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SCHWARTZ’S
PRINCIPLES OF SURGERY
ABSITE and Board Review
NOTICE
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Medicine is an ever-changing science. As new research and clinical experience broaden
our knowledge, changes in treatment and drug therapy are required. The authors and the
publisher of this work have checked with sources believed to be reliable in their efforts
to provide information that is complete and generally in accord with the standards
accepted at the time of publication. However, in view of the possibility of human error
or changes in medical sciences, neither the authors nor the publisher nor any other
party who has been involved in the preparation or publication of this work warrants
that the information contained herein is in every respect accurate or complete, and
they disclaim all responsibility for any errors or omissions or for the results obtained
from use of the information contained in this work. Readers are encouraged to confirm
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SCHWARTZ’S
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PRINCIPLES OF SURGERY
ABSITE and Board Review
11th Edition
Edited by
F. Charles Brunicardi, MD, FACS
Professor of Surgery, Department of Surgery
Senior Vice President
Dean, College of Medicine
SUNY Downstate Health and Sciences University
Brooklyn, New York
Associate Editors
Dana K. Andersen, MD, FACS
Senior Scientific Advisor
Division of Digestive Diseases and Nutrition
National Institute of Diabetes and Digestive and Kidney Disease
National Institutes of Health
Bethesda, Maryland
Timothy R. Billiar, MD, FACS
George Vance Foster Professor and Chair
Department of Surgery
Distinguished Professor of Surgery
Executive Vice President and Chief Scientific Officer for UPMC
Associate Senior Vice Chancellor for Clinical Academics
University of Pittsburgh Health Sciences
Associate Medical Director, UPMC International and Commercial
Services Division
University of Pittsburgh School of Medicine
University of Pittsburgh
Pittsburgh, Pennsylvania
Karen J. Brasel, MD, MPH, FACS
Professor of Surgery
Division of Trauma, Critical Care and Acute Care Surgery,
School of Medicine
Assistant Dean for Graduate Medical Education
Office of the Dean, School of Medicine
Residency Program Director, Surgery, School of Medicine
Oregon Health and Science University
Portland, Oregon
Lisa Dresner, MD, FACS
Program Director and Vice Chair for Education
Associate Professor of Surgery
Department of Surgery
College of Medicine, SUNY Downstate Health and Sciences University
Brooklyn, New York
John G. Hunter, MD, FACS
Professor of Surgery, School of Medicine
Executive Vice President, OHSU
Chief Executive Officer, OHSU Health System
Oregon Health and Science University
Portland, Oregon
Lillian S. Kao, MD, MS, FACS
Jack H. Mayfield, MD, Chair in Surgery
Vice-Chair for Quality of Care
Professor and Chief, Division of Acute Care Surgery
Department of Surgery
McGovern Medical School at UTHealth Houston
Houston, Texas
Jeffrey B. Matthews, MD, FACS
Dallas B. Phemister Professor
Chairman, Department of Surgery
Pritzker School of Medicine
University of Chicago
Chicago, Illinois
Raphael E. Pollock, MD, PhD, FACS
Director, Ohio State University Comprehensive Cancer Center
Kathleen Wellenreiter Klotz Chair in Cancer Research
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
Professor, Division of Surgical Oncology, Department of Surgery
Ohio State University College of Medicine
Columbus, Ohio
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
Copyright © 2023, 2016, 2011, 2007 by McGraw Hill LLC. All rights reserved. Except as permitted under the United States Copyright
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ISBN: 978-1-26-046976-9
MHID: 1-26-046976-X
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CONTENTS
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Contributors vii
Preface ix
Acknowledgments xi
PART I
Basic Considerations 1
1 Leadership 3
2 Systemic Response to Injury
and Metabolic Support 7
3 Fluid and Electrolyte Management
of the Surgical Patient 13
4 Hemostasis, Surgical Bleeding,
and Transfusion 21
5 Shock 29
6 Surgical Infection 37
PART II
Specific Consideration 127
16 The Skin and Subcutaneous Tissue 129
17 Breast 137
18 Head and Neck 143
19 Chest Wall, Lung, Mediastinum, and Pleura 145
20 Congenital Heart Disease 157
21 Acquired Heart Disease 171
22 Thoracic Aneurysms and Aortic Dissection 181
23 Arterial Disease 189
24 Venous and Lymphatic Disease 197
25 The Esophagus and Diaphragmatic Hernia 207
26 Stomach 223
7 Trauma 49
8 Burns 65
9 Wound Healing 73
10 Oncology 83
11 Transplantation 87
12 Patient Safety 97
13 Physiologic Monitoring
of the Surgical Patient 105
14 Minimally Invasive Surgery 115
15 Molecular and Genomic Surgery 119
27 The Surgical Management of Obesity 233
28 Small Intestine 235
29 Colon, Rectum, and Anus 241
30 The Appendix 259
31 Liver 263
32 The Gallbladder and
Extrahepatic Biliary System 279
33 Pancreas 289
34 The Spleen 297
35 Abdominal Wall, Omentum, Mesentery,
and Retroperitoneum 307
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36 Soft Tissue Sarcomas 311
CONTENTS
37 Inguinal Hernias 313
38 Thyroid, Parathyroid, and Adrenal 323
39 Pediatric Surgery 329
40 Urology 337
41 Gynecology 341
42 Neurosurgery 345
43 Orthopedic Surgery 351
44 Surgery of the Hand and Wrist 355
45 Plastic and Reconstructive Surgery 361
46 Anesthesia for the Surgical Patient 363
47 Surgical Considerations in the Elderly 365
48 Ethics, Palliative Care,
and Care at the End of Life 369
49 Global Surgery 373
50 Optimizing Perioperative Care:
Enhanced Recovery and Chinese Medicine 377
51 Understanding, Evaluating, and
Using Evidence for Surgical Practice 381
52 Ambulatory Surgery 385
53 Skills and Simulation 387
54 Web-Based Education and
Implications of Social Media 389
Index 391
CONTRIBUTORS
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Dana K. Andersen, MD, FACS
Senior Scientific Advisor
Division of Digestive Diseases and Nutrition
National Institute of Diabetes and Digestive and Kidney Disease
National Institutes of Health
Bethesda, Maryland
Shay Behrens, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
Andrew J. Benjamin, MD
Assistant Professor of Surgery
Pritzker School of Medicine
University of Chicago
Chicago, Illinois
Timothy R. Billiar, MD, FACS
George Vance Foster Professor and Chair
Department of Surgery
Distinguished Professor of Surgery
Executive Vice President and Chief Scientific Officer for UPMC
Associate Senior Vice Chancellor for Clinical Academics
University of Pittsburgh Health Sciences
Associate Medical Director
UPMC International and Commercial Services Division
University of Pittsburgh School of Medicine
University of Pittsburgh
Pittsburgh, Pennsylvania
Jillian Bonaroti, MD
Department of Surgery
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Karen J. Brasel, MD, MPH, FACS
Professor of Surgery
Division of Trauma, Critical Care and Acute Care Surgery
School of Medicine
Assistant Dean for Graduate Medical Education
Office of the Dean
School of Medicine
Residency Program Director, Surgery
School of Medicine
Oregon Health and Science University
Portland, Oregon
F. Charles Brunicardi, MD, FACS
Professor of Surgery, Department of Surgery
Senior Vice President
Dean, College of Medicine
SUNY Downstate Health and Sciences University
Brooklyn, New York
Daniel T. Dempsey, MD, FACS
Professor of Surgery, Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Ankit Dhiman, MD
Research Fellow, Department of Surgery
Pritzker School of Medicine
University of Chicago
Chicago, Illinois
Lisa Dresner, MD, FACS
Program Director and Vice Chair for Education
Associate Professor of Surgery
Department of Surgery
College of Medicine
SUNY Downstate Health and Sciences University
Brooklyn, New York
Jodi-Ann Edwards, MD
Resident
Department of Surgery
College of Medicine
SUNY Downstate Health and Sciences University
Brooklyn, New York
Erfan Faridmoayer, MD
Resident
Department of Surgery
College of Medicine
SUNY Downstate Health and Sciences University
Brooklyn, New York
Sam Guyer, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
Patrick Harbour, MD
Chief Resident in Plastic Surgery
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC
Ahmed Hozain, MD
Chief Resident
Department of Surgery
College of Medicine
SUNY Downstate Health and Sciences University
Brooklyn, New York
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CONTRIBUTORS
John G. Hunter, MD, FACS
Professor of Surgery
School of Medicine
Executive Vice President, OHSU
Chief Executive Officer, OHSU Health System
Oregon Health and Science University
Portland, Oregon
Lillian S. Kao, MD, MS, FACS
Jack H. Mayfield, MD, Chair in Surgery
Vice-Chair for Quality of Care
Professor and Chief, Division of Acute Care Surgery
Department of Surgery
McGovern Medical School at UTHealth Houston
Houston, Texas
Marina Affi Koprowski, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
Jeffrey B. Matthews, MD, FACS
Dallas B. Phemister Professor
Chairman, Department of Surgery
Pritzker School of Medicine
University of Chicago
Chicago, Illinois
Katherine Reitz, MD, FACS
Department of Surgery
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Robert E. Roses, MD, FACS
Associate Professor of Surgery
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Ashley Sweet, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
Alexander Schwartzman, MD, MBA, FACS
Vice Chair and Clinical Professor of Surgery
Department of Surgery
College of Medicine
SUNY Downstate Health Sciences University
Brooklyn, New York
David H. Song, MD, FACS
Professor and Chairman
Department of Plastic Surgery
Georgetown University School of Medicine
Washington, DC
Munier Nazzal, MD, MBA, FRCS, FACS, DFSVS
Professor, Department of Surgery
Vice Chair, Research and Education
Chief, Division of Vascular, Endovascular and Wound Surgery
University of Toledo College of Medicine
Toledo, Ohio
Junaid Nizamuddin, MD
Assistant Professor of Anesthesia and Critical Care
Pritzker School of Medicine
University of Chicago
Chicago, Illinois
Michael O’Connor, MD
Professor of Anesthesia and Critical Care
Pritzker School of Medicine
University of Chicago
Chicago, Illinois
Raphael E. Pollock, MD, PhD, FACS
Director, Ohio State University
Comprehensive Cancer Center
Kathleen Wellenreiter Klotz Chair in Cancer Research
Arthur G. James Cancer Hospital and Richard J. Solove
Research Institute
Professor, Division of Surgical Oncology, Department of Surgery
Ohio State University College of Medicine
Columbus, Ohio
Joseph Tobias, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
Samuel Torres Landa Fernandez, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
Kiran K. Turaga MD, MPH, FACS
Professor of Surgery
Pritzker School of Medicine
University of Chicago
Chicago, Illinois
David Warner, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
Lye-Yeng Wong, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
Ryan Randle, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
Sarah Wonn, MD
General Surgery Resident
Department of Surgery
Oregon Health and Science University
Portland, Oregon
PREFACE
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This 11th edition of Schwartz’s Principles of Surgery: ABSITE and
Board Review marks a new milestone of excellence in surgical
education for the betterment of craft, quality of care, and the edification
of surgical students and colleagues alike. With 870 questions
spanning the 54 updated chapters of this edition, including five new
chapters, Optimizing Perioperative Care: Enhanced Recovery and
Chinese Medicine, Understanding, Evaluating and Using Evidence
for Surgical Practice, Ambulatory Surgery, Skills and Simulation,
and Web-Based Education and Implications of Social Media, this is
the comprehensive companion text for reviewing and assessing the
information compiled in the main textbook and for preparation for
the American Board of Surgery In-Training Examination (ABSITE)
and Board Review.
Contributors of the primary book have updated the questions
for each chapter since the last edition in an effort to continue to
provide a high level of review on the most up-to-date information
and techniques currently taught and employed in the operating
theater. We have maintained the proven format of providing the
answer-bearing portion of the text immediately following the
question and answer as an efficient method for reinforcement and
recall. The user may read the question followed by the answer as a
form of review, or by covering the right-hand column of the page,
the user can complete the questions in a more authentic test format
and uncover the answers for review/scoring.
ix
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