- •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 751 |
What is the treatment |
|
according to stage: |
|
Stage 0? |
TURB and intravesical chemotherapy |
Stage I? |
TURB |
Stages II and III? |
Radical cystectomy, lymph node |
|
dissection, removal of prostate/uterus/ |
|
ovaries/anterior vaginal wall, and urinary |
|
diversion (e.g., ileal conduit) chemo |
Stage IV?
What are the indications for a partial cystectomy?
What is TURB?
If after a TURB the tumor recurs, then what?
What is and how does bacillus Calmette-Guérin work?
PROSTATE CANCER
Cystectomy and systemic chemotherapy
Superficial, isolated tumor, apical with 3-cm margin from any orifices
TransUrethral Resection of the Bladder
Repeat TURB and intravesical chemotherapy (mitomycin C) or bacillus Calmette-Guérin
Attenuated TB vaccine—thought to work by immune response
What is the incidence? |
Most common GU cancer ( 100,000 |
|
new cases per year in the United States); |
|
most common carcinoma in men in the |
|
U.S.; second most common cause of death |
|
in men in the U.S. |
What is the epidemiology? |
“Disease of elderly men” present in |
|
33% of men 70 to 79 years of age and in |
|
66% of men 80 to 89 years of age at |
|
autopsy; African American patients have |
|
a 50% higher incidence than do white |
|
patients |
What is the histology? |
Adenocarcinoma (95%) |
752 Section III / Subspecialty Surgery |
|
What are the symptoms? |
Often asymptomatic; usually presents |
|
as a nodule found on routine rectal |
|
examination; in 70% of cases, cancer |
|
begins in the periphery of the gland |
|
and moves centrally; thus, obstructive |
|
symptoms occur late |
What percentage of patients |
40% of patients have metastatic disease |
have metastasis at diagnosis? |
at presentation, with symptoms of bone |
|
pain and weight loss |
What are the common sites |
Osteoblastic bony lesions, lung, liver, |
of metastasis? |
adrenal |
What provides lymphatic |
Obturator and hypogastric nodes |
drainage? |
|
What is the significance of |
Spinal cord venous plexus; route of |
Batson’s plexus? |
isolated skull/brain metastasis |
What are the steps in early |
1. Prostate-specific antigen (PSA)—most |
detection? |
sensitive and specific marker |
|
2. Digital rectal examination (DRE) |
When should men get a |
Controversial: |
PSA-level check? |
1. All men 50 years old |
|
2. 40 years old if first-degree family |
|
history or African American patient |
What percentage of patients |
60% |
with prostate cancer will |
|
have an elevated PSA? |
|
What is the imaging test for bladder cancer?
How is the diagnosis made?
What is the Gleason score?
What are the indications for transrectal biopsy with normal rectal examination?
TransRectal UltraSound (TRUS)
Transrectal biopsy
Histologic grades 2–10:
Low score well differentiated High score poorly differentiated
PSA 10 or abnormal transrectal ultrasound
|
Chapter 76 / Urology 753 |
Staging (AJCC): |
|
Stage I? |
Tumor involves 50% of 1 lobe, no nodes, |
|
no metastases, PSA 10, Gleason 6 |
Stage II? |
Tumor within prostate; lobe 50% but |
|
PSA 10, or Gleason 6; or 50% of |
|
1 lobe, no nodes, no metastases |
Stage III? |
Tumor through prostate capsule or into |
|
seminal vesicles, no nodes, no metastases |
Stage IV? |
Tumor extends into adjacent structures |
|
(other than seminal vesicles) or nodes |
|
or metastases |
What does a “radical prostatectomy” remove?
What is “androgen ablation” therapy?
How do LHRH agonists work?
What are the generalized treatment options according to stage:
Stage I?
Stage II?
Stage III?
Stage IV?
What is the medical treatment for systemic metastatic disease?
1.Prostate gland
2.Seminal vesicles
3.Ampullae of the vasa deferentia
1.Bilateral orchiectomy or
2.Luteinizing Hormone-Releasing Hormone (LHRH) agonists
Decrease LH release from pituitary, which then decreases testosterone production in the testes
Radical prostatectomy
Radical prostatectomy, lymph node dissection
Radiation therapy, androgen ablation
Androgen ablation, radiation therapy
Androgen ablation
754 Section III / Subspecialty Surgery |
|
What is the option for |
XRT |
treatment in the early stage |
|
prostate cancer patient 70 |
|
years old with comorbidity? |
|
BENIGN PROSTATIC HYPERPLASIA
What is it also known as?
What is it?
What is the size of a normal prostate?
Where does BPH occur?
What are the symptoms?
How is the diagnosis made?
What lab tests should be performed?
What is the differential diagnosis?
What are the treatment options?
BPH
Disease of elderly men (average age is 60 to 65 years); prostate gradually enlarges, creating symptoms of urinary outflow obstruction
20 to 25 gm
Periurethrally
(Note: prostate cancer occurs in the periphery of the gland)
Obstructive-type symptoms: hesitancy, weak stream, nocturia, intermittency, UTI, urinary retention
History, DRE, elevated PostVoid Residual (PVR), urinalysis, cystoscopy, U/S
Urinalysis, PSA, BUN, CR
Prostate cancer (e.g., nodular)—biopsy Neurogenic bladder—history of
neurologic disease
Acute prostatitis—hot, tender gland Urethral stricture—RUG, history of STD Stone
UTI
Pharmacologic— -1 blockade Hormonal—antiandrogens Surgical—TURP, TUIP, open prostate
resection
Transurethral balloon dilation