- •Dedication
- •Editors and Contributors
- •Foreword
- •Preface
- •Contents
- •PREPARING FOR THE SURGERY CLERKSHIP
- •SURGICAL NOTES
- •COMMON ABBREVIATIONS YOU SHOULD KNOW
- •RETRACTORS (YOU WILL GET TO KNOW THEM WELL!)
- •SUTURE MATERIALS
- •WOUND CLOSURE
- •KNOTS AND EARS
- •INSTRUMENT TIE
- •TWO-HAND TIE
- •COMMON PROCEDURES
- •NASOGASTRIC TUBE (NGT) PROCEDURES
- •CHEST TUBES
- •NASOGASTRIC TUBES (NGT)
- •FOLEY CATHETER
- •CENTRAL LINES
- •MISCELLANEOUS
- •THIRD SPACING
- •COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
- •CALCULATION OF MAINTENANCE FLUIDS
- •ELECTROLYTE IMBALANCES
- •ANTIBIOTICS
- •STEROIDS
- •HEPARIN
- •WARFARIN (COUMADIN®)
- •MISCELLANEOUS AGENTS
- •NARCOTICS
- •MISCELLANEOUS
- •ATELECTASIS
- •POSTOPERATIVE RESPIRATORY FAILURE
- •PULMONARY EMBOLISM
- •ASPIRATION PNEUMONIA
- •GASTROINTESTINAL COMPLICATIONS
- •ENDOCRINE COMPLICATIONS
- •CARDIOVASCULAR COMPLICATIONS
- •MISCELLANEOUS
- •HYPOVOLEMIC SHOCK
- •SEPTIC SHOCK
- •CARDIOGENIC SHOCK
- •NEUROGENIC SHOCK
- •MISCELLANEOUS
- •URINARY TRACT INFECTION (UTI)
- •CENTRAL LINE INFECTIONS
- •WOUND INFECTION (SURGICAL SITE INFECTION)
- •NECROTIZING FASCIITIS
- •CLOSTRIDIAL MYOSITIS
- •SUPPURATIVE HIDRADENITIS
- •PSEUDOMEMBRANOUS COLITIS
- •PROPHYLACTIC ANTIBIOTICS
- •PAROTITIS
- •MISCELLANEOUS
- •CHEST
- •ABDOMEN
- •MALIGNANT HYPERTHERMIA
- •MISCELLANEOUS
- •OVERVIEW
- •CHOLECYSTOKININ (CCK)
- •SECRETIN
- •GASTRIN
- •SOMATOSTATIN
- •MISCELLANEOUS
- •GROIN HERNIAS
- •HERNIA REVIEW QUESTIONS
- •ESOPHAGEAL HIATAL HERNIAS
- •PRIMARY SURVEY
- •SECONDARY SURVEY
- •TRAUMA STUDIES
- •PENETRATING NECK INJURIES
- •MISCELLANEOUS TRAUMA FACTS
- •PEPTIC ULCER DISEASE (PUD)
- •DUODENAL ULCERS
- •GASTRIC ULCERS
- •PERFORATED PEPTIC ULCER
- •TYPES OF SURGERIES
- •STRESS GASTRITIS
- •MALLORY-WEISS SYNDROME
- •ESOPHAGEAL VARICEAL BLEEDING
- •BOERHAAVE’S SYNDROME
- •ANATOMY
- •GASTRIC PHYSIOLOGY
- •GASTROESOPHAGEAL REFLUX DISEASE (GERD)
- •GASTRIC CANCER
- •GIST
- •MALTOMA
- •GASTRIC VOLVULUS
- •SMALL BOWEL
- •APPENDICITIS
- •CLASSIC INTRAOPERATIVE QUESTIONS
- •APPENDICEAL TUMORS
- •SPECIFIC TYPES OF FISTULAS
- •ANATOMY
- •COLORECTAL CARCINOMA
- •COLONIC AND RECTAL POLYPS
- •POLYPOSIS SYNDROMES
- •DIVERTICULAR DISEASE OF THE COLON
- •ANATOMY
- •ANAL CANCER
- •ANATOMY
- •TUMORS OF THE LIVER
- •ABSCESSES OF THE LIVER
- •HEMOBILIA
- •ANATOMY
- •PHYSIOLOGY
- •PATHOPHYSIOLOGY
- •DIAGNOSTIC STUDIES
- •BILIARY SURGERY
- •OBSTRUCTIVE JAUNDICE
- •CHOLELITHIASIS
- •ACUTE CHOLECYSTITIS
- •ACUTE ACALCULOUS CHOLECYSTITIS
- •CHOLANGITIS
- •SCLEROSING CHOLANGITIS
- •GALLSTONE ILEUS
- •CARCINOMA OF THE GALLBLADDER
- •CHOLANGIOCARCINOMA
- •MISCELLANEOUS CONDITIONS
- •PANCREATITIS
- •PANCREATIC ABSCESS
- •PANCREATIC NECROSIS
- •PANCREATIC PSEUDOCYST
- •PANCREATIC CARCINOMA
- •MISCELLANEOUS
- •ANATOMY OF THE BREAST AND AXILLA
- •BREAST CANCER
- •DCIS
- •LCIS
- •MISCELLANEOUS
- •MALE BREAST CANCER
- •BENIGN BREAST DISEASE
- •CYSTOSARCOMA PHYLLODES
- •FIBROADENOMA
- •FIBROCYSTIC DISEASE
- •MASTITIS
- •BREAST ABSCESS
- •MALE GYNECOMASTIA
- •ADRENAL GLAND
- •ADDISON’S DISEASE
- •INSULINOMA
- •GLUCAGONOMA
- •SOMATOSTATINOMA
- •ZOLLINGER-ELLISON SYNDROME (ZES)
- •MULTIPLE ENDOCRINE NEOPLASIA
- •THYROID DISEASE
- •ANATOMY
- •PHYSIOLOGY
- •HYPERPARATHYROIDISM (HPTH)
- •PARATHYROID CARCINOMA
- •SOFT TISSUE SARCOMAS
- •LYMPHOMA
- •SQUAMOUS CELL CARCINOMA
- •BASAL CELL CARCINOMA
- •MISCELLANEOUS SKIN LESIONS
- •STAGING
- •INTENSIVE CARE UNIT (ICU) BASICS
- •INTENSIVE CARE UNIT FORMULAS AND TERMS YOU SHOULD KNOW
- •SICU DRUGS
- •INTENSIVE CARE PHYSIOLOGY
- •HEMODYNAMIC MONITORING
- •MECHANICAL VENTILATION
- •PERIPHERAL VASCULAR DISEASE
- •LOWER EXTREMITY AMPUTATIONS
- •ACUTE ARTERIAL OCCLUSION
- •ABDOMINAL AORTIC ANEURYSMS
- •MESENTERIC ISCHEMIA
- •MEDIAN ARCUATE LIGAMENT SYNDROME
- •CAROTID VASCULAR DISEASE
- •CLASSIC CEA INTRAOP QUESTIONS
- •SUBCLAVIAN STEAL SYNDROME
- •RENAL ARTERY STENOSIS
- •SPLENIC ARTERY ANEURYSM
- •POPLITEAL ARTERY ANEURYSM
- •MISCELLANEOUS
- •PEDIATRIC IV FLUIDS AND NUTRITION
- •PEDIATRIC BLOOD VOLUMES
- •FETAL CIRCULATION
- •ECMO
- •NECK
- •ASPIRATED FOREIGN BODY (FB)
- •CHEST
- •PULMONARY SEQUESTRATION
- •ABDOMEN
- •INGUINAL HERNIA
- •UMBILICAL HERNIA
- •GERD
- •CONGENITAL PYLORIC STENOSIS
- •DUODENAL ATRESIA
- •MECONIUM ILEUS
- •MECONIUM PERITONITIS
- •MECONIUM PLUG SYNDROME
- •ANORECTAL MALFORMATIONS
- •HIRSCHSPRUNG’S DISEASE
- •MALROTATION AND MIDGUT VOLVULUS
- •OMPHALOCELE
- •GASTROSCHISIS
- •POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
- •APPENDICITIS
- •INTUSSUSCEPTION
- •MECKEL’S DIVERTICULUM
- •NECROTIZING ENTEROCOLITIS
- •BILIARY TRACT
- •TUMORS
- •PEDIATRIC TRAUMA
- •OTHER PEDIATRIC SURGERY QUESTIONS
- •POWER REVIEW
- •WOUND HEALING
- •SKIN GRAFTS
- •FLAPS
- •SENSORY SUPPLY TO THE HAND
- •CARPAL TUNNEL SYNDROME
- •ANATOMY
- •MISCELLANEOUS
- •NOSE AND PARANASAL SINUSES
- •ORAL CAVITY AND PHARYNX
- •FACIAL FRACTURES
- •ENT WARD QUESTIONS
- •RAPID-FIRE REVIEW OF MOST COMMON CAUSES OF ENT INFECTIONS
- •THORACIC OUTLET SYNDROME (TOS)
- •CHEST WALL TUMORS
- •DISEASES OF THE PLEURA
- •DISEASES OF THE LUNGS
- •DISEASES OF THE MEDIASTINUM
- •DISEASES OF THE ESOPHAGUS
- •ACQUIRED HEART DISEASE
- •CONGENITAL HEART DISEASE
- •CARDIAC TUMORS
- •DISEASES OF THE GREAT VESSELS
- •MISCELLANEOUS
- •BASIC IMMUNOLOGY
- •CELLS
- •IMMUNOSUPPRESSION
- •OVERVIEW OF IMMUNOSUPPRESSION MECHANISMS
- •MATCHING OF DONOR AND RECIPIENT
- •REJECTION
- •ORGAN PRESERVATION
- •KIDNEY TRANSPLANT
- •LIVER TRANSPLANT
- •PANCREAS TRANSPLANT
- •HEART TRANSPLANT
- •INTESTINAL TRANSPLANTATION
- •LUNG TRANSPLANT
- •TRANSPLANT COMPLICATIONS
- •ORTHOPAEDIC TERMS
- •TRAUMA GENERAL PRINCIPLES
- •FRACTURES
- •ORTHOPAEDIC TRAUMA
- •DISLOCATIONS
- •THE KNEE
- •ACHILLES TENDON RUPTURE
- •ROTATOR CUFF
- •MISCELLANEOUS
- •ORTHOPAEDIC INFECTIONS
- •ORTHOPAEDIC TUMORS
- •ARTHRITIS
- •PEDIATRIC ORTHOPAEDICS
- •HEAD TRAUMA
- •SPINAL CORD TRAUMA
- •TUMORS
- •VASCULAR NEUROSURGERY
- •SPINE
- •PEDIATRIC NEUROSURGERY
- •SCROTAL ANATOMY
- •UROLOGIC DIFFERENTIAL DIAGNOSIS
- •RENAL CELL CARCINOMA (RCC)
- •BLADDER CANCER
- •PROSTATE CANCER
- •BENIGN PROSTATIC HYPERPLASIA
- •TESTICULAR CANCER
- •TESTICULAR TORSION
- •EPIDIDYMITIS
- •PRIAPISM
- •ERECTILE DYSFUNCTION
- •CALCULUS DISEASE
- •INCONTINENCE
- •URINARY TRACT INFECTION (UTI)
- •MISCELLANEOUS UROLOGY QUESTIONS
- •Rapid Fire Power Review
- •TOP 100 CLINICAL SURGICAL MICROVIGNETTES
- •Figure Credits
- •Index
|
Chapter 76 / Urology 747 |
BPH |
Benign Prostatic Hyperplasia |
Epispadias |
Abnormal urethral opening on the dorsal |
|
surface of the penis |
Hypospadiasis |
Abnormal urethral opening on the |
|
ventral surface of the penis; may occur in |
|
anterior, middle, or posterior of penis |
Erectile dysfunction |
Inability to achieve an erection |
Sterility |
Inability to reproduce |
Appendix testis |
Common redundant testicular tissue |
VUR |
VesicoUreteral Reflux |
SCROTAL ANATOMY
What are the layers of the scrotum?
Skin
Dartos
External
spermatic
fascia
Cremaster 
muscle
Internal
spermatic
fascia Parietal and visceral layers of tunica vaginalis
Tunica albuginea
UROLOGIC DIFFERENTIAL DIAGNOSIS
What is the differential |
Cancer, torsion, epididymitis, hydrocele, |
diagnosis of scrotal mass? |
spermatocele, varicocele, inguinal hernia, |
|
testicular appendage, swollen testicle after |
|
trauma, nontesticular tumor (paratesticular |
|
tumor: e.g., rhabdomyosarcoma, |
|
leiomyosarcoma, liposarcoma) |
748 Section III / Subspecialty Surgery
What are the causes of hematuria?
What is the most common cause of severe gross hematuria without trauma or chemotherapy/radiation?
Bladder cancer, trauma, UTI, cystitis from chemotherapy or radiation, stones, kidney lesion, BPH
Bladder cancer
What is the differential |
BPH, stone, foreign body, urethral |
diagnosis for bladder outlet |
stricture, urethral valve |
obstruction? |
|
What is the differential |
Stone, tumor, iatrogenic (suture), |
diagnosis for ureteral |
stricture, gravid uterus, radiation injury, |
obstruction? |
retroperitoneal fibrosis |
What is the differential |
Renal cell carcinoma, sarcoma, adenoma, |
diagnosis for kidney tumor? |
angiomyolipoma, hemangiopericytoma, |
|
oncocytoma |
RENAL CELL CARCINOMA (RCC) |
|
|
|
What is it? |
Most common solid renal tumor (90%); |
|
originates from proximal renal tubular |
|
epithelium |
What is the epidemiology? |
Primarily a tumor of adults 40 to 60 years |
|
of age with a 3:1 male:female ratio; 5% of |
|
cancers overall in adults |
What percentage of the |
1% |
tumors are bilateral? |
|
What are the risk factors? |
Male sex, tobacco, von Hippel-Lindau |
|
syndrome, polycystic kidney |
What are the symptoms? |
Pain (40%), hematuria (35%), weight loss |
|
(35%), flank mass (25%), HTN (20%) |
What is the classic TRIAD of |
1. Flank pain |
renal cell carcinoma? |
2. Hematuria |
|
3. Palpable mass (triad occurs in only |
|
10%–15% of cases) |
How are most cases diagnosed these days?
What radiologic tests are performed?
Define the stages (AJCC): Stage I?
Stage II?
Stage III?
Stage IV?
What is the metastatic workup?
What are the sites of metastases?
What is the unique route of spread?
What is the treatment of RCC?
What gland is removed with a radical nephrectomy?
What is the unique treatment for metastatic spread?
What is a syndrome of RCC and liver disease?
Chapter 76 / Urology 749
Found incidentally on an imaging study (CT, MRI, U/S) for another reason
1.IVP
2.Abdominal CT scan with contrast
Tumor 2.5 cm, no nodes, no metastases
Tumor 2.5 cm limited to kidney, no nodes, no metastases
Tumor extends into IVC or main renal vein; positive regional lymph nodes but2 cm in diameter and no metastases
Distant metastasis or positive lymph node2 cm in diameter, or tumor extends past Gerota’s fascia
CXR, IVP, CT scan, LFTs, calcium
Lung, liver, brain, bone; tumor thrombus entering renal vein or IVC is not uncommon
Tumor thrombus into IVC lumen
Radical nephrectomy (excision of the kidney and adrenal, including Gerota’s fascia) for stages I through IV
Adrenal gland
1.-interferon
2.LAK cells (lymphokine-activated killer) and IL-2 (interleukin-2)
Stauffer’s syndrome
750 Section III / Subspecialty Surgery
What is the concern in an Left RCC—the left gonadal vein drains adult with new onset left into the left renal vein
varicocele?
BLADDER CANCER
What is the incidence? Second most common urologic malignancy Male:female ratio of 3:1
White patients are more commonly affected than are African American patients
What is the most common histology?
What are the risk factors?
Transitional Cell Carcinoma (TCC)— 90%; remaining cases are squamous or adenocarcinomas
Smoking, industrial carcinogens (aromatic amines), schistosomiasis, truck drivers, petroleum workers, cyclophosphamide
What are the symptoms?
What is the classic presentation of bladder cancer?
What tests are included in the workup?
Define the AJCC transitional cell bladder cancer stages:
Stage 0?
Stage I?
Stage II?
Stage III?
Stage IV?
Hematuria, with or without irritative symptoms (e.g., dysuria), frequency
“Painless hematuria”
Urinalysis and culture, IVP, cystoscopy with cytology and biopsy
Superficial, carcinoma in situ
Invades subepithelial connective tissue, no positive nodes, no metastases
Invades superficial or deep muscularis propria, no positive nodes, no metastases
Invades perivesical tissues, no positive nodes, no metastases
Positive nodal spread with distant metastases and/or invades abdominal/ pelvic wall