnormalities of the normal development and CTCV congenital talipes calcaneo valgus
involution (of the breast) CVA cerebrovascular accident
AP angina pectoris CVI chronic venous insufficiency
AP anteroposterior CVP central venous pressure
APACHE acute physiology and chronic health evaluation CVS cardiovascular system
APTT activated partial thromboplastin time CXR chest X-ray
ARB angiotensin receptor blocker D type 2 dopaminergic receptors
2
ARDS adult/acute respiratory distress syndrome DCIS ductal carcinoma in situ
ARF acute renal failure DDAVP 1-desamino-8-arginine vasopressin
ASA American Society of Anesthesiologists (desmopressin)
ASCA anti-Saccharomyces cerevisiae antibodies DDH developmental dysplaia of the hip
ATN acute tubular necrosis DHEA dihydroepiandrosterone
AV arteriovenous DIC disseminated intravascular coagulation
BCC basal cell carcinoma DM diabetes mellitus
BCG bacillus Calmette–Guérin DMARDs disease-modifying antirheumatic drugs
b.d. twice daily DMSA dimercaptosuccinic acid
BDM bone mineral density DU duodenal ulcer
BE base excess DVT deep venous thrombosis
BEP bleomycin, etoposide, cisplatin Dx diagnosis
BMI body mass index DXA dual energy X-ray absorptiometry
BP blood pressure DXT deep X-ray therapy
BPH benign prostatic hypertrophy EAS external anal sphincter
BS breath sounds EBV Epstein–Barr virus
bx biopsy ECG electrocardiogram
C&S culture and sensitivity EMLA Eutetic Mixture of Local Anaesthetic
CABG coronary artery bypass graft ER oestrogen receptor
CAD coronary artery disease ERCP endoscopic retrograde cholangio-pancreatograph
cAMP cyclic adenosine monophosphate ESR erythrocyte sedimentation rate
CA-MRSA community-associated methicillin-resistant ESWL extracorporeal shock-wave lithotripsy
Staphylococcus aureus EUA examination under anaesthesia
CAS carotid angioplasty and stent EUS endoscopic ultrasound
CBD common bile duct FAP familial polyposis coli
CCF congestive cardiac failure FBC full blood count
CD Clostridium difficile FCD fibrocystic disease
CDH congenital dysplaia of the hip FFP fresh frozen plasma
CDI central diabetes insipidus FHx family history
List of abbreviations 7
FNAC fine-needle aspiration cytology LCA left coronary artery
FSH follicle-stimulating hormone LDH lactate dehydrogenase
5-FU 5-fluorouracil LDL low density lipoprotein
gFOBT guaiac faecal occult blood test LDUH low dose unfractionated heparin
γ-GT gamma glutamyl transpeptidase LFT liver function test
GA general anaesthetic LH luteinizing hormone
GC gemcitabine, cisplatin LHRH LH-releasing hormone
GCS Glasgow Coma Scale LIF left iliac fossa
GFR glomerular filtration rate LMWH low molecular weight heparin
GH growth hormone LOC loss of consciousness
GI gastrointestinal LOS lower oesophageal sphincter
GIST gastrointestinal stromal tumour LPS lipopolysaccharide
Gm+, Gm– Gram-positive, Gram-negative LRD living related donor
GORD gastro-oesophageal reflux disease LSE left sternal edge
GSF greater sciatica foramen LSF lesser sciatica foramen
GTN glyceryl trinitrate LSV long saphenous vein
GU gastric ulcer LUQ left upper quadrant
GU genito-urinary LURD living unrelated donor
GVHD graft-versus-host disease LUTS lower urinary tract symptoms
HALO haemorrhoidal artery ligation operation LV left ventricle
Hb haemoglobin LVF left ventricular failure
HCG human chorionic gonadotrophin MAG3 mercapto acetyl triglycine
β-HCG beta-human chorionic gonadotrophin MAP mean arterial pressure
Hct haematocrit MCP metacarpophalangeal
HCT hematopoietic cell transplantation MC+S microscopy cultures and sensitivity
HDL high density lipoprotein MDRO multidrug-resistant organisms
HDU high-dependency unit MDT multidisciplinary team
HER2/neu human epidermal growth factor receptor 2 MEAC minimum effective analgesic concentration
HIDA hepatabiliary imido-diacetic acid MEN multiple endocrine neoplasia
HLA human leucocyte antigen MI myocardial infarction
HNPCC hereditary non-polyposis colorectal cancer (Lynch MIBG meta-iodo-benzyl guanidine
syndrome) MM malignant melanoma
HoLEP holium laser enucleation of prostate MND motor neurone disease
hPTH human parathyroid hormone MODS multiple organ dysfunction syndrome
HRT hormone replacement therapy MRA magnetic resonance angiography
HVA homovanillic acid MRCP magnetic resonance cholangio-pancreatography
Hx history MRI magnetic resonance imaging
I&D incision and drainage MRSA methicillin-resistant Staphylococcus aureus
IBS irritable bowel syndrome MS multiple sclerosis
ICP intracranial pressure MSH melanocyte-stimulating hormone
ICS intercostal space MSU mid-stream urine
ICU intensive care unit MT major trauma
IFN-γ interferon gamma mTOR mammalian target of rapamycin
Ig immunoglobulin MTP metatarsophalangeal
IGF insulin-like growth factor MUGA multiple uptake gated analysis
IL interleukin MVAC methotrexate, vinblastine, doxorubicin (Adriamycin),
iNOS inducible nitric oxide synthetase cisplatin
INR international normalized ratio N&V nausea and vomiting
IPPV intermittent positive pressure ventilation NAdr noradrenaline/norepinephrine
IV intravenous NDI nephrogenic diabetes insipidus
IVC inferior vena cava NF-κB nuclear factor-κB
IVU intravenous urogram NG nasogastric
JGA juxtaglomerular apparatus NK natural killer
JVP jugular venous pulse NPO nil per oram (nil by mouth)
KUB kidney, ureter, bladder NSAID non-steroidal anti-inflammatory drug
LA local anaesthetic NSGCT non-seminomatous germ cell tumour
LAD left anterior descending NSTEMI non-ST elevation myocardial infarction
LATS long-acting thyroid stimulating (factor) NSU non-specific urethritis
LBO large bowel obstruction OA osteoarthritis
8 List of abbreviations
