SURGERY PLATINUM FIRST EDITION 2018 LOUBOMIR CYRUS E. ANTONIO, MD RONNIE E. BATICULON, MD JOHN PAUL EMERSON S. MARINAS, MD JAIME ALFONSO M. AHERRERA, MD. MARC DENVER A. TIONGSON, MD. ENRICO PAOLO C. BANZUELA, MD EDITOR ENRICO P. RAGAZA, MDi png Srgey Pinna Fra ition anced Top hraice Medial Pubsstng Corporation Mania Phiippines Proceeds rm the Fist tha Sek wl ad the developments ngrovenen tre eit oft book Please vis our Ota Facebook Page, hips: /wwdacebook com rgerypltina, for ifermaton on how to procire your Surp=y Pinta boo st the lowest possible price argery Tati copies canbe delivered to your toorttep anywhere nthe Pipes wit 37 days afer bank poyment. Unauthoraed reproduction o th bot is thegal Beware of cutters an orginal Surgery Panu coy et ype nt mt en popes Yu eee ‘pine Copright 201 8b Tp Paice Medal Putting Cop Back design and aout by Fine Mecy Rubin Alrightreserved No prt ofthis pubaton may be reproduced, tered na etieval sytem, wars ny Form bya means witout ‘rior permision fom Top race Meal Pubishing Corporation| abled by. ‘Top racic Medcl Putin Corp 27 Merery Street Fue, Quezon Cty Printed the Pippines sonra 62.9998:24CONTRIBUTING AUTHORS Karlos Noel R. Aleta, MD, FPCS, FPATACSI, FPSVS, FPAMITS David Vincent J. Antonio, MD, FPOA ‘Anne Kathleen B. Ganal-Antonio, MD, FPOA Deonne Thaddeus. Gauiran, MD, FPCP Ma, Concellene L. Laforteza, MD, DPBA, MHPEd, FPSA ‘Timothy L. Tang Lee Say, MD, DPBO ILLUSTRATORS Mark Anthony G. Marifias, MD, FPCS Joerelle V.Mojica, MD, FPCP Jose Manuel S. Santiago LAYOUT EDITORS Frinz Moey C. Rubio Victor Cesar 1. UbaldoNOTICE ‘The infrmation inthis book has been reviewed and weed wth ‘elle source andthe appraaches to management ve been ized In inkl practice However meine san ever changing sence New ‘ach, Gung in Gin. ma crore The ator ‘tr and pubser are not responsible fr errors or omissions of {cany untoward outcomes rom sppication of data i this book. The thors er polisher and other fates who fave been valved a the preparation of his book make no verry, exressed crimped twit reapect to the completeness, cra. of beng op todate fa the information contained in thi ablation. The authors. dor and Publier encnurage the readers 0 cnfrm the information here ‘th ther source andto exeree ciel thang based on the ceil resentation ofthe pant a aking decsonsortmanagemenInloving memory of, Luciano L.. Antonio May 23, 1939 January 15, 2018PREFACE Because Surgery covers such a wide array of topics, many textbooks are too overwhelming for most students of Surgery. Surgery Platinum was created so the student of Surgery would find an easily readable, practical, and portable reference source that would be of use on a daily basis This handbook provides 4 brief yet most up-to-date discussion of surgical disorders, with liberal use of tables, pictures, and algorithms to help reinforce the information in each chapter. Although one does not become a surgeon by learning through books alone, Surgery Platinum is a good foundation to start the journey. May you all {ind this book helpful and friendly! MESSAGE FROM THE MAIN AUTHOR It would have been impossible to turn my dream of writing a book in Surgery ‘without the help of many wonderful people. In particular, | am indebted to Dr. Enrico Paolo C. Banzuela for his patient encouragement for me to make this hhappen for our students. though I have the contents ready for a long time, it Is through Broli, together with Jaime, Denver, Ronibats, and JP that this book finally came to fruition. I also would like to thank my mentors and colleagues at Our Lady of Fatima University, Quezon City General Hospital, and St Luke's Medical Center ~ too many to mention individually - for believing in me. 1am especially grateful to my family, especially my mother for the unconditional love, and friends who have steadfastly given me practical support and moral encouragement. Karla, Lecs, and Loul deserve special praise for their forbearance and understanding Without all their prayers, support and encouragement, this book would still bein the sundry filefrom whence itcame. LowACKNOWLEDGEMENT “othe LrdAimighy wo makssltngspassBle: ‘post famles fr herunalinglovesndsupport Ora Man Dumas Marts Fama Mar asa ipo: (Spe hime olan te Ma Reso Akers rc Marrs be ane & Mtr Pathe arise ‘ongon Or Rady Um, bis rae Cheng Bats Me Anna fares ope” Un Bras GSA ei es Ce ern te yon nc Mage SesaYenn in? & ese Toy& af and orange Har Chica dng a Rone {Ener Orgracos& hes Tina Cason Or Hector € rte: De Lauren Lira, ee © Lap Sosa usar Me Ania brs Rosemarte Tang se So ‘ew AW IGP, and We ‘Toallor mentors rom the UP-PHDeprtnent of Suge fr triable uidace md wom: ‘Te De Eduardo Garcatn De Denn erage are Camels M.Lptan, Dnson of Urslgy Pat Deparment See {ee for toner rhe pony Gods Pe Nnane Peay Ds Romeo Arlen lr speng us Fetsnine Fv hot Ansa bin Quer De Aton on De Aledo Bega SEE ‘othe Don of Tora &Criovassar Surgery UP GH Deparment of Surge peel De ose (orate br flrs Laan, rot tas Asmar Mana Cnr Conte Tian supetommanes ‘edmond Vilsoman Or Maram Grace AUeina Ora Sephonc Haag boaters tet tt ert seta agiy momma tarp tne Rance Seimak ais nor anwerancore emrcsemraea Soca weenie a ecgrons ameia ce ies esuecienecrig ar cte succmacpece ace eee can perma Sasa 1 hm Matin ee api rs ee ana theFattpine Conta Razpal wna em wouter bw am My ans Osn bats) (Gta frost Le Profesor Kenneth Chang Wong Yt Wa orbleving me lth ove ices hn pcay nay geting omecrhingersebyng atk you a0 ® erat Depormen of Anesbsly,epecaly De Loreto Fella whe npr uo be beer Siemans eel Sec pc De agree Arye ted Frere ry een tae te rte ie cian erent oor eee eet iarmale een neeee mn eeec Sao teoetngrt op bargin nt ‘orton reg wnt soy averpaneererecace ‘Thstooks loving delle to Deamon Aare | Me Lace Ana and ty ihoTingson Lu, oni ane, Denes Br ie Kal, gay, Pebbles Denne Mark yen TeTHE AUTHORS Loubomir Cyrus E. Antonio, MD, FPCS, FPSGS Anan ranted with 8S. Pharmacy degre he Ui Tomas in 197 Nein i eal age vm te OnLy a Foe Unory in S00) rere he mn rane al sede {aarhinand ished comloueand on Outtading Cal Get Heise esta he 2003 yon iSteareEraminrsos He ls ttemse 9 epentof svar of sadem dtncon rom he Pipe Medial Acton the Pipes Bord of Medic andthe Paitin Repsey Commcan He {ck cna Srry ong any Seal 2009 pursed Srp Oncology Fbawahp taming att Lat dale Sorgeon. the Pippin Socey of General Surgeons and the Surgeal Oncology Society of he Philippines Ronnie E. Baticulon, MD, FAFN ‘An Otaton sean NTARMD stadet Oe tcl rade cam nade rm the Unecstyohe Pipes Coleg oftedine He compleedhisneurarery ang Pn Coser sd ‘Aiale he terry arma profesor oe OFM Departs of Anatomy Sad» feo oe ‘ead tpn earns Une he oe is essays ond stones ia seg Bp //robotsp John Paul Emerson S. Marifias, MD, DPBU, FPUA, FPES Seepage hey Cann aireaae eet nate Bane ee Sacgeerece pteacd ert eect ter avery sat gag tigate. ‘tangas Hedi Specs and rly Contant fe Antipan Cy Hosp! Sem (A) Dee iS haply marae obs oy wie Or Haan Dumiso Maras m opthninolgst ale» peda of UP {alee of Meiene aod pred ot URN Deparment of Ophissimolony& Vl Scenee Ne es ‘esding aed Sing ens Sart: motes nd repre ands soveimseea le so ce wes ‘ietion pn ember sts ther te Poppa Me seo, Jaime Alfonso M. Aherrera, MD, FAMP, FPCP, FPCC De Atereragradute ith 3S Hunan Boog degree Banorsbe mention om e a Salle Unerty- Monde 26h He obiied hs metic epee Fhe Ge Sale Unneraty-eh Sauce state ln 2000 wher he shed Rat Hoare tenon garnering tarsi the Deon Special hard for Aesdame Perormnce Spec Caton for Andee Exon onthe Dr Rms Ae Host ‘Staten nce dn henson ain ee Poe [teoare amt Aut 200) He compre hs retry intern ene te Fl ‘Ener ap in 2012 drag whch he sere ss stot Ch! Rent for Pongradte Tring Derg rendeny me eed academy wth several research award and er ospl competes: Sderot radstedas Mort Oustong ene! 201 and wazone the atonal its seen pes ins ee ronnie ‘ars 2014382015} rece of tc Host Outnding For Cana rom the Pipi ear. etwas be Php Catege ef Pyican se Pipe CaegeatCadclogy ss presenty Pacing = on teen Cotloget Depe thes seg shen me Fens owned. emtoeoi andy endo a pees smd cleagarsMarc Denver A. Tiongson, MD, FPCP De Tlongson graduated with 05 Blogy dere. Marin Cll and Meee Boog. cu ade rom Uo a Baas 206 te ened namic Segresrom the UP Calege a Meet e701 aed wa ‘ranted Outing ttn seer Sepertnents Un paring he ec bur xine, be tare {oy meme fie Secon af ayo, Bec Scour ond Cnc Sener an Boda alee of Hen firs ass scl member of Topas Mees ard rep tang ches, Aa Pharmcsloey and Pathology e was one of he pepe wn sured the Pipne Soy of Coe (igs lacey pared to trove the pace of gal psc te oy. Dorr Ged ‘SPrsteny neal Medina Pipe Gert Hest where he served a Asstt Cet eden for nrmaton Manage Systeme urge snr per Carrey, hes» Doma of the Pitre alee of Pyne Hes present pug eowsip taining Nl arog {Ses isttn ce esr tte nek tude ans on ond ok Enrico Paolo C. Banzuela, MD Sep tel ie eal cars one ico tony THE EDITOR Enrico P. Ragaza, MD, FPSCRS, FPCS SE a er rete ee ‘lp aoc Surgery nth ae cton hs ener af leaser, Be {Beater ae aeen nae tana cece ie peinerantesdagratey co tanetrs Raeectre ae Hetbye gad tanec eee omnie eecionaenars ss apis ca cemen ore tracos enters oemasccpeercteeeeaahamtas mecaget eee eelsCONTRIBUTING AUTHORS Karlos Noel R. Aleta, MD, FPCS, FPATACSI, FPSVS, FPAMITS DcAleagradentedwitha BS Bag deges om elniversyelth Pilipines(UP Dinan He ane {nthe Deportes of Surry Me hs uo ben spine acy ol he Cleef Mee he Pauw ag Ungsd ng Moy snce 2005 nce prety an Asan Prosar wth et 1 pecsenty ng arnt rath rotesaner axion a fhe UP Res Tne Ting {tefl Pesan where ne as bec! Clg Shlae Ade ors pring {feral TS n bath pra and goverment spt Dr Alta so Specs fn Mal vai ‘face Surgery (vider ised Trace Surge an avoid Thorac Surge heehee Pata sua ean perfor ReboisAcated MajorLangenectoe aly Hees acing Ee apering era proud aly man wh enjoy the spp of his wife and riven Hs ates ino ply muses struments reading came bankreagtrathion events ond wach met Saye hs ly David Vincent J. Anto De Antonio ote Mi 5. Md Scenes (NTARMED)o 200220 men on conte Me med ‘de tom he U Cage a Medien 205 Ne nak op he redeney Wang for Ortop she ‘lipe onc Vxp ad inched in 2009, ok tres mt fll of Adu Orthopedics sed Medea Year eae hppa tot scoped snd pbs ethos, ene athens Coa anim sath sare many common Gren ot toyes ln aspee tine ‘totaling coking thelr hs ami eng ns or ong onan hr Beh ‘Sed Taon lisa fn ofall hing vintage od ese aout the Sco Wold War Anne Kathleen B. Ganal-Antonio, MD, FPOA Sere eee meres herrea etna ree ete pera eee aera eee fee ee ee ae see ected Soe eee ata Se eee rre cence sae erie vests aa Fo Cr be a a no ssa ete a erie eae ae eee (rocaor tthe Atco SEheulef Meine ted ABN Resin whee she tescks Anatomy and O ee ete cee ete elena eee cas cece snes pes eerie rege {hoypurcyted i smeics monn aremet om Minor nate Ratatonofbow este ‘Sponge ieath cr tera ar Soper twa ade ehhDeonne Thaddeus V. Gauiran, MD, FPCP De Cauran graded with 05 Bsc Med Snes dre (NTARMED) com ude om UP Man ‘oe ie Sound Ne metal dpe am tie UP Cage of edn 01 wher be Red ed te hs cas, com fede and asa 4 board tpmtce daring the fugit 2011 Pipl Pye teanore mins eine sng nts in teeta Meine 201) a resdoey Intra Melanin 2014 am the Uiippne Coe ape where reed seem ower Se acer gee rt Manas Ceti Users ote Pipe" Plippine Genera Hosp he hs been nal pct 56 years ‘ula steeds caeperon or the Ueprtment of fassthesnbgy athe del Mende edi Cntr {onc rey Cres Mca Cntr Pipi) were secrets te postion a oe ‘Seopa rman FOND Pa Cet: She sre er spe ney in erent capaci bere {ctncame the ee reste ofthe Pepi See of step Se war speed be prt ‘fine Profeion)Repton Commasons FRCS) Tchad Working Growp af Petes Medes Elscatrsc ah slo lhe er baste neh reson Eda ie Users he Pepe ‘whereabe wars Caege Scone hers tacdenian cnet wth en Bos User ead of ‘ote Mee Eveston's Featy Devapment Une cree oer ting and penne se hen sted osewe a apeaer varus conven ta tsemtics Sele sn nected ee ese Rncltin trae Snetoes ttre ith er vr supporwe usando a pedatcan ed ‘erauphter nto sbosphycanand owarprertbe lke eranestenopst mom. Timothy L. Tang Lee Say, MD, DPBO neering nt oi ge ety Spee leat era a ee Sener: mae meeene rane HSS eae hres ees ce) the oe yee shed Optailogy ote Department of Gps toa Weal ences othe Unters of {Gc etligpine- Pll Geer apa ar the ach Wetonan 2016 ibe Digan ‘Se Pipe Gord Opting 2017 Me cent the Wrearetal ello Crd Satot ical ace grmcred eel ends on esse eye eng eaten rng an UWetldsotcomeiwaness energy mene span snd semILLUSTRATORS Mark Anthony G. Marifias, MD, FPCS Joerelle V.Mojica, MD, FPCP 1 Mojea complete herdepreein BS eapation! Therspy the nersy of he Plies oda bctrat edna sere atte Unter otc ts Ramon Magna email Cetet i: 2010 ander mera escterenieny sbondaDtors Hosp 214 Sets aCarSlogy alow ath nest tbe tines. Patppn cel opal nd pao persicae ‘Care ectrophyscogy Se pressed er rsarces nbc seineratonalconeenes Faeelye wating moves ving ou th my a nen nd econ ene ahr Png ae Stic tobe pur a someun haere te arg ne my Jose Manuel S. Santiago 1M Sotgo gested wih a 8S logy dee fram the Univer ty of he Pipes Maia in 201. [enrards he pursued Meine atthe Unorty the Phipps Clee of Mescne Ne Warren aid yon meal see mpg to picts slog argon Be mre, a is et talncafetm ns exre cra botte suchas laying fr the Utimat frsuewom ofthe Calg of Heine mnehngmones and stows png oketungpamtngFesding cio or ler tee Sctying ou nen pe atin LAYOUT EDITORS Frinz Moey C. Rubi Fie Rb dunedwith05 Pic teat are, magna cum inde, eC of Pubic eh (Gon SRRESeyeFign bas SON We haga Ne morte Sean ar ee ‘egete rope sar Sty rope coal eas Meth Coeny he an eed (ikea rte Unica the Pp ctege of ne, spring pre sa ronan ‘tte tre ent Cteg Solar be managers tances seaterstc harps weet ‘Neste ce wscing ner ig ge asa a okey ar Victor Cesar I. Ubaldo Vie Ube cre hid er mec stent ate Ue fhe PilpiesCalege of eine (are prsugitesione he scomplahe hs segrecin 0 Buttes: zononoer athe vray of he ‘Phtipoes Bios grading mags cam as Wie tpn in UP Bean esl waned ata taint te het of Detdopen tod Econ: Aap neo ie ts Koes rece ‘Setopcs fled omanagemet td beth rl ppbmg tes cre ake ‘ates eal he beater ounres newerTABLE OF CONTENTS ‘GHPTER 1 GOOD SURGICAL PRACTICE AND PATIENT SAFETY "PART ONE AFPROACH TO APRIEM WHASURGICA COMPLANT ‘Onto ae Gee Poach a 2 Caratanestabn Surges Osos 3 PART TWO: GUDE TO COMFOBWG OFOERS aig Ores at Petem One Pres es ‘ec roma tee Peopaaie nas Specie Pasoperave Woes PART THREE CURIA SAFETY 1 Det of em en oP Sly 2 2. SugeatyReevr Outy mpevene Pics 3 3. Wot eh Ogansaton Sey hea ‘ ‘CHAPTER 2 BULDING A SURGICAL VOCABULARY PART ONE ANATOMICOWEDICALTERNOLOGIS i I ag Two, DESEAING PATENT POSITIONS THE OPERATING ROOM ART THREE COMMON URGCALTERMNOLOGES ART FOUR: COMMON SURGICA ISIS ‘faa rch f i Peres (HAPTER 3: MEDICAL ASPECTS OF SURGERY PART ONE: PREOFERATVE EVALUATION ‘, saiclon » 2 roan Suga % ART WO: SEFC AND SEPTICSHOCK 1 Uptaa Deets Based on Sep 3 » 2. Overview l te Margene Sepa and Sac Sack 2 PART THREE ASEPIS,ANTISEPS, ND PROPHTLAKS. ‘Dato t Teme © 2 elton ecus Py 3. Prope Aste Tee a 1 mes rasa “ Sarda Pecutrs sd Dentons a "Supt Si ncon (SS) Cea “ 2 estes Neon eto Suen Soe ad ik. SS. a 3. Charaeises hairs Rho SS 6 4 Prevetonel SS & 5. Parma bts commented x Sup Pops « aR FIVE HEMOSTASIS COAGULOPNTHY, TONSEUSON AND PEROPERATIVE slEEDRG Honstass « Compost Tune a Spay Paes Resting Angus o Fano Us of Sond nd eed Pros o‘HMPTER 4: FLUDS, ELECTROLYTES, AND ACID-BASE DISORDERS PART ONE FLLIDBALANCE Neal Pad ce Bas Repro Water ond crs ‘seseg ee Sans ‘Beco Conpostne of ds (reg) \Conmen Gece eades Pacoae Marnaredt id Regent PART TWO: ITRAVENOUS FLUDS FOR THE SURGICAL PATIENT 1. BaseTypest zens ies 2. Conposton fhaareros Puss PART THREE INTRAVENOUS FLUOS AND THE PEROPERATIVE STATE 1 aperae Fad Therapy 2 Paper These Moneeg 4 Aeeng Poster Voe Se ‘HAPTER: SURGICAL METABOUSM ANDNUTRIION PART ONE PREOPERATIVE NUTRITIONAL ASSESSMENT ‘eo PART TWO: AGING NUTRITION I THE SURGCAL TENT 1 Goat Nariel Sipe 2. Esimaing Ero eh Reptenants 3 et Feaieg NRT THREE PARENTERAL NUTRITION rates ad Coens ‘pe oP ton Sioa ees Sone | Oe ‘Conplestrs Assckatd wih be Use of TPN (CHAPTERS: WOUND HEALING PART ONE WOUND ASSESSMENT 1 Dacia Word 2. Ceoteaon Wds PART TWO: WOUND HEALING 1 Foe Wand sig 2 Wad Goa 4. Fac iting Wound Hea 4 ldgeat Ace cies ne ag PART THREE: WANAGEIENT OF WOUNDS Morano ne Clan Woon Notognertot te Catone Wout ‘Wow Debian Chore te Hel sng Cann reso aera gee es eeessee 8 8 aw aseasCHAPTER 7: ONCOLOGY PART ONE: BASIS OF ONCOLOGY 1. Epon of Caesinne gps es 2 Gores Nome % 3 Srp ban eae ts e Tres a PARTI WG SURO WAUGEMEAT OF CANCER 1 dan = 2, pay a Specinen Heng a opie Suge % PART THREE: CHEMOTHERAPY, RADIOTHERAPY 6 TREATMENT RESPONSE 2 a * 9% % * 7 ” * ‘0 10 0 = @ ‘0 ‘0s 4 rd . 1 3. Lehi Graig dma ‘ PART FOUR: RETRACING NSTROMENTS a PART EVE: WOUND CLOSING NSRUMENTS AND MATERIALS 19 PART Sie SURGICAL NEEDLES us PART SEVEN SUTURES ANO SUTURE TECHMQUES Me PART ECT: MER SURGICAL NSTRUMENTS &EQUPMENT 1 Conny Use Dts 1 2 OberOeves m ‘HAPTER: PRACTICAL OPERATIONS AND BEDSIDE PROCEDURES PART ONE: CENTRAL VENOUS CATHETERIZATON SELDNGER TECHWQUE) 135 PART TWO: CHESTIUBE NSESTION = PART THREE: RICOTHYROWDOTEMY a PART FOUR: VENOUS CUTDOHN 3 FART FVEDAGNOSTIC PERITONEAL LACE ‘0 PART Sic LAPROTOUY “ PART SEVERE CRCUNCISION ie PART EGHT: NOSION AND DRANAGE 1 PARTNNE: PERIARDCOENTESS 18 PART TEN MANAGEMENT OF ESTAS. weCHAPTER 10- TRAUMA AND BURN RUURES PART ONE APPRORCH TO APRIEN WTH TRAUMA, ‘, Ona 2 Panay Suey 3. Senay Suney 44 Connor Canton Systm ced ART TWO ABA. BTESAND TETANUS 1 Manapowat Po Rais Ege 2. Preven an Cana ears PART THREE: URN NJURES ‘Orv fu py Marapament ressonrttbun ay ‘tan of Bu ny ‘San oes of un ry un Sern Calgozsen nd arapsnet Intalnerene Reon Marana Tope mcr gets Us Bu Care encanta Cre Dave anagem? ‘CHAPTER 11: MINMALLY IWVASWESURGERY (VERVEW PART ONE TH ae 1. Phyakdoge Efe fLapacsipy ‘CHAPTER 12: EADAND NECK PART ONE: SURGICAL ARATOUY OF THE HEAD AND NECK. PART TAREE HEAD AO RECATRAWUR 1. Haji oS Tease Taunt Head and Nec 2 Mander eres 3. Nasal Fazes 4 Aeace aces PRT FOUR: NEDPLASNS OF THE HEAD AND NECK “ ww Me 10 19 0 181 ‘st 8 ‘et ‘et is 1s ry ” m iw we rm 1 1 m m m 1 1s 1 19 19 1% at 185 1 5 cs = ‘ae i(HUPTER 13: THESKN AND SOFTTSSUES PART ONE: SURGICAL ALATOUY 1 GrssAnatmyaatitegy 2. Pyselny Pat Iwo ISORDERSOF THE SAN ‘. irestoe Sie 2. Means ate aR THREE: EENGN NEOPLASHS OF THE SAN ‘Bonn Ouran Necrlsms PART FOUR ALIGN NEOPA OF THE SHIN 1 Nenana Sen Canes SC) 2 Melgar (CHAPTER 14: THE BREASTS ART ONE: SURGICAL ANATOUY 1 Goss frau the Beast 2 \ymchbeinae 5. SupetPeas PART 1WO- DISORDERS OFTHE GREAST {orga cai me eet 2. Grecnasa| aso or tanto Dace fe Bast PRT THREE GENGN BREAST NEOPLASNS ‘Ome 2, Sen opm PART FOUR NONINVASIVE MALGNANT BREAST NEOPLASUS ‘ue Caoma nS 2S) 2 Utter Crome S23) PART FME:IMASWE WALIGAANT BREAST NEORASS 1 panayaclony ‘hoa anteatans Bagese Mrcoanet Sod Conaintns ast Seana or yoga CHAPTER 1: THE THYROID AND PARATHYROID GLANDS PART ONE: SURGEAL ANATOMY 1 Ty id 2 Pachyod ent PARTI WO: DORDERS OF THE THYROD GLAND ‘y "Daveupmets Pats 2 Cater 4. Were tes het may Bonet fom Spry Teas Suey or Ty Dees yey) PART THREE OPUS OF HE THYROD 1. Approach Ted Noplasns 2 Benge nya eopasne 3. Tyeotcaceane aR FOUR" SOROERS OF THE ARATHYROD GLANDS 1 Gera Geeta te Paty Gl 2 Neeplunsol ne Pobre Gant 3 1% 185 196 19 msPARE CN: SURGICAL AMATONY PART TWO: ORDERS OF THEESOPHAGUS \Gatroesprapen Re x Disease (CERO) Daptapmac a) Han Esopaqeal Ove omy Daas (cates Exped Ptecion etlneae Lesone ART THREE: NECPLASMS OF TE ESOPHAGUS 1 Espagel acim 2 EsanapeSatare CHAPTER 17: THE STOMACH "PART ONE: SURGICAL ANATOMY FART TWO, DISOROERS CF THE STOMACH 1. Pec cer Doss (PU). Ete nee nat NEOPSS OFTHE STOMACH 1 Geli Acenecrana 2 Caste mons 3) Gsroitestea Seon TunerT) 4 Gasietaas ‘HAPTER 18: THE SMALL TESTES. PART XE: SURGICAL ANATOMY PART TWO GORENG OF THE ALL NTESTRES {1 Smal onl Caren $80) 2 ei Fee 3 Wes Ovetein 4 Mesanste oer ART THREE: NEOPLASMS OF THE SMALL TESTES ‘PTE 18: THE APPEND PART ONE: SURGDALARATONY PART TWG.ACUTEAPPENDISTS 1 Patephycony 2 Gina tantettens 3. Dapestes Margene 5. sesame ompctons PARTTAREE APPENEICTSW SPECIAL PORRATINS 1 heYang epee ae Si prs PART FOUR: NEOPLASMS OF THE APPENOD 2 m 2s 6 PY Es eee REE ©CHAPTER 20 THE COLON RECTUM. AND ANUS PART ONE: SURGICAL ANATOMY 1 TheCaon 2. Thee fs PART WO: DRORDERS OF THE COLON 1 Coens 2. Der oso 3. reels 4 tana BoweiDscse 05) SCs Bee PART THREE DSORDERS OF THE RECTMANOANLS 1 Re Pree Prost) 2. Henomoe 4) oleae andre Abc Fauna PART FOUR: NEOPASMS OF THE COLON, RECTUM, AND ANUS 1 Catreds Pepe 2 Comesal Corona sna Regonheosasns (HAPTER? THELVER PART ONE:SURGICALANATONY PART TWO: VERVE OF THE DSORDERS OF THE VER 1 OreawofLie Findon Tale PART REE: PORTAL HYPERTENSION AND TS COMPLCATIONS Pancho (ca tele igtes atupnenttVatsa Beng ‘Sapeal Paros Sn ond Supe Prods “TsjalarvatepaPerosstone Stns 1S) PART Fou: BFECTIONS OF THE VER 1 female Uvesosees 2. Prope Ass 5 tase see ART FE BENGN NEOPLASMS OF THELVER. 1. Ovevew ale Ban Neosat Lie 2 Srp aie 3 Homage 4 epaedenona Feed hpetsa PARTS: MALIGNANT EOPASUS OF THELVER 1 Oval te Maga Negasal te Lar 2 Repaooasa Cane 00) BES BBE Se eaaaa 8 Beeeess BS 88888 888(HAPTER 2: THE GALLBLADDER AND BILIARY SYSTEM PARTON: SURGICAL ANATOMY PART IWO: DSOROERS OF THE GALGLADUER AO BUARY SYSTEM ‘Cats Paps 2 able Etans 1 Cnsepeercnons (HMPTER 23: THE PANCREAS. PART ONE: ARCA. ANATOMY PART TWO: ACUTE PANCREATITIS PART THREE: CRONG PRIGREATIN PART FOUR: PANCREATIC NECPLASS 1 Perea Saree epee 2 Paronstcerscie cen A. PaneatOste orp CHAPTER 24: THE SPLEEN PART NE SURCICALANATONY PART TWO: DIGOROERS OF THE SELEEN ‘t Ovavew Date Tes fa Seic Exton 2 Spencaosess 2 Spe os ra Maes 4 Aboal ne Trae pon ee RECON nro pom 2 Conseaoret Saracen 5 Osean Poseecy etoSep (OPS ‘rss. 4 Poslnecamy Vaca ryan (CHAPTER 25: HERMAS, MESENTERY, AND OMENTUM. PART ONE: SURGEALANATOMY PART TWO: DSOROERS OF THE ABDOWNAL WAL PART THREE: NGUNAL HERNIAS ART FOUR: OTHER TYPES OF HERNA oa Hani 2 Faraone 3. Homa arms PART FIVE ISORCERS OF THE OMENTUMAND MESENTERY PART SX. NEOPLASMS OFTHE ARODUMAL MALL CMEN LAND MESENTERY 1 Nesoons te Aba Wal 2. Nelms be Onan ae Meno 7 m an 7 EG 0 me S88 88H 833 & 40 42 “2 “2 “a 2 Pr a a Pr a 2(HAPTER: ORTHOPEDICS ‘PART ONE: PRNCPLES OF FRACTURES AND ISLOCATONS PART TWO: OPEN FRACTURES PART THREE: COWNEN FRACTURES AND DSLOCATINS PART FO PEDATR ORTHOPEDICS PART VE OSTEUNELITSAND SEPTICARTHRITS PART SI ORTHOPEDICS OSORDERS SEENATTHE CLINGS PART SEVEN MUPUTATONS A DSARTIORATIONS PARTENGHT- FRACTURE EPONMS ‘CHAPTER 27: NEUROSURGERY PART OE: SURGICALAMATOMY “ PART TWO: NEUROSURGCAL TRAUMA 1 uot, o 2. Connon Palos erhesdhy s 3. Coneaspre hay “ Compe Coney “ 5. people Cox Syodomes ‘na THREE COMMON CONCENTALL ACQURED NEUROSURGCALCONGTIONS dt PART FOR: VASCULAR NEUROSURGERY ‘Erdal Wie 4 2. Varn Dears n Nero 3. Mit tes an Soon teed wanna Aon PART VE NTRACRANAL TORS ‘t hanaion 2 Comma racan Tae ‘ONPTER 28: UROLOGE SURGERY PART ONE SURGCALANATCN BR RE 1 pe ery te ” 2 torrney Tt ” i Gow ” tanto ODICTON TO DSERDERS NURCLOGY 1 Cammen Spin ob) m 2 Daponeam oy m aR Tee baoRDERSENCOUNTERED NURCLOGY 1a eterno as 2 NewapetieOpcon os famine Deer cogy pi & Groscteaee Dees nseiy in 5, eres im ant Fou nEORASUS NUROLOGY i fencer en e Raval Paecal Tums we(HAPTER 28 THORACIC AND CARDIOVASCULAR SURGERY PART ONE: SURGICAL ANATOMY OFTHE HEART AND LUNGS Thebean Takoes Te edo ‘he Lingsard owt ‘nao te Cea Wet aby oe ese PART WO: CORONARY TERY DISEASE ‘chong 2. vets ocCoorayAeyDeoase PART THREE DSEASES OFTHE AORTA. 1 bane ae Arey AA) 2, Tromlehanesomyen (8) 3 daneDeseaon ART FOUR: VASCULAR DISEASES OF THEEXTREMTES 1 Pewleaiatet Dee 2 out ani ART FIVE PULMONARY OSEASES ‘apesic recites in Ths Supety Premetaee Ps esecn EnoyamaThaees Satay Puma Node Braga Catone CHAPTERS: OPHTHALMOLOGY PART ONE: PEARLSIN OPHTHALMIC EXAMNATION PART TWO TRUE OPFTHALIC EMERGENCE "Gane Reml ty Osn CRA} 2 Chem ue ‘marti Oen mA BERCENCES ‘ee Coase Gave 2 emmpancpst Cees 4 Extn or Comes Coaione & ceca ‘etal Darna van Fur COMaDN GAT THAC CANE CASES ‘tEmeatRetacon 2 Date Renepony 3. Carats 4 OherCommn Chicas ‘HAPTER 3 PEDITIE SURGERY PART ONE: OVERVEW OF FLUDS, ELECTROLYTES, AN NUTRTTON inreoaTacs 1. PudRectonens 2 Beers 3 on 4 Peepaste Pepraon PART TWO RESPRATORY OSORDERS ‘1, ealisol te not Rexpaey Syn 2 Common spate Osc Pea Potent PART THREE ANTERIOR ABDOMNAL WAL DEFECTS ‘t Ovewanet Connon dls 2 Tino Supe Corcion nConprtlAbonal Wl Detets FOURS NTESTNALCESTRUCTIN PEDIATRIC PATIENTS 1 Ov fiesta Obsnclon 2. ConmonDisorer Casing mest Obsticion PRT FIVE THE EDIT ACUTE ABDOMEN ‘Connon Osada Cag Rate binnen a Psics a8 geee28 88 B88 SSeee 8 € 888 on s” se ste si Be ea a‘HAPTER 32: PLASTIC SURGE "PART ONE NTRCDUCTION TOPLASTIC SURGERY “he Reser acer PIRTIWO:GRIETSAD FLIPS ‘incre 2 Fetioebess Ce Unt kchage Cer ea ge 88 gegeee Bee8I GICAL PRACTICE AND |AFETY Pd ood cle mee ee 41. Overview of the General Appreach 2, Cexdinal Manifestations of Surgical Disorders prec eecy Tareas) REWMgee ume ner hae a) eee ey eee eee otter ta CU ee aang Pec inMmceGc recites 2. Surgically Relovant Quality Improvement Practices eer terrace melo tPE aan 1 OVERVIEW OF THE GENERAL APPROACH In medicine problem analysis and decison making conse fhe olowing eps 2 Paysca examination 5 iferentia agnosis 4 Dageosses Treatment 6, Observation ofthe fects of trestment 7 Re-erdution ofthe Stuton, the agri and the reanent "ARDINAL MANIFESTATIONS OF SURGICAL DISORDERS. “A: Common Surgial Symptoms perce ' Frovocatin andPllaon | Chest auatty ‘Muscular cardi pneumothorax aortic patio, Region nd Ration |“ ehleystis pancreas, ppt et GERD. S Sevety Timing Egastic Cate esophagis gas peptic weer {Pancreat panerents mass “Oe cardiae sore disectn, mesenteric schema bibay bowel struction gyncobpe Fgh Upper Quadran (ROO) lary chlecyetis,cholethit, holangte “Hepa abecess epi, ass “Rena nephrotic, pyshnephs ‘Others cada, palmonry. gastric igh ower Quadrant (RQ) on: appends colts, vera nflamatory “Gyecologte etepepregnany ovarian torsion pele | ‘nammatry disease Renner pene getouinay rt Late vpper Quadrant (100) Pancreatic pancte ats mass “eat nepilahias pyelonephritis “others card, gas Late LowerQudean (1.0) Colonic, vertu inlammatory “Gynec tp ep ovarian rson.pbc Renal epi ethiass plone anks *Nephrothias,petonephets mass Back Muscular sponds, actre feferte pik aot pathologyPERTINENT INFORMATION es peed ‘Massor Sweling Sito lesion = Congentat {Steand shape arama or in etious Neoplastic whether benign or malignant ihershersiaiymphnodes ‘Temperaure “eonssteney + Aswdted symptoms or signs] «intestinal obstruction (complet orncmpete) fsharp pain fever tention, | Pertons rom appeathats,prfersted PUD. et Srastometlekalver surgery strangled bowel, otaninationafthecavty) | Trauma Upper Costrolntetival (cy Complalte =PeRST * Dysphogls esphogis ctares, veri, achalasia {Asouated symptom of ‘euophaea cancer “ysphogclyraphagla. refx | eeartburn esophagitis gsr, gustrcesophgea refx UMEtcing nausea orvoniting |" ease (GERD) cancer + Upper Cl bleeding (UGIB:esophagtsesophagea rcs peptic leer dseae esophageal orgasticeancer “ower Glcomplalie “PORST + Dlarrber: ifetions gu astruction Asecated with pain artes, | “Cansipaton incon cbeton, cancer ‘antpation beeing “oer eng (C8 tomer cee Towne sPQRsT. Hepat disease (alah wal neoplastic fects) {Rote symptoms “ny dei (th hractontcmmon bled) ‘Trauma, Barn and Wounds TOE Tine iniry [Penetrating gunotknfeimpalement ‘| Trot Paceotinjary {ume motor vee aces, motor eden {0k te ofinjury cident fal aggravated asa MOI: Mechanism ofiniry | + Mscelancous erste Masts bors 1+ Pus or uid inexternal ew anal see0 ‘ough otoscopy conducted with hepatint blows paced ote + Brngoer tbe mast procs (mst “Tympanie membrane perlorton na [ey re Berry sign “+ Absentor muffled carotid pulse ani. a a ~ as | a ‘posuve pressureduringpocumaticotoscopy | * mus a ceameropa | Rign tress tena | nar 2 eae man [nega com | Scan Sarat. a Se | pa - = third) ofthe eyebrow tances Fs | Se “iar oe PattlogiesofikeThorae ae "etme attend adhe tent ‘devatedoverthehcadas they ouch the face -Resptory dares may aoa besten aun | Thoearmnameeeseein moet | “Dapeee “while hotding his breath mr ara “Heckycnengergeret mule heart ‘ cardac amped Cece rang ent pe _ Coen entree een | torkane tne Tesora | ee Ses Sei gee eR Superior vera symdrome Ce Chega haetamrest feo | Seperate | pan Breeserasaatenaes $e ee prt mae eminence ets shee tin | ete) eaerven | Suatfan daar | oc pe sevens |stpeanaveone aac aman | el eer err, | teams. Tape ceca [hea=m Ea So > Metastasis the pouch numer ney | -Se palpable on rector even vaginal | ”ofDougls secondary to ‘nmieaton ing pert or gate Right sibcaplr pan or Boas sign Typeaeaed (neresed or akered | Choe cholesyat senitiay) Enea thenveching orchararind | Abdominal tention sGasre vlahs — ~ Exacerbation of pain when te eras | Acute appendiiin siftedtotherghtside presnancy Capormedusae 7 Ditenaed or engoraed sper ‘est rating ra the + Porathypertension (eg, Ter erbous) + Poshve Carnet sige unremitting or ‘indo pa whee Tifpoative source af somal pants tn the ‘torial al cornettsign Negative armettsign: dcresses negative, source ominal pain when pant sasked |" afabcominal puns tewlehead intaaomina “Change of ote rom resonant todall costl ign ‘tthe owestintercontalspace eighth] +Splenomegaly net) thet anterior slay He uring ll pean and inspeation “cand ia mason tees se == ‘gon erie manpulion (pain so | *Fevcinlmimaory gm | greattha patent retlexely reaches | dese ecto pregnancy ibe chance L Teer coarcottiad | SJaunce + Cholangis | :r0gpan ‘+ Meartor teat sounds heard trough | * Retard atdominal aybrook ign wt |” oes trom bt ‘he abdoranal walonssclation ‘Soria tena ~ Apalpabiegalsadcer wah panes + Obsrecive june evens involving umbiesl ‘nd Parsumbieal eine burning Sun (rt heard over he eo + Portal hypertension + Respro can sign ence emarragetrom ‘Absence of palpable vera athe ance sen Fighter quadrant caused by cen Imoing ay rome ight usa + Souler pun onspration de to duphragmaticiertaton by emipertoneu Terese abdominal pa on coughing = Anpenacts+n contraction ofsbdoninal muscles, sh srdonina wallace remaine Unchanged and does nterossthe Fothergtisign |e (ematoma or mass inthe ‘Thissgns used to dierent domain wall Imasin the abdominal wal frm an intrsabdominal nase ~Revopertonea beeing Foxsign “guinaligament cehymess romacate hemorrhagic pancreatitis Retroperitoneal Greyturnersign | +Flinkdiscolraton or ecehymeste |“ hemorrage from panereaits ‘anningtontit | | -Abseatadductorretexintbethiehin | souuraor ara sign the presence of postive patellar ‘owshipomberg_| ner thigh pain on tera rotation at 7 sen thehipthatmayradatetothe nee | *Obratorber as Let anilary adenopathy assed | cari carcn wh metastatic ast archos = ean ee referred punioibeleRsboaler |, asin Secondarytodophragmaticwetatin | "SPM rupture sd torent + Vile peristalsis ofthe ureter when ely sign Sete entiation during pressed gently = aia tinal stars athe weal Kocher (Kosher gener fos) | egtonandthen migatestothe right | + Appeniis ise regen Markiesignor | +RLQpainondroppingtrom stdin | pppenacus Jartendetness [toes tohele with urting nding wen Grimace ited when the exasiner Performs afm swish withthe dex asso ted midlefingeracross the bomen | «Appendicitis rom the epigastm to teight he (oa ecinccags | gee TOOT P| pepramienarag Tenderatat McBurony pot (one ‘hird the distance om theater Mebueneysign | superior ite spine tothe unbicus) | Appenditis This point corresponds the neon of vermform appends cect. nspratory arrest with deep paps murphy sign Inthe ghtsubeastl area (the + Rate Cholecystts sppronate location othe galblader) ss Perinepric bees, Teaicraackisign | “Cosovertbralangetenderness upon |" Pyelonephriis pereussee Kidney stone ‘or Coldtam sign ‘omaratorsgn | PatvethineratvaatoneTO= 8 | appenaans ‘tht ip snake xed.co DEFINITION CoE Painwith extension ofthe eke foes ftertation nthe proxy of | « Appenditis the ight psoas mse) Intestin intent oftransmited soundinintrrebdominaeaey Sscendarytopercasion when the | Detects smalamunts of seit patents psionedonsiteursandthe | "aches ethoacopetsgrtualy oved toward {hen peste pression Ransohetsign | cYolow pigmentation in until regan | “Rare comenon be ott pargan | since Reyrtd-barean | “Rghtpperqudrant pin hese cng hala change 1 Stackorsepis Tenderness inthe rt ower quadrant __ Increterwhenthepatent tera | aan, | ‘hesupie piontonrccumbent ” ) APM postreon heise Govingugear |“ Inectenernss Ge pada fe | gener | eklower quran restingin pan | «Apes thevghlower guaran) Stormy FH | apt until Neato ambi sien pei msn des em gantrconcer Sherrer ingle [sAreacfiyperheaoverthe RQ | - Append ranean neue genet 088 Tg appenacne om | Spmaicee send ‘Valeting sgn or | =O pam rom apepueaker tha Saarome evaratestrogh te retropertncam | Pfr pete er sass oe Wechownode | Papel aupacvicdarnade | "stpracear ade om iccancer ‘Pathologic of the Brees = Stall sects intraneseus becest ‘tat fequnty obese corer an rotieabscess | Set eqety mvs iiecrerand | sayatetxeonyelts pest years ‘Bode. 1 Spertial vans peressed pros TTrendeleturg | Sitimpulscistenoverthe var dstaly,” | «Venousinuicency pereussionvest__ | “yahalarincompetences preset Homanssign | = aifpuin on (ered doratexonofeot_| VF fected finger sight en in mboeinrsnet leet |e gg ager com je Meas tenosynovitis tend {Pann pase extension Tasarevcsignoe | Tailed wien he saightegis | Hered die taraggicten oc | “ane tan ang between 30a 70 degrees+ Fale to elevate the contralateral ongeial dsloeation| _reendtenvurgsgn | Pes 800 whde Banding on one the hp, ocantere rss" | Cegscenin people with weak ghtews | face spinal erveroot esis bod mains mace ein plo + Worsesingof pain while einer ‘Shes emnateton sn bow fe feaalreaton andelbow | + Scepstendinis, houer texen Impingement ny, the bow steel 90 derees dhe ar ducted OierPatiooges + Change nmen status orgmentsna | remtaicontaniaartrms | Fuente bane Syme Pt corona | SBareh - arc snrome {iia te oa sealer prmaliewnes_( share ams Ponty fay siting | Saar Canes, ‘ete peter seny fener nc patron apace Pater of inh seen wassinriss | netbdointrinairasenjry | *Paterat ab reenn ae ‘ssteoneanga pede cae cc dinpryeoriceiostest | met € pasos " Laberatary exams and dagnose imaging studies are ued to confirma hypothesis {These wil not mae the Gognos in oan '. Therapeutic Decision Making "our ea assessment the patent my inate that surgery required “itotrgery ts neded conser the olowing portant sues ‘an we dothe procedure here? isthe operating rom aval sf and forse? {Arete ecestry equipment vale? “hell members f the team avalible? {Dot have the kawedge and shil to perform the necessary procedure? ‘an we manage thi patient? there Backupar extra suppor avaible required? ‘anwe manage the potent complains problems aie? {Dawe have using ute fr god post-op ere? ithe answer to any of tes uettonsis"Na" ite OT advisable to proceed with surgery and ‘waster ssuggested Transferring Patients Contact the entero make referak make ure center aceptsthetraner “hthe»dgoods 4 teaoent pn pir to raspert, 1 Sabie patent eare wanspr® (eg. creation, away, breathing: immobile fractures) {Asses the need foreare and tervention drag rasp {Stable poet beforetranspor (eg. cretion, say, breathing Inmablze rare pa tral) Rotipae an prepaeforanyehangesthat may ocr o the way 1 ek ptien we is ranferred to aather harp should be accompanied bya ter of eerPostoperative Signsand Symptoms PERTINENT INFORMATION TO pc Fever Poem ube of oop { asocted complaints 12-24 hours atelectasis {2 Sehours ery wound infections (Cost species, Streptoocus seis) 1 3Sdays urinary actinfction {Seer neti pace ‘edema Ditton + Number of dys pstoperation ‘Mediation being talon {Previous operaton done ‘rssctedcomplats asp ‘tre ofsurgeryor procedure eas id ble 1 Otwous leesing source Metetons beg en Tipeension Hemodynamic dats ervtal | Shock signe 1 iiypootemic nadequatehemostass.trdspcesses) ‘Neogene (pal cord trauma) vasogenic shock, anaphyatsarenal ineatieney) = Cardiogente (ACS arrhythmia, cardiomyopathy) Gligaria or Anarla *ateeyofurary catheter esln renal unc {editions eng aon (vepieatowe) Perna shock, hypovolemia, nadeguate ids tard Spor losses) ‘Renal (act tublar necro, aminoglycoside, contrast ey tac traction, etropertenel rs) ‘Wound Dehiacence ~ Fresposng faars “edna tes py ped crs pote + Leal wound problems (fection hematomas) Agee ‘oharacterofthedrainage olime faring atage ‘Poor wound healing (malnctriton, diabetes sterols ‘Genatherspy) Decreased tension on wound (estes, lated bowels, couphing voting) oun Drinage “impendingdehiscence {ul (enerocuancous,cloataneous) iemerrhage|Pv Saar ADMITTING ORDERS ‘Rdmitpatintto (eg room of choke, trauma ward operating room, bar unit ICU) ‘tending sargeon (complete nme, incadng eam) Secore consent or sisson and management ‘TR saltand record Input ad output rsing odes (eg bed postion elevate ed 30 degrees, dressing changes, woundare) Diet (eg et sclera of DAT, nothing pr orem or NO dabei et) 1 (PUR DSLR, pS) and spe rage (eg 1 Lor 8 hours) Diagnostics (og inom sich CRC, ways, abdominal Teen) ‘Therapeanes eg. preoperative ants, ant secretary agents, ood product) Pan (eg, foremergency appendectomy) Notfeaons (Anesthesia surgcalrsient OR mse) fale acoringy IL DAILY PROBLEM-ORIENTED PROGRESS NOTES Subjective (5) | + Indicate al symptoms and subjective complaints of patient (eg, pal) ‘Objecive(0) | staat he general appearance of patient, {il sigas and temperature {Physcalexmination {tiboratory data andimagingstdies ‘Assesment (A) | «Inst concsins drawn ra the signs andsymptoms ted above Pian) nat farther gnosis or terapetks to aes the problem IIL BEDSIDE PROCEDURE NOTES Ina the edad procedure done eg. apy, svar of wound) “Indeaons fo procedure {Patan present 1 ily describe technique and instruneats used * complcatons ‘stinated ood oss 1 Specimens orfindigs obtained 1 Postoperative tat and wal ignsIV. PREOPERATIVE NOTES Wren before surgi procedure Orders would depend onthe cea prle steutonal giles and pysian preference Ens fom Mistry apd Physical Exam | +5 yea lf mae with RUQ pa and enderess™ “ereoperative Dlagnoste | - Act chlecystiia Open chlecytectomy {Real her dating pramcters “ineede aval lod products (needed) 1 Preoperative autos MPO, MF pin meds ‘terra to medica special (needed) anesthesiologist {Consent blaine. risks benelitsexplaned V. OPERATIVE NOTES Sd Banus ae suparaive appcdiiis” Sprsppendectomy 87 xmoniofaania ‘diate ESL andthe blood products transfused during OR {Total amoun’ and peo ad dmastered ring case ‘econ Pratedat night lower quran” ‘Mallammed ppenui sett pathology {conptiatons {No tntoardevents daring after the stgery™ {Past Op Condition {Transferred tothe recovery room instal condiion™ VI. POSTOPERATIVE NOTES Wren few hours after surgery (eg. within the sae ay) Done to documen! inet postoperative state a the patent (Smlarto 0-4? noes) Sn REMARKS Incate procedure performed nclading deine surgeons “enlaces ctv comps “skate pertinent phys examination fangs 1 Cheat mewn o ids nsed balanced wah rine outst “ket erent symp or sigsto watch ot for “diate sessment ad conchsion ram ator ndings “neat forther agnosti, chargs in mecatonsPE aa )EFINITION OF TERMS RELATED TO PATIENT SAFETY ~ ry that was cad Wy mec management and tal esas an measurable disatity Fala fs planned acon be completed as tended or theuse eevee ‘fa rong plano achieve a an (can inched problemsin practice, products procturs and ystems) A adver event tht ie atbaable eon ‘Unpreventabie adverse |» Anadvrse even esutingirom a competion tha cant be cot reveled given the crrent tat of aowedge Aa event of station that cold have resulted i ace my oF loom ‘ess but id not ether by chance or teough ney etervnton ae An averse evento eros hat prevent with the carent a ac ofmmedisl knowledge — A reg ineracing oF terSependent group of Kens orwanga ied whe AnerTor thats nthe eset oan niin batt systemserror predicate outcome ofa sees of actos and facts ta lke op 3 Sisgeatccortreamentprocese Saray Wie Cum fr Pee er fe ep TA ae 1, SURGICALLY RELEVANT QUALITY: IMPROVEMENT PRACTICES Use of msimam tere ariers wie placing central venous catheters to prevent infection ofan propia to prevent postoperaveiectns ing hat pacts cal ate what iy Sar ect rng the normed consent cee + Contnuou aptton of sgt secretan to preven vetltor atscaed pretncna “seo pressure tehevng bedding materials preven pressure cers {seo Fete otracound gudaie uring central Une placement to prevet compkeations “Patt et-manaerment fr warfarin acleve appropiate outpatienc anticoagulation and preven “complications Appropriate provision of autricon, wid pardstr empha onary eters nurom incr rast patents Une of antic snprgnaed cetralvenout catheters to prevent catheter related infections Swe Sj tl Meieg Heth re Sof Arte Anite Pate Sf rcs: 20WORLD HEALTH ORGANIZATION SURGICAL SAFETY CHECKLIST The WHO has underaken atvesto adress surgical sty ‘Checks blow anaes tree phases of operation “Tesch phase 8 coordinator mus otra the tama competed the ted aks Peete [REFERENCES Bae ePaal rahi eco Dang Wha ous fo Pte Sey Fra Acs ede Mee rea Th pct Rep h ly ‘espe okt (Qa rn ay 7 Tn Etec fre: red Hew Yer Mra Cpa ne: 2002 etal exe che eer anbeck of Chal python rey e202 + Sf Selecta an ten rr rs mabe Pn, MertWeathrmesion rain at pal abe ye Wo eth Ont 2004 1 Wa anes tr ates 0 Spry Cc a impemennrsMeeal Wesee 20. ‘aieathep/fowetpetseryeseugey ie cheerA URGICAL RON emus emer} eee eee erecta coeTe cg Deuce u ooo Pea Bee och a SUN aor] COMMON SURGICAL TERMINOLOGIES eel Reena oT Head and Neck Pitts Peery ROR e ea ote ttc)GES ANATOMICOMEDICAL TERMINOLOGIES ANATOMICAL Pt OSITION Upp bs the ides wit the pbs aig sternly ILANATOMICALPLANES oo DESCRIPTION 7 vertzal plane passing rough the body paral tothe mean pane 7 Vertzalplanes passing trough he body atght anges the median pane ‘bids body anterr (rent) ad pester (bck) “Planes passing rough boy tight angles tothe median and corel plane 1 Horzoal plane wick sides boy superior (oper fer (omer) MILANATOMICALSECTIONS SECTIONS: om DESCRIPTION Run egthuiseinthelongasisothe body or any ots pars stees ofthe body oritepurescut aright anglesto the longitu Obiigue ection nosy mene anes IV. TERMS OF LATERALITY Tone ode cay (gape) [sso the same sie of the body (9g gh ami ight) Ets on opposite ie ofthe oly (eg gh tad +e hand)V. TERMS OF RELATIONSHIP AND COMPARISON Ee Eng supertiiat Nearer the sce i Ena ee Deep [Farther ran the race | ~The bamerat i deep ote arm muscles Ce Eng “lodeatestatasuvcureis | *Tlithdig(smallfiage) ison the es aes a aime |" medial siete and aatomia 2 stn) a “lodiatetatastracreie | «Thetis igh (hunb) is onthe tera ‘Grherfom te median lane | "se othe hand (anatomical postion) Cores Eg vedorsy | "Deen superil and deep_| +The biceps muscle sintermedite Ga Ew vieterstoastractarestuated | i tesrertesoleoftheteet |< e gomuh taferorw the head Eng maa sChsertopotefatacinet | ceo oul the west rere rrissy om = er) = ecru ac of th oot (lata aut)VL.TERMS OF MOVEMENT. ~ Bending or decreasing angi between the bones or part of body "Dorsal oi (tng tos). x + Planar: ars foot tear plata suas (pte) -Beample: Flxon ote upperlimt at elbow pt anterior bending reas ~ Salghcning or nceating he angle between Does or parts fhe bly or “hiyperetenton exten joe onal aie pm = Movingavay rom the medion nthe onal plane {Example Movag upper ln oway um side ofthe body ‘Mowingioward the medion na corona plane ‘ample moving an upectinb toward sie ofthe body revalanga porto the bay around longitainal as ging anerior src of closer to median plane incerea tation ringing the anterior surface flab away rom median plane ~ Grealirmovenens thats a contain offion sv exesion abduction sdductlonoceurgin such awaythatdstalend fhe partmovesina de Pade ¥ digtis bough anotber digit pd (eg, button Opposition eyes te Reposition 7 Moveant of at digicams potion Everson = Moving the sl ofthe ootaway rom median pln (a wrangle lateral) Taversion Moving esl ofthe ot owardimedian plane (le, fog sake medial) Presatien Rotation 50 a palaces posteriorly ‘Supination Rotation stat pl aes ately Protraion + Movinganeriony or forward (prorat) (2 iting chino) Retrusion Moving posteriony ortokovardreracon) levaton Moving par superiorly (eg sugsieg) Depression | Loweringor moving partial (eg. depressing solders)aaa DESCRIBING PATIENT POSITIONS IN THE OPERATING ROOM Pron Supine Peo ncuat othe Phced on bck ithegs Head ae wth he spine sod thea isupward ps are parallel the spine {Shey tet paced above he Een et = Feedage + Ghest all pce lengthwise ‘der he elas slong the ‘vie toa crests trie ‘the weigh hb ft ‘bomen snd thore) Rrra placed ate tacor peeve eta mst be re rom pressures torn Suey bet placed above knees 7 Soler ad ps oe {ero ofthe ed preat + Lower legs lec atthe hip spperteg strat Hazen Signent Breasts geoata cms be ‘reir pesure "Ta ena down eno protect raha pes}, Pring laced ver ower eg rae ad foo ‘peri. ender owe ‘(palm wp) od pe io paced genes Setwentegand between Renal an aden sages,Prd ‘eendelenborg per postlon.telegsarerased Sha sbaiced expose he periearegin sKemsaeplaced on pide fides or placed scrossthe sideman Uagesnd fetareplced in + Adegste padding and ‘pportor hele or eet Soul eliminate pressure on Jot and eves +The perineum shuld bein lige withthe oneal es tthe OR bed ‘edited tox hea down tt 135-45 depres resiing Intheneadbemgiower than Se aa Fost ofthe OR bed lower toa deared ange Th nie OR bed ed the ead higher han theteet, Inbeeathngand decrease ood sup tothe area oT ‘USED FOR Sblominoperteal tescton) procedures Gijrodectomy. et sei) ‘gutromtest Surgeries (Gert surgery) a2 Pre Faek xnifeposition Pe sPauentbegasin the spine postin | sFostf Ofte lowered gi lenge ees, ‘de he ay set ‘sed 35-45 depres, shy comings sighy withthe headend doweward (preventing pent fom ang) Feet padded Rema arerotsdleosly ‘rete someon ane {Upc placed on the ide ‘foreranlpeocedues the esa putonathece pn head dlp + Modineaton othe poston + Paes placed in he prone postin om he OR ean then averted in Vpzston ‘The hip are ove the eter break ofthe OR bed teeventhe body andleg Ame arene on Sealed rm burs wit the cows flexed and the aims down ‘Rplow placed unde ‘heads tore the fst does of pressure The OR bel eg section | Iowered ad he OR bed, ‘Teed ata S-degree gle so thatthe hips ae med above herertot thetedy OTT co Surgeries ofthe Eid shouer ‘Anorectal surges (Ustuotomies, Nemorrtendertmice)GE Sanaa ‘COMMON SURGICAL TERMINOLOGIES SERS Chote(eyst0) Bleor bar system Calon) ergs towel Ose. inary ade Hystere Weert eo: Smallbowel (ast) ‘par "Abdomen or peritoneal ay Nephi ney [ee ena pes [horace Gest GEE = == = = [Freshy T Tosewtogeterorrepae i cc 7 omy Tocreate an opening (ana = mouth) = Some Examples eral mastopexy: breast ts *Choledochoduodenostomy: an opening between he tle dicta the duodenum { yelaithopany: detract of peveaiyeal snes “Peretancousaterogran rari tee imaging by ect pure injection {Rhinoplasty nose reshapingPES! COMMON SURGICAL INCISIONS LLHEAD ANDNECK een Py ore oo Modified ae incson Sknereasebeginning Ht mesoidt sParadaurpery } An incision placed on the -— ¢ Cherlitomy hat | fortunes cng xf - “fiereeioe aac 1 || SEERA | race contageI. THORAX Inco ade from otek upto the ipo perso stncson of choice ormostopeneat Srgeries, open beat surgery tontfthe anterior ely ine atthe Aten borde of extends posteriorly ‘nd cepa many Serene ptr ‘he medi border of begins tera tothe sera edge ‘follows the ‘nt sammy eresse uptotheameror +g surzey Ace eo (ctu esophags) en performed over Ss 1S appre achoice {orpmonary reseion ferpacumonecomyor tehetony) open cet lat the tion of chi) performed slong the Iramammatyerene, foursing upwards ofthe merpency anterior thoractony performedia ieralcesiohriesora) reer Peo FOR ‘aptertaratony =n mae x a the sternal otcheared Wy \| eS } ( \|Seees | ‘Exposure ofthe rand (eg, vesclr rama) U1. ABDOMEN errr NAME OF INCISION Py ce entering ro the rea afsiphoid andending | atmos at operations tothe pus by curing tteaugh he umbleus etrpertneum| Paramedian incision tomidine over the | *Pridestaeratty to erat aspectafthe || Sowingaccesto te NT (Gemtunar tne sence (ge. Spechanine) " sRighe seas snesionstartsia mitine |"incion gate 25-S0embelowsiphoid | (chlecyatectmy} ber fmuenfocavarate | Tincisewselcte ‘detance stlenectomyero aa I | Pen ottque incision made stthecburney point (Guncton ofthese ‘iperir ls sp} Inco the lniion err eo terete f cision is lacedin the simpy putsPE Seana NAMES OF SURGICAL PROCEDURES, EPONYM DESCRIPTION [Altemeler procedure | +Reseing the prolapsed tween the erie Procedreio reat recurrent shoulder dori by stein the pe inc capule tothe genad abr “valves igh gation of he guia beri sac lowed by posterior oe ‘gua wallreconstrucon by sxtriog Gat tamoustrpolayer (Gh ansversls as the ansversu abomins and the internal figue muscle) medial tothe guia gamer ]-Ateciiquedatanchorstheroud igamentofihewerastote | Basonetipoceanre |“ Leuina lor during hernia eptr Bata proces eniiclr edhton surgery wen asso cardomyopay eek Fundopiation with 270-degree wrap of the dstalesophagus op legre wap. pha =a 7 Conapaie rt replconent of art vavesrtrootB ascending ert with replantation ofthe cornaryareres iat the galt. ~eareion ofthe pylori antrum apd endo end anastomosis. ‘irotht procedure ofthe gaticrotnant tothe duoden entretony etrodsodenostony) 7 Reson fhe pylori strum and side t-side aastomoais ofthe gasriremnant (othe eam (atrectmy + gatokpestony) ~The proximal tended mb othe small bovels ined to aie of Bishop Koopenteostomy. | "the dtl smal bowel whch s then vented tothe abdorial wall ted in childre wth meconium deus ‘utroh nprocegure Shunt between subelavin artery and pulmonary tery wed to eat Bialockmusdgstane | “Tice esta. ~Anoncontnentiypeof cetony where the ed ofthe leurs palled Brooke Meostomy ‘Gvauph the abdominal wallandis verted and sutured tothe stn, leaving smooth rounded, sie ot eum the stom ~ Aiypeof blader ned suspension rocedare woe forsee Burch procedure ‘ncatinence, consisting of ratn ofthe eral vagal ores © the toperincal igen Fenestra of he anterior wall the asian dus andthe ‘alawelLtncprocedure Sergi draage of his snus tothe nose Vaan anrostany Right side medal viceral rotation wed to expose the Cateraasch manewer_ | “Rebs medi 7 Aparasteral medastnotony incon rated wed biopsy Iymph nodes or masses inthe aortopulmonary window en elt Sel he cto des nthe lar ares ea ‘Chamberlain proce Cole Ganropasty Procedre wo lenient onal ep habe A primary sue hernia repair almost alnaysreservedTorfenoral eis that imebes staring the conoed tendon (prin) 0 ooper-Mevayproceaure | the pectinealgament or Cooper hgament (fers) medal othe Fesoralvein andthe lngnal ligament atthe evel and lteralto thefenoralvel 2