Lecture Notes

1 Lecture Notes :General SurgeryCompanion websiteThe book is supported by a website containing a free bank of interactive questions and answers. These can be found website includes: Interactive Multiple-Choice Questions for each chapter Interactive Short Answer Questions for each chapterLecture Notes :General SurgeryHarold EllisCBE DM MCh FRCSE meritus Professor of Surgery, Guy s Hospital, LondonSir Roy CalneMS FRCS FRSE meritus Professor of Surgery, Addenbrooke s Hospital, CambridgeChristopher WatsonMD BChir FRCSR eader in Surgery and Honorary Consultant, Addenbrooke s Hospital, CambridgeTwelfth EditionA John Wiley & Sons, Ltd., PublicationThis edition fi rst published 2011 1965, 1968, 1970, 1972, 1977, 1983, 1987, 1993, 1998, 2002, 2006, 2011 2011 Harold Ellis, Sir Roy Y.

2 Calne, Christopher J. E. WatsonBlackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell s publishing program has been merged with Wiley s global Scientifi c, Technical and Medical business to form offi ce: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UKEditorial offi ces: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USAFor details of our global editorial offi ces, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at right of the author to be identifi ed as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act rights reserved.

3 No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the published 1965 Fifth edition 1977 Ninth edition 1998 Revised edition 1966 Sixth edition 1983 Reprinted 1999, 2000 Second edition 1968 Reprinted 1984, 1985, 1986 Tenth edition 2002 Third edition 1970 Seventh edition 1987 Reprinted 2003, 2004, 2005 Fourth edition 1972 Reprinted 1989 (twice) Eleventh edition 2006 Reprinted 1974 Eighth edition 1993 Twelfth Edition 2010 Revised reprint 1976 Reprinted 1994, 1996 Greek edition 1968 Portuguese edition 1979 Indonesian edition 1990 Turkish edition 2005 Wiley also publishes its books in a variety of electronic formats.

4 Some content that appears in print may not be available in electronic used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be of Congress Cataloging-in-Publication DataEllis, Harold, 1926 Lecture Notes .

5 General surgery / Harold Ellis, Sir Roy Calne, Christopher Watson. 12th ed. p. ; cm. General surgery Includes bibliographical references and index. ISBN 978-1-4443-3440-1 (pbk. : alk. paper) 1. Surgery. I. Calne, Roy Yorke. II. Watson, Christopher J. E. (Christopher John Edward) III. Title. IV. Title: General surgery. [DNLM: 1. Surgical Procedures, Operative. WO 100] 2011 617 dc22 2010036446A catalogue record for this book is available from the British in Utopia by Toppan Best-set Premedia Limited01 2011 ContentsIntroduction, viiAcknowledgements, ixAbbreviations, xi 1 Surgical strategy, 1 2 Fluid and electrolyte management, 5 3 Preoperative assessment, 10 4 Postoperative complications, 15 5 Acute infections, 26 6 Shock, 31 7 Tumours, 36 8 Burns, 41 9 The skin and its adnexae, 4710 The chest and lungs, 6011 The heart and thoracic aorta, 6912 Arterial disease, 8013 Venous disorders of the lower limb.

6 9814 The brain and meninges, 10515 Head injury, 11416 The spine, 12617 Peripheral nerve injuries, 13718 The oral cavity, 14319 The salivary glands, 15320 The oesophagus, 15821 The stomach and duodenum, 16722 Mechanical intestinal obstruction, 18323 The small intestine, 19424 Acute appendicitis, 19925 The colon, 20426 The rectum and anal canal, 21827 Peritonitis, 23028 Paralytic ileus, 23629 Hernia, 23930 The liver, 25031 The gallbladder and bile ducts, 26632 The pancreas, 27633 The spleen, 28934 The lymph nodes and lymphatics, 29235 The breast, 29536 The neck, 30837 The thyroid, 31138 The parathyroids, 32339 The thymus, 32840 The suprarenal glands, 33041 The kidney and ureter, 33542 The bladder, 35343 The prostate, 35844 The male urethra, 36745 The penis, 37046 The testis and scrotum, 37447 Transplantation surgery, 384 Index, 391 Companion websiteThe book is supported by a website containing a free bank of interactive questions and answers.

7 These can be found website includes: Interactive Multiple-Choice Questions for each chapter Interactive Short Answer Questions for each chapter Introduction The ideal medical student at the end of the clinical course will have written his or her own textbook a digest of the lectures and tutorials assiduously attended and of the textbooks meticulously read. Unfortunately, few students are perfect, and most approach the qualifying examinations depressed by the thought of the thousands of pages of excel-lent and exhaustive textbooks wherein lies the wisdom required of them by the examiners. We believe that there is a serious need in these days of widening knowledge and expanding syl-labus for a book that will set out briefl y the impor-tant facts in general surgery that are classifi ed, analysed and as far as possible rationalized for the revision student.

8 These Lecture Notes represent our own fi nal - year teaching; they are in no way a substitute for the standard textbooks but are our attempts to draw together in some sort of logical way the fundamentals of general surgery. Because this book is written at student level, principles of treatment only are presented, not details of surgical technique. The need after only 4 years for a new, 12th, edition refl ects the rapid changes which are taking place in surgical practice. We are confi dent that our constant updating will ensure that this volume will continue to serve the requirements of our medical students. We advise you to read this book in conjunction with Clinical Cases Uncovered Surgery , which provides illustrated case studies, MCQs, EMQs and SAQs, cases that correspond to the chapters in this volume.

9 H . E . Acknowledgements We are grateful to our colleagues registrars, housemen and students who have read and criticized this text during its production, and to many readers and reviewers for their con-structive criticisms. In particular, we are indebted to Simon Dwerryhouse (Chapters 20 and 21 ); Justin Davies (Chapters 22 , 23 and 25 ); Gordon Wishart (Chapters 35 , 37 and 38 ); Neville Jamieson (Chapters 30 33 and 40 ); Kathryn Nash (Chapters 21 and 30 ); and Andrew Doble (Chapters 41 46 ). Finally, we would like to acknowledge the con-tinued help given by the staff at Wiley Blackwell, in particular to Jane Fallows, who has created some new diagrams and brought colour to others, Rebecca Huxley, who oversaw the production, and Lindsey Williams.

10 Who has meticulously steered this edition from text to fi nished Abbreviations ABPI ankle brachial pressure index ACE angiotensin - converting enzyme ACTH adrenocorticotrophic hormone ADH antidiuretic hormone AFP - fetoprotein AIDS acquired immune defi ciency syndrome ALP alkaline phosphatase ALT alanine transaminase APACHE Acute Physiology And Chronic Health Evaluation APUD amine precursor uptake and decarboxylation ASA American Society of Anesthesiologists AST aspartate transaminase ATN acute tubular necrosis BCG bacille Calmette Gu rin CABG coronary artery bypass graft CEA carcinoembryonic antigen CNS central nervous system CRP C - reactive protein CSF cerebrospinal fl uid CT computed tomography DCIS ductal carcinoma in situ DIC disseminated intravascular coagulopathy DMSA dimercaptosuccinic acid DOPA dihydroxyphenyl alanine DTC differentiated thyroid cancer DTPA diethylene triamine pentaacetic acid ECG electrocardiograph EMG electromyography ER oestrogen receptor ERCP endoscopic retrograde cholangiopancreatography ESBL extended spectrum beta - lactamase ESR erythrocyte sedimentation rate ESWL extracorporeal shock wave lithotripsy EUS endoscopic ultrasound FAP familial adenomatous polyposis FEV 1 forced expiratory volume in 1 second