- •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
542 Section III / Subspecialty Surgery
MECONIUM PERITONITIS
What is it? |
Sign of intrauterine bowel perforation; |
|
sterile meconium leads to an intense |
|
local inflammatory reaction with eventual |
|
formation of calcifications |
What are the signs? |
Calcifications on plain films |
MECONIUM PLUG SYNDROME
What is it?
What is it also known as?
What are the signs/ symptoms?
What is the nonoperative treatment?
What is the major differential diagnosis?
Is meconium plug highly associated with CF?
Colonic obstruction from unknown factors that dehydrate meconium, forming a “plug”
Neonatal small left colon syndrome
Abdominal distention and failure to pass meconium within first 24 hours of life; plain films demonstrate many loops of distended bowel and air-fluid levels
Contrast enema is both diagnostic and therapeutic; it demonstrates “microcolon” to the point of dilated colon (usually in transverse colon) and reveals copious intraluminal material
Hirschsprung’s disease
No; 5% of patients have CF, in contrast to meconium ileus, in which nearly all have CF (95%)
ANORECTAL MALFORMATIONS
What are they? |
Malformations of the distal GI tract in |
|
the general categories of anal atresia, |
|
imperforate anus, and rectal atresia |
IMPERFORATE ANUS |
|
|
|
What is it? |
Congenital absence of normal anus |
|
(complete absence or fistula) |
|
Chapter 67 / Pediatric Surgery 543 |
Define a “high” imperforate |
Rectum patent to level above |
anus. |
puborectalis sling |
Define “low” imperforate |
Rectum patent to below puborectalis |
anus. |
sling |
Which type is much more |
Low |
common in women? |
|
What are the associated |
Vertebral abnormalities, Anal abnormalities, |
anomalies? |
Cardiac, TE fistulas, Esophageal Atresia, |
|
Radial/Renal abnormalities, Lumbar |
|
abnormalities (VACTERL; most |
|
commonly TE fistula) |
What are the signs/ |
No anus, fistula to anal skin or bladder, |
symptoms? |
UTI, fistula to vagina or urethra, bowel |
|
obstruction, distended abdomen, |
|
hyperchloremic acidosis |
How is the diagnosis made?
What is the treatment of the following conditions:
Low imperforate anus with anal fistula?
High imperforate anus?
HIRSCHSPRUNG’S DISEASE
Physical exam, the classic Cross table “invertogram” plain x-ray to see level of rectal gas (not very accurate), perineal ultrasound
Dilatation of anal fistula and subsequent anoplasty
Diverting colostomy and mucous fistula; neoanus is usually made at 1 year of age
What is it also known as? |
Aganglionic megacolon |
What is it? |
Neurogenic form of intestinal obstruction |
|
in which obstruction results from |
|
inadequate relaxation and peristalsis; |
|
absence of normal ganglion cells of the |
|
rectum and colon |
What are the associated |
Family history; 5% chance of having a |
risks? |
second child with the affliction |
544 Section III / Subspecialty Surgery |
|
What is the male to female |
4:1 |
ratio? |
|
What is the anatomic |
Aganglionosis begins at the anorectal line |
location? |
and involves rectosigmoid in 80% of cases |
|
(10% have involvement to splenic flexure, |
|
and 10% have involvement of entire colon) |
What are the signs/ |
Abdominal distention and bilious vomiting; |
symptoms? |
95% present with failure to pass |
|
meconium in the first 24 hours; may also |
|
present later with constipation, diarrhea, |
|
and decreased growth |
What is the classic history? |
Failure to pass meconium in the first |
|
24 hours of life |
What is the differential |
Meconium plug syndrome, meconium |
diagnosis? |
ileus, sepsis with adynamic ileus, colonic |
|
neuronal dysplasia, hypothyroidism, |
|
maternal narcotic abuse, maternal |
|
hypermagnesemia (tocolysis) |
What imaging studies should |
AXR: reveals dilated colon |
be ordered? |
Unprepared barium enema: reveals |
|
constricted aganglionic segment |
|
with dilated proximal segment, but |
|
this picture may not develop for 3 to |
|
6 weeks; BE will also demonstrate |
|
retention of barium for 24 to 48 hours |
|
(normal evacuation 10 to 18 hours) |
What is needed for |
Rectal biopsy: for definitive diagnosis, |
definitive diagnosis? |
submucosal suction biopsy is adequate in |
|
90% of cases; otherwise, full-thickness |
|
biopsy should be performed to evaluate |
|
Auerbach’s plexus |
What is the “colonic |
Transition (taper) from aganglionic small |
transition zone”? |
colon into the large dilated normal colon |
|
seen on BE |
What is the initial |
In neonates, a colostomy proximal to the |
treatment? |
transition zone prior to correction, to allow |
|
for pelvic growth and dilated bowel to |
|
return to normal size |
Chapter 67 / Pediatric Surgery 545
What is a “leveling” Colostomy performed for Hirschsprung’s colostomy? disease at the level of normally innervated
ganglion cells as ascertained on frozen section intraoperatively
Describe the following procedures:
Swenson Primary anastomosis between the anal canal and healthy bowel (rectum removed)
Duhamel |
Anterior, aganglionic region of the |
|
rectum is preserved and anastomosed to |
|
a posterior portion of healthy bowel; a |
|
functional rectal pouch is thereby created |
|
(Think: duha dual barrels side by side) |
7
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“Dual barrels”