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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1232_Библиотеки_им_академика_М_И_Перельмана.pdf
506
M. Ne and J. Sadeh
• Discuss the goals of care in early phases and document.
• Determination of caregivers and decision makers, POA,
and legal guardians.
In the Case of a Terminal Diagnosis, the Goal Should Be
to:
• Minimize time in the hospital and invasive tests and allow
patients to go home and be with family
• Schedule regular family meetings with adequate time
• Be honest in your communications and to not ll the
patient or their family with false hope
• Document all goals of care discussions in the chart
Important Considerations for Family Discussions:
• Patients/families are often faced with very difcult decisions with limited medical background/information and
struggle to understand the risks/benets involved.
• Calculating NSQIP scores can sometimes make family
discussions easier.
• Cultural and religious beliefs can also play an important
role in decisions about life-sustaining treatments.
• There may be a history of distrust of the hospital or medical professionals because of prior family experiences.
• A small window of time may allow families to better cope
and grieve.
• Palliative care consult—may be helpful to facilitate these
discussions.
Lastly, clinicians need to be aware of their own uncon-
scious biases, for example, we may not want to live with a
spinal cord disability or paralysis, but this may not make a
therapy truly futile.
If a treatment produces an effect on only one aspect of the
patient’s physiology, but fails to provide a benet to the
patient as a whole, it may be deemed futile (Udwadia etal.
2023).
Common Curveballs
The patient will be unable to make decisions for
themselves.
Language barrier making discussions more difcult.
Your colleague/another medical service disagrees with
your opinion that the situation is futile.
Clean Kills
You let family completely dictate the level of treatment/care
even when you disagree with therapy or the therapy is completely inappropriate.
Discussing potential heroic options like chemotherapy
when you know this is truly hopeless.
Bonus Points
You consider getting second opinion or help from another
surgeon, surgical group, chair of the department of surgery,
or hospital’s ethics committee.
Words ofWisdom
Our overriding goal in futile situations must be “First, Do No
Harm.” This patient should have been made hospice once a
treatable malignancy was ruled out. This is loosely based on
a real patient who ultimately had an EGD and colonoscopy,
complicated by a perforation from the colonoscopy, ultimately leading to an emergent colectomy, and return to the
operating room for a leak. The patient was ultimately made
hospice after 2 weeks of torture in the hospital. This is not
the goal of quality surgical care in futile situations.
No matter what eld you choose, you will eventually face
a similar circumstance in your patient. When this occurs,
approach it with the utmost compassion, but recognize that
“not every patient needs an operation before they die”
(Rhoads Jr. n.d.).
There will be a complication of whatever biopsy you try to
perform (lymphatic drainage from lymph node biopsy, leaking ascitic uid from IR sampling, perforation from EGD).
The family will want you to do “everything” done at “any
cost.”
Bibliography
Jonathan Rhoads Jr. Quote from residency training; n.d..
Udwadia F, Zhu J, Khan H, Das S.Futility considerations in surgical
ethics. Ann Med Surg. 2023;85(1):1–5.
Conclusion
MarcNe
145
If you have made it to this point in the book, I congratulate
you. Surgery is a difcult chosen profession, and nding the
time to study amid all your other tasks in life (and not end up
burned out and socially isolated with some rather unhealthy
coping skills) is a true accomplishment. I rmly believe that
we aren’t really taught well enough how to take the 4 years
of knowledge from medical school, translate that into practical and efcient clinical algorithms for how to approach surgical patients when we are exhausted or overwhelmed or
short staffed, and then to nally rene that into 7–10-min
evidence-based focused responses in an oral board-type
examination format. A practical revision of our medical education system is beyond the scope of this book, but I agree
with what you are thinking, that it shouldn’t take 28 years of
schooling and sacrices to become a surgical attending. I do
sincerely hope you will nd this codex of knowledge helpful
in your future adventures and endeavors in the surgical arena.
Last Suggestions as You Prepare for This Exam:
1. Whatever you do to study, do it completely. If a book,
read it completely; if a course, study the materials. Be
condent going into the exam that you’ve done all that
you’ve needed to prepare.
2. Read and practice lots of scenarios. Practice with your
colleagues and mentors. Record yourself, not only what
you say but how you say it.
3. Remember, to get to this point, you have taken care of
literally thousands of patients and survived grueling
nights on call and long hours in the operating room. You
passed the written; you know the material.
4. Never make up answers or operations and don’t waste
time on history and physical examination if they tell you
“that is all you need”—both are sure ways to fail.
Remember: the exam starts right after they shake your
hands (or after the introductions on Zoom).
M. Neff (*)
Department of Surgery, Jefferson Health of New Jersey,
Cherry Hill, NJ, USA
e-mail: Marc.Neff@jefferson.edu
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
M. Neff et al. (eds.), Passing the General Surgery Oral Board Exam, https://doi.org/10.1007/978-3-031-78244-2_145
507
Index
A
AAST colon injury scale, 271
ABC’s in trauma, 155
ABCDEs of trauma, 343
Abdominal aortic aneurysms (AAA), 135–137, 395, 396
Abdominal compartment syndrome (ACS), 269, 270, 288, 336
Abdominal entry for laparoscopic surgery, 457
Abdominal pain, 47, 91
Abdominal wall reconstruction (AWR), 265, 266
Abdominoperineal resection (APR), 87
Abnormal pulmonary mechanics with increased pulmonary airway
pressure, 269
Achalasia, 107, 108
Actinic Keratosis, 480
Acute appendicitis, 73, 74, 91, 92, 427–429
Acute cholecystitis, 177, 178
Acute colitis, 96
Acute compartment syndrome of the extremity, 275, 276
Acute extremity ischemia, 401–403
Acute ank pain, 245
Acute kidney injury (AKI), 451–453
Acute limb ischemia, 401
Acute pancreatitis, 189, 190
Acute respiratory distress syndrome (ARDS), 361, 362, 365
Acute severe ulcerative colitis (ASUC), 97
Acute SMA embolism, 41–42
Acute SMA thrombosis, 42
Acute tubular necrosis (ATN), 452
Adenocarcinomas, 51, 230
Adhesiolysis, 69, 265
Adhesions, 55
Adrenalectomy, 207
Adrenal glands, 205
Adrenal hyperplasia, 216
Adrenal insufciency, 437
Advanced trauma life support (ATLS) algorithms, 285, 321
Advanced trauma life support (ATLS) protocols, 315
Air emboli in peripheral tissues, 446
Airway, 297
Airway pressure release ventilation (APRV), 363
Aldosterone, 216
Aldosterone-producing adenoma, 215
Alpha blocker (Phenoxybenzamine), 209
Altemeier procedure, 49
American board of surgery, 503
American college of radiology (ACR), 7
American Society of Clinical Oncology (ASCO) clinical practice
guideline, 23
Amoebic abscess, 175
Anal stulas, 85
Aneurysm rupture, 409
Angioedema, 358–359
Angioembolization, 309
Angiogram, 309, 402
Ankle-brachial index (ABIs), 399
Annual ovarian cancer screening, 28
Anorectal abscesses, 83
Anterolateral thoracotomy, 316
Antibiotics, 498
Anticoagulation, 304, 403, 441
Aortoenteric stula, 136, 396
Appendectomy, 52, 91, 92
Appendiceal cancer, 51, 52
Appendiceal carcinoid lesions, 52
Appendiceal carcinoid tumors, 51–52
Appendicitis
acute, 73, 74, 91, 92, 427–429
Aromatase inhibitor (post-menopausal), 16
Arterial gas embolism (AGE), 445–447
Atelectasis, 439
Atherosclerotic disease, 244
ATLS algorithm, 348
Atrial brillation, 41
Atrial injuries, 339
Atypical ductal hyperplasia (ADH), 18
Atypical lobular hyperplasia (ALH), 18
Axillary lymphadenopathy, 33
B
Band erosion, 383
Band prolapse, 383, 384
Bariatric procedure, 383, 384
Bariatric surgery
obstruction, 388
Bariatric surgery complications, 387, 388
Barrett’s esophagus, 109, 110, 392
Basal cell carcinoma (BCC), 483
cystic, 483
diagnosis, 484
follow up, 484
histopathology, 484
inltrative, 483
micronodular, 483
morpheaform, 483
nodular, 483
risk factors for recurrence, 484
supercial spreading, 483
treatment, 484
types, 483
Bassini repair, 259
Battle sign, 348
Benign breast mass, 12
Best practices for virtual oral boards, 503
Bilateral adrenalectomy, 207
Bilateral adrenal hyperplasia, 215
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
M. Neff et al. (eds.), Passing the General Surgery Oral Board Exam, https://doi.org/10.1007/978-3-031-78244-2
509
510
Index
Bilateral breast examination, 17, 27
Bilateral diagnostic mammogram, 19
Bilateral lower extremity Doppler ultrasound, 441
Bilateral prophylactic mastectomy, 28
Bile duct injury, 173, 174
Bile leaks, 171–173
Biochemical hypoglycemia, 219
Biologic mesh or synthetic mesh, 49
Biopsies return with high grade dysplasia, 110
Biopsy of neck mass, 230
BI-RADS, 8, 9
BI-RADS 0, 8
BI-RADS 1, 8
BI-RADS 2, 8
BI-RADS 3, 8
BI-RADS 4, 8
BI-RADS 5, 8
BI-RADS 6, 8
BI-RADS category, 7
Bispectral index monitor, 362
Bladder injury grading, 281
Bladder pressure, 269, 270
Blast injury, 325
Bleeding after a Roux-en-Y gastric bypass, 379, 380
Blood clots, 413
Bloody diarrhea, 97
Bloody discharge, 3
Blunt cardiac injury (BCI), 339–341
Blunt trauma, 355, 356
Body mass index (BMI), 311
Boerhaave syndrome, 115
Bowel obstruction, 79
Bowel resection, 60
Branchial cleft cyst, 230
BRCA1 mutation, 27
BRCA2 mutation, 27
Breast biopsy, 12, 15
Breast cancer, 12–13
screening mammography, 7, 8
Breast cancer during pregnancy (PrBC), 21, 22
Breast conservation therapy, 16
Breast cyst, 12
Breast imaging reporting and data system (BI-RADS) classication
system, 7
Breast mass, 11–13, 33
Breslow depth of invasion, 465
Breslow thickness, 466, 469
Buffalo hump, 205
Burn escharotomy, 329, 330
Burn injury, 326, 330
Burn resuscitation, 331
Burn sepsis, 335, 336
Burn wound infection, 335
Burns, 325, 326
Bypass graft, 400
Bypass leak, 387
C
Carcinoid syndrome, 201
Carcinoid tumors, 74, 201–203
Cardiac causes of postoperative hypotension, 437
Cardiac laceration repair, 339
Cardiac trauma
evaluation, 337–338
Cardiac valve or multi-chamber injury, 339
Caroli disease, 167
Carotid artery stenting (CAS), 298, 405
Carotid endarterectomy (CEA), 406
Carotid injury, 297
Carotid stenosis, 405, 406
CBD stones
recurrent, 183
Cecal volvulus, 47, 48
Cecopexy, 48
Cellular signaling pathways, 483
Cellulitis, 68
Central line associated bloodstream infections (CLABSI), 440
Central neck dissection (CND), 238
Cerebral blood ow (CBF) and herniation, 347
Cerebral spinal uid (CSF) rhinorrhea, 348
Cervical Esophagus, 300
Cervical spine management, 356
Cervical Trachea, 299
Charcot’s triad, 169
Chemo-radiation, 149
Chemotherapy, 23, 24
Chest tube drainage versus CT-guided catheter placement, 370
Children’s oncology group (COG) staging system, 250
Cholangitis, 170
Cholecystectomy, 165, 171
Cholecystitis
acute, 177, 178
Cholecystocholedochal stula, 134
Cholecystoduodenal stula, 133, 134
Cholecystoduodenocolic stula, 134
Cholecystoenteric stula, 134, 165
Cholecystogastric stula, 134
Choledochal cysts, 167, 168
Choledocholithiasis, 169
Cholelithiasis, 185
Chronic empyema, 370
Chronic gallbladder disease, 185
Chronic gastric atony, 149
Chronic lower extremity ischemia, 399, 400
Chronic malnutrition, 312
Chronic pancreatitis, 193
Circulatory failure, 366
Circumferential burns of the abdomen, 332, 333
Circumferential burns of the chest, 332, 333
Circumferential full-thickness burns to extremities, 330, 331
Cirrhosis, 117, 179
Clamshell, 316
Coagulopathy, 322, 323
Coagulopathy of trauma, 319, 320
Colectomy, 75
Colectomy with ileorectal anastomosis, 65
Collis gastroplasty, 264
Colon adenocarcinoma, 414
Colon cancer, 76
adjuvant chemotherapy, 63
average risk patient, 64
clinical presentation, 63
diagnostic tests, 63
etiology, 63
familial, 63
hereditary, 63
high risk patient, 64
prevalence, 63
screening recommendations, 64
sporadic, 63
surgical resection, 63
Index
511
Colon injuries, 271
Colon trauma, 271, 272
Colonic stricture, 75
Colonic volvulus, 47, 48
Colorrhaphy versus colectomy versus fecal diversion, 273
Communication, 455
Community-acquired empyema, 370
Compartment syndrome, 336
Complete eradication of intestinal metaplasia (CEIM), 110
Complete oncologic resection, 474
Completion lymph node dissection, 469
Complex abdominal wall reconstruction, 265
Complicated diverticulitis with abscess, 72
Complicated diverticulitis with perforation or peritonitis, 72
Constipation, 49
Contrast esophagogram, 115, 116
Conversion surgery, 391
Coronary artery injuries, 339
Coronary revascularization, 437
Cough, 373
Critical limb ischemia, 399, 400
Crohn’s disease (CD), 67, 93, 94
Cross clamping of pulmonary hilum, 447
Currant jelly stool, 79
Cushing reex, 347
Cushing’s syndrome, 205, 207
Cystic nodules, 237
Cystogastrostomy, 198
D
Damage control laparotomy, 287–288, 308
Damage control procedure, 271, 272
Damage control surgery, 321
denitive repair phase, 323
initial phase, 322–323
intraoperative considerations, 322
massive transfusion, 322
resuscitative phase, 323
DDX, 155
Decompressive escharotomy, 332
Decompressive fasciotomy, 275, 331
Decompressive gastrostomy, 128
Decompressive laparotomy, 269, 270
Dedifferentiated Liposarcoma, 476
Deep surgical site infection, 440
Deep vein thrombosis (DVT), 304, 413–415
anticoagulation, 413
post-operative patients, 414
Denitive airway, 355
De-novo GERD after SG, 392
Dermatobrosarcoma protuberans (DFSP), 475
Desmoid tumors, 474
Destructive injury, 273
Destructive versus non-destructive injury, 273
Diabetes mellitus, 491
Diagnostic laparoscopy or thoracoscopy, 352
Diaphragmatic injuries, 351–353
Diaphragmatic repair, 317
Dieulafoy lesion, 159–161
endoscopic characteristics, 160
operative management, 160–161
tortuous arterial formations, 160
Direct injury/cytotoxicity to tubular epithelial cells, 452
Direct pressure, 455
Distal esophageal varices, 157
Distal small bowel obstruction, 79
Diversion or damage control procedure, 271
Diverticulectomy, 60
Diverticulitis, 71, 72
“Double rupture” phenomenon, 409
Drugs, 440
Duct of Luschka, 171
Ductal carcinoma in situ (DCIS), 15, 16
Ductal ectasia, 3
Dumping syndrome, 149
Duodenal cancer, 123, 124
Duodenal hematoma, 278
Duodenal injuries, 277–279
Duodenal injury grading, 277
Duodenal mass, 123
Duodenal perforation, 277
Duodenal stump blow-out, 149
Duodenal stump defect, 131
Duodenal stump stula, 131
Duodenal ulcers, 141, 142
Dysphagia, 101
E
Early wound dehiscence, 492
ECF
operative timing, 69
patient comorbidities, 69
Echinococcal cysts, 176
Eczema, 37
EDH, 347
EET modality, 110
EGD, 157
Elective laparoscopic sigmoidectomy, 72
Elective repair, 263
Electrical burn injury, 330
Embolectomy, 402
Emergency airway management, 355–359
Emergency department thoracotomy (EDT), 337
Emergency hemorrhoidectomy, 44
Emergency repair, 264
Empyema, 369–371
Endocrine therapy, 16
Endorectal advancement ap, 84
Endoscopic cystogastrostomy, 198
Endoscopic eradication therapy (EET), 110
Endoscopic retrograde cholangiography (ERC), 287
Endoscopic ultrasound (EUS), 146
Endovascular RAS revascularization, 243
Endovascular repair, 136, 243, 396
Endovascular therapy, 410
Enteral nutrition, 152–153
Enteric bypass, 128
Enterochromafn cells (Kulchitsky cells), 201
Enterocutaneous stulas (ECFs), 312, 313, 494
anastomotic leak and breakdown of repair, 69
characteristics, 67, 69
classication, 68
computed tomography, 68
early management, 68, 69
endoscopy, 68
enteric contents, 68
epithelialized surfaces, 67
etiology, 67
feature, 68
management, 68
512
Index
Enterocutaneous stulas (ECFs) (cont.)
pathophysiologic consequences, 68
patient factors, 67
substantial morbidity and mortality, 67
topical skin products, 68
workup, 68
Enterolithotomy, 133
Epithelial lesions, 51
ER- and/or PR-negative and HER2 negative cancers, 34
ER- and/or PR-positive and HER2 negative cancers, 34
ER- and/or PR-positive and HER2 negative cancers with extensive
visceral disease, 34
ERCP, 185
Eschar, 329
Escharotomies, 333
Escharotomy, 329
complications, 329
Escharotomy of the arm and forearm1, 331
Escharotomy technique, 329
Esophageal adenocarcinoma, 110
Esophageal anastomosis, 432
Esophageal atresia, 432
Esophageal cancer, 114
Esophageal conduit creation, 113
Esophageal dysmotility, 119
Esophageal malignancy, 113
Esophageal manometry, 120
Esophageal motility, 119
Esophageal perforations, 115, 116
Esophageal squamous cell carcinoma, 113, 114
Esophageal varices, 117, 118
Esophageal varies in Japan, 156
Esophagectomy, 110
Esophagogastroduodenoscopy (EGD), 146
Estimated blood loss (EBL), 451
Evidence based-focused responses in an oral boards type examination
format, 507
Excisional biopsy, 8
Excisional hemorrhoidectomy, 44
Excluded small bowel, 379
Exploratory laparotomy, 321
Extended cholecystectomy, 181
Extended FAST (eFAST), 321
External hemorrhoids, 43
Extracolonic cancers, 64
Extracorporeal membrane oxygenation (ECMO), 365, 366
Extraperitoneal vs Intraperitoneal bladder injury, 281
Extrasphincteric stula (Parks Type 4), 84
Extremity amputation, 487
Extremity compartment syndrome, 275, 276
clinical diagnosis, 275
Extremity STS, 474
F
Familial adenomatous polyposis (FAP) syndrome, 64–65
Familial hyperaldosteronism, 215
Fascial dehiscence with evisceration of bowel, 492, 493
Fasciotomy, 402
Fecal immunochemical test (FIT), 64
Fecal incontinence, 49
Feeding tubes and nutritional support, 151–153
Femoral hernias, 257
Fibroadenoma, 12
Fine needle aspiration (FNA), 237–238
Flail chest, 295
Fleischner Society Guidelines for Management of Incidentally
Detected Solid Pulmonary Nodules in Adults, 374
Flexible sigmoidoscopy, 64
Fluid resuscitation, 189, 326
Fluid resuscitation with lactated ringers, 325, 326
Focused assessment with sonography for trauma (FAST) exam, 321
Forearm fasciotomy, 276
Fredet-Ramstedt Pyloromyotomy (Open), 421
Full thickness burn, 325, 329, 333
Fulminant colitis, 97, 98
Fundoplication, 263
Fungal abscess, 175
Fusiform cysts, 167
Futile care, 505, 506
G
Gallbladder cancer, 181, 182
Gallstone ileus, 165
Gallstone pancreatitis, 189
Gastrectomy, 149
Gastrectomy complications, 131
Gastric band slippage or prolapse, 383, 384
Gastric bubble, 431
Gastric bypass, 128, 380
Gastric cancer
anastomotic leak, 149
cross sectional imaging, 146
diagnostic laparoscopy & peritoneal washings, 146
diagnostic tests, 146
differential diagnosis, 146
GI bleeding, 149
hereditary syndrome, 145
oncologic resection, 147
palliative treatment, 149
physical examination, 146
reconstruction option, 148
risk factors, 145
surgical approach based on T-stage, 148
surveillance, 149
symptoms, 145
Gastric decompression, 128, 129
Gastric mass
differential diagnosis, 146
Gastric outlet obstruction, 127, 128
Gastric pouch, 379, 380
Gastric remnant, 379, 380
Gastric volvulus, 263, 264
Gastrinoma, 211, 212
Gastroesophageal reux (GER), 419
Gastroesophageal reux disease (GERD), 119, 120, 419
after sleeve gastrectomy, 392
symptoms, 109
worsening, 392
Gastrointestinal bleeding, 123, 379
Gastrointestinal carcinoid tumors, 203
Gastrointestinal stromal tumor (GIST), 474
Gastrostomy tube decompression, 129
Gastrostomy tubes, 152
General surgery certifying examination, 503
Genetic testing, 27
Genitourinary (GU) injuries, 281–283
Germ cell tumors, 249
GI bleed management, 160
GI bleeding, 159, 160
Glasgow coma score (GCS), 287, 347, 348
Index
513
Glasgow coma score adult and pediatric, 347
Glucocorticoid excess, 205
Glucocorticoids, 96
Gluteal fasciotomy, 276
Graves’ disease, 225
Great vessel injury, 317
Groin hernias, 255–258
H
Hasson port entry, 457
Hasson port placement, 458
Head and neck lesions, 480
Heartburn, 120
Hematemesis, 155
Hematuria, 245
Hemodynamic stability, 308
Hemodynamically compromising gastrointestinal (GI) bleeding, 159
Hemorrhage
intraoperative complications, 455
Hemorrhagic shock, 291, 345
Hemorrhoidectomy, 44
Hemorrhoids, 43–45
external, 43
internal, 43
Heparin, 402
Hepatic pseudoaneurysm, 288
Hepatic venous-portal gradient (HVPG), 117
Hepaticojejunostomy anastomosis, 174
Hepatobiliary iminodiacetic acid (HIDA) scan, 287
HER2 positive cancers, 35
Hereditary breast cancer, 27, 28
Hereditary syndromes associated with gastric cancer, 145
Hiatal hernia, 263, 264
High peak and low plateau pressures, 363
High plateau and high peak pressures, 362
High risk pregnancy, 461
Hilar injury, 317
Hinchey classication, 71
Hirsutism, 205
HNPCC, 64
Horseshoe abscess, 83–84
Hospice, 506
Hospital-acquired empyema, 370
Hot nodule, 239
Hydronephrosis, 245
Hyperaldosteronism
primary, 215, 216
Hypercalcemia, 233
Hyperparathyroidism, 233, 234
Hypertension, 491
Hyperthyroidism, 225, 226
Hypertrophic pyloric stenosis (HPS), 421, 422
Hypoalbuminemia, 369
Hypocalcemia, 234
Hypoglycemia, 219
Hypotension, 437
I
ICP reduction, 348
ICU care, 348
Idiopathic hyperaldosteronism, 215
Ileal Pouch Anal Anastomosis (J pouch), 98
Ileocecectomy or R hemicolectomy, 74
Image-guided percutaneous core needle biopsy, 34
Incarcerated inguinal hernia, 259, 424
Incarcerated ventral hernias, 261
Incisional hernia, 261, 265
Infection/sepsis control, 69
Inferior mesenteric artery (IMA), 136, 396
Inferior vena cava (IVC) lter placement, 304
Inammatory bowel disease (IBD), 93
Inammatory bowel disease of uncertain etiology, 93
Inammatory breast cancer (IBC), 19
Inammatory intestinal disease, 94
Infrared photocoagulation, 44
Inguinal hernias, 255, 256, 423–424
Insulinoma, 219–221
Intermediate-grade ductal carcinoma in situ, 15
Internal hemorrhoids, 43
Internal hernia, 388
Internal Jugular Vein, 298
Internal oblique aponeurosis, 266
Intersphincteric abscess, 83
Intersphincteric stula (Parks Type 1), 84
Intra-abdominal bleeding, 380
Intra-abdominal or retroperitoneal STS, 474
Intra-abdominal pressure, 269
Intra abdominal solid organ injury, 287
Intracranial hemorrhage (ICH), 347
Intraductal papilloma, 3
Intraoperative hemorrhage, 455
Intraperitoneal Onlay Mesh (IPOM) techniques, 262
Intraperitoneal rectal injury, 273
Intraperitoneal versus extraperitoneal, 273
Intrathoracic pressure, 295
Intravascular air embolism, 445–447
Intrinsic PEEP (Auto-PEEP), 363
Intrinsic renal, 452
Intussusception, 79, 80
Invasive breast cancer, 23
Invasive lobular breast cancer, 25
IPH, 347
IR (Interventional Radiology) angiography management, 285
Ischemic bowel, 41, 42
Ischioanal abscess, 83
IVC lter retrieval, 304
Ivor-Lewis esophagectomy, 113
J
Jejunojejunostomy, 379
K
Kidney stones, 245, 246
Killian’s triangle, 101
L
Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score,
488
Lactated Ringers resuscitation uid rate calculation, 326
Lactation, 3
Laparoscopic adjustable gastric banding (LAGB)
acid suppressing medication, 384
endoscopy, 383
erosion, 383
fundoplication, 384
gastric band slippage or prolapse, 383, 384
long-term weight loss outcomes, 384
514
Index
Laparoscopic appendectomy, 73, 91, 427
Laparoscopic inguinal hernia repair, 423
Laparoscopic Pyloromyotomy, 421
Laparoscopic segmental ileal resection with primary end to end
anastomosis, 60
Laplace’s Law, 76
Large bowel obstructions, 47, 48, 75, 76
Larynx, 300
Left anterolateral thoracotomy with possible conversion to bilateral
thoracotomy, 339
Leg escharotomy sites, 331
Leg fasciotomy, 275
Limb loss, 401
Limb-sparing oncologic resection, 474
Liposarcoma, 475
Liver abscesses, 175, 176
Liver injury
initial workup and management, 289
interventional radiology, 288
intra abdominal free uid, 287
laparotomy with multiple intra-abdominal injuries, 286
non-operative management, 285
operative management, 286, 289
operative strategy, 285
post-operative management, 286–288
resuscitation during the primary survey, 288
transient responder, 285
Liver trauma, 285–288
Lobectomy, 238, 374
Lobular carcinoma in situ (LCIS), 17, 18
Local wound care, 492
Locally advanced breast cancer, 29–32
Low anterior resection (LAR), 87
Low grade dysplasia (LGD), 109
Lower esophageal sphincter (LES) pressures, 119
Lower gastrointestinal hemorrhage, 81, 82
Lumpectomy, 16
Lumpectomy and XRT (breast conservation), 25
Lung Cancer, 373, 374
diagnosis, 373
staging, 374
Lung empyema, 370
Lung nodule, 373, 374
Lung protective ventilation, 362
Lymph nodes assessment, 30
Lymphadenectomy, 148, 149
Lymphoma, 230
Lynch syndrome / HNPCC, 64
M
Malignant bowel obstruction, 65
Malnutrition, 491
Malnutrition in critical illness, 312
Malrotation, 58
Mammography, 9
Management approach by injury grade, 278
Marginal ulcer, 379, 380
Massive transfusion, 322
Maxillofacial/neck trauma, 355
McBurney’s point, 428
Mechanical obstruction and motility disorders, 127
Mechanical obstruction from strictures, 55
Mechanical ventilation (MV), 361
Mechanical ventilation and oxygen support, 326
Meckel scan, 59
Meckel’s diverticulum, 59–61
Median sternotomy, 316, 338
Medical oncology assessment, 31
Medically refractory ulcerative colitis/fulminant colitis, 97–99
Medullary vasoconstriction/ischemia, 452
Melanoma
staging, 465
Melanoma (thick), 469–471
Melanoma operative management, 466
Melanoma rates in the United States, 465
Melanoma treatment strategies, 466
MELD score, transplant referral, 179
MEN syndrome, 234
MEN-1, 212, 219
MENII syndrome, 210
Mesalamine, 96
Mesenteric angiogram, 82
Mesenteric ischemia, 41, 42
Mesenteric swirl, 57
Mesenteric thrombosis (sleeve), 388
Mesenteric venous thrombosis, 42
Mesenteric volvulus, 57, 58
Mesh placements, 262
Mesh repair, 259, 264
Metanephrines, 209
Metastatic breast cancer, 33–35
Metastatic or locally advanced disease, 212
Midgut volvulus, 57
Minimally invasive surgery, 459
Mirizzi syndrome (MS), 185, 186
Mixed lesions, 51
Modied radical neck dissection (MRND), 231, 238
Moon facies, 205
Motility disorders, 127
MRCP, 185
Mucoceles, 51
Multidisciplinary conference/Tumor board, 30
Multidisciplinary therapy, 35
Multi-model pain control, 295
Murphy’s sign, 177
Myocardial infarctions (MI), 443, 444
Myxoid/Round Cell Liposarcoma, 476
N
Nasogastric tubes, 152
National Comprehensive Cancer Network (NCCN), 7
NCCN guidelines, 480
Neck mass, 229–231, 237
Necrotizing fasciitis, 487
Necrotizing pancreatitis, 190
Necrotizing soft tissue infection (NSTI), 487–489
Needle Cricothyroidotomy, 358, 359
Neoadjuvant chemotherapy (NAC), 30, 31
Neoadjuvant therapy in a clinical trial, 470
Nephrolithiasis, 245
Neuroendocrine tumors, 202
Neuromuscular blockade, 362
Nipple discharge, 3–5
Nipple involvement, 29
Non-contiguous cecal inammation, 96
Non-epithelial Lesions, 51
Non-invasive and invasive ipsilateral breast tumor recurrences, 16
Non-melanoma skin cancers, 485
Non-occlusive mesenteric ischemia, 42
Nonselective Angioembolization, 309
Index
515
Nutrition, 68, 69
Nutritional needs, 151–152
Nutritional status, 311
O
Obesity, 205, 491
Obstructive jaundice, 185, 186
Obturator hernias, 258
Ofce-based Treatments, 43–44
Oliguria, 269
Open abdomen, 323
Open abdominal aortic aneurysm (AAA) repair, 452
Open appendectomy, 74, 92, 428
Open gastrohepatic omentum, 136
Open inguinal hernia repair, 423
Open jejunostomy, 152, 153
Open necrosectomy, 190
Open repair, 243, 396
Open Stamm gastrostomy, 152
Open thoracotomy and decortication, 370
Open vs laparoscopic pyloromyotomy, 421
Open vs laparoscopic repair, 423
Operative hemorrhoidectomy, 44
Operative hemostatic techniques, 286
Oral Board (OB), 29, 30
P
P53 tumor suppressor gene, 483
Paget’s disease, 37, 38
Palliative care in surgery, 151
Pancolitis, 96
Pancreatic cancer, 195, 196
Pancreatic mass, 195
Pancreatic neuroendocrine tumor (PNET), 221
Pancreatic pseudocysts, 197, 198
Pancreatitis, 167, 197
acute, 189, 190
chronic, 193
Paraesophageal hernia, 263, 264
Paralysis, 401
Parasternal pericardial window, 338
Parenchymal Injury, 317
Partial thickness burn, 325
Pathologic discharge, 3
Patient centered approach, 505
Peak pressure, 361
Pediatric inguinal hernias, 423, 424
Pelvic binder, 291
Pelvic fracture, 291–293
Pelvis
trauma, 291–293
Penetrating cardiac injury, 337, 338
Penetrating injury, 351
Penetrating neck trauma, 297–301
Penetrating thoracoabdominal injuries, 352
Penetrating trauma, 356–358
Peptic ulcer disease, 211
Perforated appendicitis, 73, 428
Perforated appendicitis, interval appendectomy, 428–429
Perforated right colon cancer, 65
Perianal abscess, 83
Perianal pain, 83
Pericardial tamponade, 337
Pericardial window, 316
Pericardiotomy with cardiac injury, 316
Perineal rectosigmoidectomy, 49
Perioperative cardiac complications, 437
Perioperative cardiac ischemia, 450
Perioperative management for recent myocardial infarction, 450
Perioperative myocardial infarction, 444, 450
Peripheral nerve monitor, 362
Peripheral vascular disease (PVD)
management, 400
Peritonitis, 71
Petrous bone fractures, 348
Phenoxybenzamine, 209
Pheochromocytoma, 209
Phi angle, 384
Phyllodes tumor, 12
Pigmented lesions, 466
Plasma aldosterone (PAC), 215
Plasma metanephrines, 209
Plateau pressure ( pPlt), 362
Platelet transfusion, 319
Pleomorphic Liposarcoma, 476
Pleomorphic lobular carcinoma, 25
Plethora, 205
Pleural effusion, 369
PNETs, 211
Pneumonia, 439
Pneumothorax, 264
Portal hypertension, 117, 155, 156
Portosystemic shunt, 117
Postcholecystectomy syndrome (PCS), 183, 184
Posterior injuries, 339
Posterior-lateral thoracotomy, 316
Postoperative anastomotic dehiscence, 274
Postoperative bleeding, 437
Post-operative cardiac events, 443
Post operative complications, 438
Post-operative fever, 439, 440, 497
infectious etiologies, 439
non-infectious cause, 439
Post-operative hypotension, 437
Post-operative myocardial infarctions (MI), 443, 444
Postoperative renal failure, 452
Postoperative tamponade, 339
Postrenal, 453
Post-resectional Empyema, 370–371
Post-splenectomy immunization, 309
Pregnancy
breast cancer, 21, 22
surgery in, 461, 462
Preperitoneal or retro-rectus mesh placements, 262
Prerenal, 452
Pressure control ventilation, 363
Pressure support ventilation (PSV), 363
Primary brain injury, 349
Primary stulotomy, 84
Primary hyperaldosteronism, 215, 216
Primary repair, 271
Primary sclerosing cholangitis, 96
Progesterone receptor, 22
Proning, 362
Prophylaxis, 414
Pseudokidney sign, 79
PTH level, 234
Pulmonary embolism (PE), 303, 304, 440
Pulselessness, 401
Pulsion diverticulum, 101, 102
516
Index
Purple abdominal striae, 205
Pyloric stenosis, 421–422
Pyloromyotomy, 421
Pyogenic abscess, 175
R
Raccoon eyes, 348
Radical neck dissection, 231
Radical orchiectomy, 251
Radioactive iodine, 225
Radioactive iodine ablation, 238
Radiotherapy, 23
Rash of nipple/areola, 37
Rectal cancer, 76, 87, 88
Rectal prolapse, 49, 50
Rectal trauma, 273, 274
Recurrent gastrinoma, 212
Refeeding syndrome, 313
Renal artery stenosis, 243, 244
Renal colic, 245
Renal failure, 453
Renal injury grading, 281
Renal replacement therapy (RRT), 453
Resection and end colostomy, 271
Resection and primary anastomosis, 271
Resuscitation, 319, 422, 455
Resuscitative thoracotomy, 315
Retained hemothorax in trauma, 369, 371
Retroperitoneal liposarcoma, 476
Retroperitoneal STS, 473, 474
Retroperitoneal/abdominal STS, 473
Retrorectus dissection, 266
Reverse I/E Ventilation / APRV, 362
Reversible hypoxemic respiratory failure, 365
Revised atlanta criteria, 189, 190
Revised cardiac risk index (RCRI), 449
Reynold’s pentad, 169
Rib fractures, 295, 296
Right lower quadrant pain, 91, 92
Risk reduction bilateral salpingo-oophorectomy (rrBSO), 28
RLQ incision, 428
Roux-en-Y gastric bypass (RYGB), 379, 380, 384
Roux-en-Y hepaticojejunostomy, 173
Rubber band ligation, 43, 44
Rule of nines for TBSA estimation, 326
RUQ pain, 183
Rutherford Classication for Acute Limb Ischemia, 401
S
Saccular diverticula, 167
SAH, 347
Sclerotherapy, 44
Screening mammogram
craniocaudal (CC) view, 7
mediolateral oblique (MLO) view, 7
SDH, 347, 349
Second degree burn, 325
Segment 4B/5 resection, 181
Selective angioembolization, 309
Seminomas, 249
Sentinel lymph node biopsy (SNLB), 23
Sentinel lymph node surgery, 23
Sentinel node biopsy, 466, 469
Sepsis, 437
Septic shock, 488, 498
Seton, 84
Short esophagus, 264
Shouldice or McVay repair, 259
Siewert Classication, 146
Sigmoid volvulus, 47
Sigmoidectomy (resection rectopexy), 49
Signet ring cell carcinoma, 51
SIRS (Systemic Inammatory Response Syndrome), 439, 440
Sistrunk procedure, 230
Skin cancer (squamous cell cancer), 479, 480, 485
Skin care, 68
Skin lesion, 479
Sleeve gastrectomy, 384, 391, 392
Sleeve leak, 388
Small bowel obstruction (SBO), 55, 56, 79
Soft tissue sarcomas (STS), 473
excisional biopsy, 473
ne-needle aspiration, 473
follow up, 474
image-guided core needle biopsy, 473
imaging, 473
imaging studies, 475
incisional biopsy, 473
management of complications, 474
non-operative treatments, 474
staging, 473
surgical excision, 475
treatment, 474
Solid pulmonary nodule, 373
Solid pulmonary nodules in adults, 374
Somatostatin receptor scintigraphy (SRS), 202
Splenectomy technique, 308
Splenic and transverse colon volvulus, 48
Splenic artery aneurysm, 409, 410
Splenic salvage, 308
Splenic trauma, 307–309
Sporadic gastrinoma, 212
Squamous cell carcinoma, 230
Squamous cell skin cancer, 479–481
Stab wounds, 297
Stage II or III with prognosis, 29
Staging laparoscopy, 195
Stereotactic core biopsy, 15
Sternocleidomastoid (SCM), 230
Strangulated (grade IV) hemorrhoids, 44
Strangulated hernia, 259
Stroke, 405, 406
Subclavian artery, 299
Subxiphoid pericardial window, 338
Sudden hypotension, 363
Sulfasalazine, 96
Supercial surgical site infection, 424
Supercial wound dehiscence, 492
Superior mesenteric artery (SMA) aneurysms, 409
Supralevator abscess, 83
Suprasphincteric stula (Parks Type 3), 84
Surgery, 22, 507
Surgery in pregnancy, 461, 462
contraindications in the surgical patient, 461
Surgical airways, 355, 357
Surgical cystogastrostomy, 198
Surgical decompression, 333
Surgical enteral access, 152–153
Surgical prophylaxis, 414
Surgical site infections (SSIs), 497, 498