- •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
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Chapter 76 / Urology 759 |
What are the symptoms? |
Pain in the scrotum, suprapubic pain |
What are the signs? |
Very tender, swollen, elevated testicle; |
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nonillumination; absence of cremasteric |
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reflex |
What is the differential |
Testicular trauma, inguinal hernia, |
diagnosis? |
epididymitis, appendage torsion |
How is the diagnosis made? |
Surgical exploration, U/S (solid mass) and |
|
Doppler flow study, cold Tc-99m scan |
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(nuclear study) |
What is the treatment?
How much time is available from the onset of symptoms to detorse the testicle?
What are the chances of testicle salvage after 24 hours?
EPIDIDYMITIS
Surgical detorsion and bilateral orchiopexy to the scrotum
6 hours will bring about the best results;90% salvage rate
10%
What is it?
What are the signs/symptoms?
What is the cause?
What are the common bugs in the following types of patients:
Elderly patients/children?
Young men?
What is the major differential diagnosis?
What is the workup?
Infection of the epididymis
Swollen, tender testicle; dysuria; scrotal ache/pain; fever; chills; scrotal mass
Bacteria from the urethra
Escherichia coli
STD bacteria: Gonorrhea, chlamydia
Testicular torsion
U/A, urine culture, swab if STD suspected,U/S with Doppler or nuclear study to rule out torsion
What is the treatment? |
Antibiotics |
760 Section III / Subspecialty Surgery
PRIAPISM
What is priapism? |
Persistent penile erection |
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What are its causes? |
Low flow: leukemia, drugs (e.g., prazosin), |
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sickle-cell disease, erectile dysfunction |
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treatment gone wrong |
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High flow: pudendal artery fistula, usually |
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from trauma |
What is first-line treatment? |
1. |
Aspiration of blood from corporus |
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cavernosum |
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2. |
-Adrenergic agent |
ERECTILE DYSFUNCTION |
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What is it? |
Inability to achieve an erection |
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What are the six major |
1. |
Vascular: decreased blood flow or |
causes? |
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leak of blood from the corpus |
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cavernosus (most common cause) |
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2. |
Endocrine: low testosterone |
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3. |
Anatomic: structural abnormality of |
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the erectile apparatus (e.g., Peyronie’s |
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disease) |
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4. |
Neurologic: damage to nerves (e.g., |
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postoperative, IDDM) |
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5. |
Medications (e.g., clonidine) |
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6. |
Psychologic: performance anxiety, |
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etc. (very rare) |
What lab tests should be |
Fasting GLC (rule out diabetes and thus |
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performed? |
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diabetic neuropathy) |
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Serum testosterone |
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Serum prolactin |
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CALCULUS DISEASE |
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What is the incidence? |
1 in 10 people will have stones |
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What are the risk factors? |
Poor fluid intake, IBD, hypercalcemia |
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(“CHIMPANZEES”), renal tubular |
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acidosis, small bowel bypass |
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What are the four types of stones?
What type of stones are not seen on AXR?
What stone is associated with UTIs?
What stones are seen in IBD/bowel bypass?
What are the symptoms of calculus disease?
What are the classic findings/symptoms?
Diagnosis?
What is the significance of hematuria and pyuria?
Treatment?
Chapter 76 / Urology 761
1.Calcium oxalate/calcium PO4 (75%)— secondary to hypercalciuria (c intestinal absorption, T renal reabsorption,
c bone reabsorption)
2.Struvite (MgAmPh)(15%)—infection stones; seen in UTI with urea-splitting bacteria (Proteus); may cause staghorn calculi; high urine pH
3.Uric acid (7%)—stones are radiolucent (Think: Uric Unseen); seen in gout, Lesch-Nyhan, chronic diarrhea, cancer; low urine pH
4.Cystine (1%)—genetic predisposition
Uric acid (Think: Uric Unseen)
Struvite stones (Think: Struvite Sepsis)
Calcium oxalate
Severe pain; patient cannot sit still: renal colic (typically pain in the kidney/ureter that radiates to the testis or penis), hematuria (remember, patients with peritoneal signs are motionless)
Flank pain, stone on AXR, hematuria
KUB (90% radiopaque), IVP, urinalysis and culture, BUN/Cr, CBC
Stone with concomitant infection
Narcotics for pain, vigorous hydration, observation
Further options: ESWL (lithotripsy), ureteroscopy, percutaneous lithotripsy, open surgery; metabolic workup for recurrence
762 Section III / Subspecialty Surgery |
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What are the indications for |
Urinary tract obstruction |
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intervention? |
Persistent infection |
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Impaired renal function |
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What are the |
Pregnancy, diabetes, obstruction, severe |
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contraindications of |
dehydration, severe pain, urosepsis/fever, |
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outpatient treatment? |
pyelonephritis, previous urologic surgery, |
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only one functioning kidney |
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What are the three common |
1. |
UreteroPelvic Junction (UPJ) |
sites of obstruction? |
2. |
UreteroVesicular Junction (UVJ) |
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3. |
Intersection of the ureter and the iliac |
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vessels |
INCONTINENCE
What are the common types of incontinence?
Define the following terms: Stress incontinence
Overflow incontinence
Urge incontinence
Mixed incontinence
Enuresis
How is the diagnosis made?
Stress incontinence, overflow incontinence, urge incontinence
Loss of urine associated with coughing, lifting, exercise, etc.; seen most often in women, secondary to relaxation of pelvic floor following multiple deliveries
Failure of the bladder to empty properly; may be caused by bladder outlet obstruction (BPH or stricture) or detrusor hypotonicity
Loss of urine secondary to detrusor instability in patients with stroke, dementia, Parkinson’s disease, etc.
Stress and urge incontinence combined
Bedwetting in children
History (including meds), physical examination (including pelvic/rectal examination), urinalysis, postvoid residual (PR), urodynamics, cystoscopy/ vesicocystourethrogram (VCUG) may
be necessary