- •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
Why do -adrenergic blockers work?
What is Proscar®?
Chapter 76 / Urology 755
1.Relax sphincter
2.Relax prostate capsule
Finasteride: 5- -reductase inhibitor; blocks transformation of testosterone to dihydrotestosterone; may shrink and slow progression of BPH
What is Hytrin®?
What are the indications for surgery in BPH?
Terazosin: -blocker; may increase urine outflow by relaxing prostatic smooth muscles
Due to obstruction:
Urinary retention
Hydronephrosis
UTIs
Severe symptoms
What is TURP?
What is TUIP?
What percentage of tissue removed for BPH will have malignant tissue on histology?
TransUrethral Resection of Prostate: resection of prostate tissue via a scope
TransUrethral Incision of Prostate
Up to 10%!
What are the possible |
Immediate: |
complications of TURP? |
Failure to void |
|
Bleeding |
|
Clot retention |
|
UTI |
|
Incontinence |
TESTICULAR CANCER
What is the incidence? Rare; 2 to 3 new cases per 100,000 men per year in the United States
What is its claim to fame? Most common solid tumor of young adult males (20 to 40 years)
What are the risk factors? Cryptorchidism (6% of testicular tumors develop in patients with a history of cryptorchidism)
756 Section III / Subspecialty Surgery |
|
What is cryptorchidism? |
Failure of the testicle to descend into the |
|
scrotum |
Does orchiopexy as an adult |
NO |
remove the risk of testicular |
|
cancer? |
|
What are the symptoms? |
Most patients present with a painless lump, |
|
swelling, or firmness of the testicle; they often |
|
notice it after incidental trauma to the groin |
What percentage of patients |
10% |
present with an acute |
|
hydrocele? |
|
What percentage present |
10% |
with symptoms of metastatic |
|
disease (back pain, anorexia)? |
|
What are the classifications? |
Germ cell tumors (95%): |
|
Seminomatous ( 35%) |
|
Nonseminomatous ( 65%) |
|
Embryonal cell carcinoma |
|
Teratoma |
|
Mixed cell |
|
Choriocarcinoma |
|
Nongerminal (5%): |
|
Leydig cell |
|
Sertoli cell |
|
Gonadoblastoma |
What is the major classification based on therapy?
What are the tumor markers for testicular tumors?
What are the tumor markers by tumor type?
Seminomatous and nonseminomatous tumors
1.Beta-human chorionic gonadotropin ( -HCG)
2.Alpha-fetoprotein (AFP)
-HCG—c in choriocarcinoma (100%), embryonal carcinoma (50%), and rarely in pure seminomas (10%); nonseminomatous tumors (50%)
AFP—c in embryonal carcinoma and yolk sac tumors; nonseminomatous tumors (50%)
Define the difference between seminomatous and NONseminomatous germ cell testicular tumor markers.
Which tumors almost never have an elevated AFP?
In which tumor is -HCG almost always found elevated?
How often is -HCG elevated in patients with pure seminoma?
How often is -HCG elevated with nonseminoma?
What other tumor markers may be elevated and useful for recurrence surveillance?
What are the steps in workup?
Define the stages according to TMN staging (AJCC):
Stage I?
Stage II?
Stage III?
What is the initial treatment for all testicular tumors?
What is the treatment of seminoma at the various stages:
Stage I and II?
Stage III?
Chapter 76 / Urology 757
NONseminomatous common 90% have a positive AFP and/or -HCG
Seminomatous rare only 10% are AFP positive
Choriocarcinoma and seminoma
Choriocarcinoma
Only about 10% of the time!
≈65%
LDH, CEA, Human Chorionic
Somatomammotropic (HCS),
Gamma-Glutamyl Transpeptidase (GGT),
PLacental Alkaline Phosphate (PLAP)
PE, scrotal U/S, check tumor markers, CXR, CT (chest/pelvis/abd)
Any tumor size, no nodes, no metastases
Positive nodes, no metastases, any tumor
Distant metastases (any nodal status, any size tumor)
Inguinal orchiectomy (removal of testicle through a groin incision)
Inguinal orchiectomy and radiation to retroperitoneal nodal basins
Orchiectomy and chemotherapy
758 Section III / Subspecialty Surgery |
|
What is the treatment of |
|
NONseminomatous disease |
|
at the various stages: |
|
Stages I and II? |
Orchiectomy and retroperitoneal lymph |
|
node dissection versus close follow-up |
|
for retroperitoneal nodal involvement |
Stage III? |
Orchiectomy and chemotherapy |
What percentage of stage I |
95% |
seminomas are cured after |
|
treatment? |
|
Which type is most radiosensitive?
Why not remove testis with cancer through a scrotal incision?
What is the major side effect of retroperitoneal lymph node dissection?
TESTICULAR TORSION
Seminoma (Think: Seminoma Sensitive to radiation)
It could result in tumor seeding of the scrotum
Erectile dysfunction
What is it? |
Torsion (twist) of the spermatic cord, |
|
resulting in venous outflow obstruction, |
|
and subsequent arterial occlusion S |
|
infarction of the testicle |
What is the classic history?
What is a “bell clapper” deformity?
Acute onset of scrotal pain usually after vigorous activity or minor trauma
Bilateral nonattachment of the testicles by the gubernaculum to the scrotum (free like the clappers of a bell)