Surgical Recall, 8th Edition

SURGICAL RECALL Eighth Edition Recall Series Editor and Senior Editor Lorne H Blackbourne, M.D., F.A.C.S Trauma, Surgical Critical Care Round Rock, Texas “In the operating room we can save more lives, cure more cancer, restore more function, and relieve more suffering than anywhere else in the hospital.” —R Scott Jones, M.D Acquisitions Editor: Matt Hauber Development Editors: Andrea Vosburgh and Kelly Horvath Editorial Coordinator: Annette Ferran Marketing Manager: Mike McMahon Manufacturing Manager: Margie Orzech Design Coordinator: Terry Mallon Art Director: Jennifer Clements Compositor: Aptara, Inc Eighth Edition Copyright 2018 Wolters Kluwer Copyright 2015, 2008, 2004, 1997 Lippincott Williams & Wilkins, a Wolters Kluwer business Two Commerce Square 351 West Camden Street 2001 Market Street Baltimore, MD 21201 Philadelphia, PA 19103 USA Printed in China All rights reserved This book is protected by copyright No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the abovementioned copyright To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via website at lww.com (products and services) 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Names: Blackbourne, Lorne H., editor Title: Surgical recall / Recall series editor and senior editor, Lorne H Blackbourne Other titles: Recall series Description: Eighth edition | Philadelphia : Wolters Kluwer, [2017] | Series: Recall series | Includes bibliographical references and index Identifiers: LCCN 2017040695 | ISBN 978-1-4963-7106-5 Subjects: | MESH: Surgical Procedures, Operative | Examination Questions Classification: LCC RD37.2 | NLM WO 18.2 | DDC 617.0076—dc23 LC record available at https://lccn.loc.gov/2017040695 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 AM to 6:00 PM, EST Dedication T his book is dedicated to the memory of Leslie E Rudolf, Professor of Surgery and Vice-Chairman of the Department of Surgery at the University of Virginia Dr Rudolf was born on November 12, 1927, in New Rochelle, New York He served in the U.S Army Counter-Intelligence Corps in Europe after World War II He graduated from Union College in 1951 and attended Cornell Medical College, where he graduated in 1955 He then entered his surgical residency at Peter Brigham Hospital in Boston, Massachusetts, and completed his residency there, serving as Chief Resident Surgeon in 1961 Dr Rudolf came to Charlottesville, Virginia as an Assistant Professor of Surgery in 1963 He rapidly rose through the ranks, becoming Professor of Surgery and Vice-Chairman of the Department in 1974 and a Markle Scholar in Academic Medicine from 1966 until 1971 His research interests included organ and tissue transplantation and preservation Dr Rudolf was instrumental in initiating the Kidney Transplant Program at the University of Virginia Health Sciences Center His active involvement in service to the Charlottesville community is particularly exemplified by his early work with the Charlottesville/Albemarle Rescue Squad, and he received the Governor’s Citation for the Commonwealth of Virginia Emergency Medical Services in 1980 His colleagues at the University of Virginia Health Sciences Center, including faculty and residents, recognized his keen interests in teaching medical students, evaluating and teaching residents, and helping the young surgical faculty He took a serious interest in medical student education, and he would have strongly approved of this teaching manual, affectionately known as the “Rudolf” guide, as an extension of ward rounds and textbook reading In addition to his distinguished academic accomplishments, Dr Rudolf was a talented person with many diverse scholarly pursuits and hobbies His advice and counsel on topics ranging from Chinese cooking to orchid raising were sought by a wide spectrum of friends and admirers This book is a logical extension of Dr Rudolf’s interests in teaching No one book, operation, or set of rounds can begin to answer all questions of surgical disease processes; however, in a constellation of learning endeavors, this effort would certainly have pleased him John B Hanks, M.D Professor of Surgery University of Virginia Charlottesville, Virginia Editors SENIOR EDITOR Lorne H Blackbourne, M.D., F.A.C.S Trauma, Surgical Critical Care Round Rock, Texas EDITOR Ramon F Cestero, M.D., F.A.C.S., F.C.C.M Associate Professor of Surgery Fellowship Program Director Trauma Surgery and Surgical Critical Care Medical Director Surgical ICU University of Texas Health San Antonio San Antonio, Texas Preface T his edition of Surgical Recall has been reengineered and distilled even further to allow optimal performance on BOTH the shelf exam and the wards We have added Rapid-Fire “microvignettes” throughout the text so you can test your knowledge and also get familiar with finding the words in every vignette that are the key to unraveling the puzzle they hold The formula for success on the shelf exam is simple: Disease Information (raw data facts) × Disease Recognition in a Vignette = SUCCESS on the SHELF exam The formula for success on the wards is also straightforward: Clinical Care Knowledge × Performance = Optimal WARD SUCCESS This text is unique in that it holds the knowledge in a very concise manner— in a self-study, right-and-left-column format—to excel on both the Wards and the Shelf exam Lorne H Blackbourne, M.D., F.A.C.S Trauma, Surgical Critical Care Round Rock, Texas Figure Credits Chapter 9 (carotid endarterectomy) Lawrence PF, Bell RM, Dayton MT Essentials of General Surgery 5th ed Philadelphia, PA: Wolters Kluwer; 2012:545 Chapter 13 (Nissen) Jarrell BE NMS Surgery 6th ed Baltimore, MD: Wolters Kluwer; 2016 Chapter 13 (Lap Nissen) Jarrell BE NMS Surgery 6th ed Baltimore, MD: Wolters Kluwer; 2016 Chapter 13 (Heineke–Mikulicz pyloroplasty) Mulholland MW Greenfield’s Surgery 6th ed Baltimore, MD: Wolters Kluwer; 2016 Chapter 13 (Pringle maneuver) Blackbourne LH Advanced Surgical Recall 4th ed Baltimore, MD: Wolters Kluwer; 2015 Chapter 13 (percutaneous endoscopic gastrostomy) Blackbourne LH Advanced Surgical Recall 4th ed Baltimore, MD: Wolters Kluwer; 2015 Chapter 15 (suprapubic catheter) Carter P Lippincott Textbook for Nursing Assistants Philadelphia, PA: Wolters Kluwer; 2015 Chapter 17 (causes of hypercalcemia mnemonic) Blackbourne LH Advanced Surgical Recall 4th ed Baltimore, MD: Wolters Kluwer; 2015 Chapter 37 (cricothyroidotomy) Britt LD, Peitzman A, Barie P Acute Care Surgery Baltimore, MD: Wolters Silver sulfadiazine (Silvadene), 170 Sitz bath, 228 Skin flora, surgical prophylaxis for, 85 Skin grafts, 405 Skin lesions basal cell carcinoma, 333 miscellaneous skin lesions, 333–334 squamous cell carcinoma, 332–333 Skull fracture, 518 Sleeve gastrectomy, 189, 189f Sliding hernia, 137, 137f Sliding hiatal hernias, 145, 145f Slipped capital femoral epiphysis, 511, 511f Small bowel, 65 anatomy, 193 daily secretion, 69 Meckel’s diverticulum, 196–197, 196f nutritional source, 131 obstruction, 121, 193–195, 194f submucosa of, 65 tumors, 196 vs colon, 65, 211 Small bowel obstruction (SBO), 121, 193–195, 194f in adults, 10 with carcinoid, 203 in children, 10 Smith’s fracture, 495 Smoking, 119 Sodium Nitroprusside (SNP), 342 Soft tissue sarcomas, 330–332 and lymphoma, 332 types, 330 Somatostatin, 131, 249 Somatostatinoma, 277, 303 Sphincterotomy, 256 Spider bite, 164, 164f Spigelian hernia, 137 Spinal anesthesia, 124 Spinal cord trauma, 518 Spinal epidural abscess, 525 Spinal immobilization, 149 Spinal shock, 110, 518 Spine cervical disc disease, 525 lumbar disc herniation, 524 spinal epidural abscess, 525 Spironolactone, 301 Spleen delayed splenic rupture, 327 functions of, 327 ruptured/injured, 327 and splenectomy, 326–330 splenic artery, 326, 326f venous drainage of, 327 Splenectomy, 327–330 complications for, 328 indications for, 327–328 Splenic artery aneurysm, 363 Splenomegaly, 329 Splenorrhaphy, 327 Split-thickness skin graft (STSG), 166 allograft, 168 autograft, 168 thickness, 168 Spurling’s sign, 525 Squamous cell carcinoma, 332–333 Stanford classifications, 471 Staple removal, 24f, 32, 32f Steri-Strips, placement of, 32, 32f Steroids, 85 Stick tie See Sutures ligature Stitch Connell’s, 25, 25f Lambert, 25, 25f removal of, 32 simple interrupted, 22, 22f simple running (continuous), 23, 23f subcuticular, 23, 23f vertical mattress, 23, 23f “Stitch” abscess, 116 Stoma, 191 Stomach, 182–188 gastric cancer, 185–187, 186f gastric physiology, 182 gastric volvulus, 188 gastroesophageal reflux disease, 182–184, 184f gastrointestinal stromal tumor, 187 MALToma, 187–188 Stress gastritis, 179 Stress incontinence, 540 Stridor, 371 Stroke, 97 Subarachnoid hemorrhage (SAH), 523 Subclavian steal syndrome, 362 Subcuticular stitch, 23, 23f Subdural hematoma, 517 Subluxation, 491 Submucosa, 65 Subtotal gastrectomy, 186, 186f Succinylcholine, 127 Sucking chest wound, 150 Sugammadex, 126 Sulfamethoxazole-trimethoprim, 84 Sump pump, 61, 61f Superficial burns, 166, 167, 168 Superficial spreading melanoma, 335 Superinfection, 111 Superior laryngeal nerve, 311 Superior mesenteric artery (SMA) syndrome, 194 Superior vena cava (SVC) syndrome, 10 Supination, 489 Supine position, 42 Supraglottic Lesions, 429 Surgeon’s knot, 27, 27f Surgical airway See Cricothyroidotomy Surgical anatomy, 64–66 Surgical complications abdominal compartment syndrome, 99 aspiration pneumonia, 92 atelectasis, 89 cardiovascular cerebro vascular accident, postoperative, 97 myocardial infarction, 96–97 DIC, 99 endocrine Addisonian crisis, 94–95, 95f diabetes insipidus, 96 diabetic ketoacidosis, 94 SIADH, 95 gastrointestinal blind loop syndrome, 93 constipation, 93 dumping syndrome, 93–94 gastric dilatation, 92 pancreatitis, postoperative, 92–93 postvagotomy diarrhea, 93 short bowel syndrome, 93 pseudomembranous colitis, 100 pulmonary embolism, 90–92 renal failure, postoperative, 97–98 respiratory failure, postoperative, 89–90 urinary retention, 99–100 Surgical hemostasis, 83–84, 83f, 84f Surgical instruments, 12–18 Surgical intensive care, 336–447 drugs, 341–342 formula, 338 hemodynamic monitoring, 344–345 ICU, 337–338 physiology, 342–343, 342–344 Surgical medications antibiotics, 84–85 heparin, 86 miscellaneous agents, 87–88 narcotics, 88 other agents, 88 steroids, 85 warfarin, 87 Surgical most commons, 10–11 Surgical nutrition, 105–107 Surgical percentages, 11–12 Surgical positions, 42–43 left lateral decubitus, 42, 42f lithotomy, 42 pregnant patient, 43 prone, 42 reverse trendelenburg, 42, 42f right lateral decubitus, 42 supine, 42 trendelenburg, 42, 42f Surgical prophylaxis, 119–120 Surgical respiratory care, 103–104, 103f–104f Surgical syndromes, 8–10 Sutures absorbable, 20 catgut, 20–21 classification of, 20 ligature, 26, 26f materials for, 20 nonabsorbable, 20 PDS, 21 pop-off, 26, 26f pursestring, 24, 24f retention, 26, 26f techniques, 22–26 Vicryl®, 21 Sutures ligature, 26, 26f Swan–Ganz (PA) catheter, 344 Sweetheart retractor, 19f Swenson procedures, 385 Sympathetic ophthalmia, 163 Synchronous tumors, 129 Syndrome of inappropriate antidiuretic hormone (SIADH), 10, 95 Synthroid, 312 Syringomyelia, 526 Systemic inflammatory response syndrome (SIRS), 110 T T10, dermatome, 66 Tachycardia, 102 Tamoxifen, 286–287 Taper-point needle, 22, 22f Tenosynovitis, 410 Tension pneumothorax, 150–151, 151f Terminal ileum, 105, 106 Testicular cancer, 535–536 Testicular torsion, 537 Testicular vein, drainage of, 64 Tetanus, 117, 168 Therapeutic PT, 82 Third-degree burns See Full-thickness burns Third-degree hemorrhoid, 231, 231f Third-generation cephalosporins, 84 Third-spacing, 68–69 Thoracic great vessel injury, 156 Thoracic outlet syndrome (TOS), 10, 437 Thoracic surgery, 437–454 chest wall tumors, 437 diseases of esophagus, 448 diseases of lungs, 440 diseases of mediastinum, 445 diseases of pleura, 439 esophageal reflux, 450 thoracic outlet syndrome, 437 Thoracodorsal nerve, 278, 279f Thoracostomy tube, 56 Thrombocytopenia, 80, 328 Thrombotic thrombocytopenic purpura (TTP), 329 Thumbprinting, 122 Thyroid carcinoma, 314 Thyroid gland, 310–321 anaplastic carcinoma, 317–318 anatomy of, 310–311, 310f, 311f benign thyroid disease, 318–319 follicular adenocarcinoma, 315–316 Hürthle cell thyroid cancer, 316 malignant thyroid nodules, 313–314 medullary carcinoma, 316–317 papillary adenocarcinoma, 314–315 physiology of, 312 thyroid carcinoma, 314 thyroiditis, 319–320 thyroid nodule, 312–313 toxic multinodular goiter, 319 Thyroid isthmus, 311 Thyroiditis, 319–320 Thyroid nodule, 312–313 Thyroid-stimulating hormone (TSH), 312 Thyrotropin-releasing hormone (TRH), 312 Tibial pin, 490 Tibial plateau fracture, 496 Tibial “plateau” fracture, 496, 496f Ticarcillin-clavulanic acid, 84 Tidal volume, 345 TIPS procedure, 250, 250f Tissue perfusion, 107 Toldt, white lines of, 65 Tonicity, accounts for, 69 Toradol, 88 Total body surface area (TBSA), 166 Total gastrectomy, 186, 186f Totally extra peritoneal approach (TEPA), inguinal hernia repair procedure, 141 Total parenteral nutrition (TPN), 106, 107 Toupet, for GERD, 184, 184f Toxic megacolon, 238 Toxic multinodular goiter, 319 Toxic shock syndrome, 10 Tracheostomy, 54 Trans abdominal pre peritoneal (TAPP), inguinal hernia repair procedure, 141 Transcervical fracture, 496 Transfusion hemolysis, 80 treatment for, 81 Transfusion reaction, 80 Transient ischemic attack, 359 Transplant complications, 487 Transplant surgery basic immunology, 475 immunosuppression, 475 kidney transplant, 480 organ preservation, 479 overview of immunosuppression mechanisms, 478 rejection, 479 Transurethral incision of prostate, 534 Transurethral resection of bladder, 532 Transurethral resection of prostate, 534 Transurethral resection of prostate (TURP), 50 Trauma, 11, 148–166 ATLS protocol, 148 facts, 159–164 penetrating neck injuries, 158–159, 158f–159f primary survey, 148–155 secondary survey, 155–157 studies, 157–158 Trauma injuries and complications, 499 Trauma resuscitation fluid, 153 Traumatic subarachnoid hemorrhage, 518 Trendelenburg, 42, 42f Trendelenburg operation, 91 Triangle of Calot, boundaries of, 252, 252f Triple A repair, 51 Trophic tube feeds, 107 Trousseau’s sign, 8, 75 Trousseau’s syndrome, 10 Truncal vagotomy, 53, 53f, 177 T-tube, 56, 56f Tube check, 193 Tube thoracostomy, 150 Tubular adenomas, 215 Tubulovillous adenomas, 215 Tumors appendiceal, 202–203 carcinoid, 203–206, 204f–205f hepatoblastoma, 400 of liver, 241–244 focal nodular hyperplasia, 242–243, 242f hepatic hemangioma, 243 hepatocellular adenoma, 242 hepatocellular carcinoma, 243–244 neuroblastoma, 398 rhabdomyosarcoma, 400 small bowel, 196 Wilms’ tumor, 397 Turcot’s syndrome, 218 Type II hiatal hernia, 146 Tympanic membrane (TM) perforation, 415 U Ulcerative colitis (UC), 235–239 anal involvement, 236 anatomic distribution, 236 bowel wall involvement, 236 cancer risk, 237 complications of, 237 diagnostic tests, 237 extraintestinal manifestations, 235 incidence, 235 initial symptoms, 236 medical treatment of, 238 mucosal findings, 237 rectal involvement, 236 route of spread, 236 surgery, indications for, 238 toxic megacolon, incidence of, 237 Ulcers with burn injury, 171 duodenal, 174–175 perforated peptic ulcer, 176–177 PUD, 173 surgical, 127–128 Umbilical hernia, 139, 380 Unasyn, 85 Universal donor for FFP, 80 for PRBCs, 79 Urethra in females, finding of, 34, 34f Urge incontinence, 540 Urinary retention, 99–100 Urinary tract infection (UTI), 111 bacterial cause of, 11 Urine output adult trauma patient, 159 for burn patients, 170 decreased, 102 Urology, 529–543 benign prostatic hyperplasia, 533–535 bladder cancer, 531–532 calculus disease, 539–540 differential diagnosis, 530 epididymitis, 537–538 erectile dysfunction, 538 incontinence, 540 priapism, 538 prostate cancer, 532–533 renal cell carcinoma (RC ), 530–531 testicular cancer, 535–536 urinary tract infection (UTI), 541 V Vagotomy and antrectomy, 178, 178f and pyloroplasty, 177, 177f Valentino’s sign, 8 Vancomycin, 85 Varicocele, 529 Vascular surgery abdominal aortic aneurysms, 356 acute arterial occlusion, 355 carotid vascular disease, 359, 362 lower extremity amputations, 354 median arcuate ligament syndrome, 358 mesenteric ischemia, 358 popliteal artery aneurysm, 364 renal artery stenosis, 363 splenic artery aneurysm, 363 Vasopressin, 249, 251, 342 Venous stasis ulcer, 128 Ventilation, 345 Ventilator associated pneumonia (VAP), 119 Ventral hernia, 138 Veress needle, 147 Vertical mattress stitch, 23, 23f Vicryl® sutures, 21 Villous adenomas, 215 Virchow’s node, 7, 185 Virchow’s triad, 8, 8f, 90 Vitamin A deficiency, 106 Vitamin B12/folate deficiency, 105, 106 Vitamin C deficiency, 106 Vitamin K deficiency, 106 Vitamin K–dependent clotting factors, 106 Vitamins soluble, 106 Volarflexion, 489 Voluntary guarding, 132 von Willebrand’s disease, 81 W Ward emergencies, causes of, 101–102 Warfarin (Coumadin), 82, 87 Warren shunt, 250–251, 250f WDHA syndrome, 277 Weiss protocol, 76 Wenckebach phenomenon, 474 Wernicke’s encephalopathy, 120 Wet-to-dry dressing, 54 Wheezing, postoperative, 90 Whipple procedure, 53, 53f, 276 Whipple’s triad, 8, 277, 302 White lines of Toldt, 65, 210 Wilms’ tumor, 397 Winged scapula, 279 Wolff–Parkinson–White, 474 Wound contraction, 404 Wound dehiscence, abdominal, 54 Wound healing, 404 Wound infection protection from, 119 Wounds, 54–55 clamp in, 84 closure, 21–22, 54 delayed primary closure, 54 healing, 21–22, 54 infections, 112–114 operative, classification of, 113 primary wound closure, 54 secondary wound closure, 54 wet-to-dry dressing, 54 Wound vac See Negative-pressure wound therapy (NPWT) Wrist dorsiflexion, 489 Y Yankauer suction, 18, 18f Yersinia enterocolitica, 202 Z Zinc deficiency, 106 Zollinger–Ellison syndrome (ZES), 10, 174, 303–306, 305f Zosyn, 84, 85 ... Introduction Surgical Syndromes Surgical Most Commons Surgical Percentages Surgical Instruments Sutures and Stitches Surgical Knot Tying Procedures for the Surgical Ward and Clinic Incisions Surgical Positions... Blood and Blood Products Surgical Hemostasis Common Surgical Medications Complications Common Causes of Ward Emergencies Surgical Respiratory Care Surgical Nutrition Shock Surgical Infection Fever Surgical Prophylaxis... Incisions Surgical Positions Surgical Speak Preoperative Surgical Operations You Should Know Wounds Drains and Tubes Surgical Anatomy Pearls SECTION II BACKGROUND SURGICAL INFORMATION 17 Fluids and Electrolytes