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ISBNSpecification
 SPECIFICATION
SRB'S MANUAL OF SURGERY, 4e (pb) 2013
Author: BHAT
ISBN: 9789350259443
Year: 2013
Publisher: JAYPEE BROTHERS MEDICAL PUBLISHERS PVT LTD.
Category: MEDICAL BOOKS  >-- SURGERY & TRAUMA  >-- SURGERY & TRAUMA Untitled Document
Edition: 4
Format: Paperback
Language: English
Pages: 1336
Level 3rd Year MBBS
Type Medical Textbook / Reference
 ABOUT THE TITLE
The manual is written for the students in this firing line for their MBBS degree. Common conditions seen on a day-to-day basis have dealt with a little more detail. the uncommon and rare conditions have been dealt briefly. the mode of clinical presentation and the physical signs are mentioned vividly so as to register in the mind of the reader. There is a brief mention of necessary investigations in each of the surgical conditions. the accepted mode of recent advances in investigation and treatment has been included. This manual is meant for Final MBBS degree examination and not a consolidated textbook. Certain chapters are included at the end of the book for the more enthusiastic students and for those interested in participating in quiz programmes.

Key Features
- Exclusive photographs of different diseases with adequate informative illustrations with adequately covered text materials in each chapter.
- Recent advances and newer staging systems are added in all malignant conditions.
- Historical quotations by surgical legends in relation to different topics are also included as an need.
- Moral and principle quotations are added in the bottom of each odd page to make the reader more memorable and pleasurable.

Author: Sriram Bhat M
Untitled Document
 TABLE OF CONTENTS
1. General Surgery 1
A. Wounds and Wound Healing 1
Wounds 1
Classification of Wounds 1
Wound Healing 5
Compartment Syndrome 8
Crush Injury 9
Crush
Syndrome 10
Degloving Injuries 10
Keloid 11
Hypertrophic Scar 12
Problems with Wound Healing 13
B. Ulcer 14
Ulcer 14
Granulation Tissue 17
Investigations for an Ulcer 19
Traumatic Ulcer 20
Trophic Ulcer (Pressure Sore/
Decubitus Ulcer) 21
U lcer due to Chilblains 23
U lcer due to Frostbite 23
Martorell’s Ulcer 23
Arterial/Ischaemic
Ulcer 23
Bairnsdale Ulcer 23
Carcinomatous Ulcer (Epithelioma, Squamous Cell Carcinoma) 24
Marjolin's
Ulcer 24
Rodent Ulcer 24
Melanotic Ulcer 24
Diabetic Ulcer 25
Meleney’s Ulcer (Postoperative Synergistic
Gangrene) 26
Lupus Vulgaris (‘Lupus’—Wolf ) 26
Tuberculous Ulcer 27
Bazin’s Disease (Erythrocyanosis Frigida/
Erythema Induratum) 27
Tropical Ulcer 27
Venous Ulcer (Gravitational Ulcer) 28
Syphilitic Ulcer 28
Soft Chancre/
Soft Sore/ Ducrey’s Ulcer/Chancroid/Bubo 28
Climatic Bubo/Tropical Bubo 29
Clinical Examination of an Ulcer 29
C. Sinus and Fistula 30
Sinus 30
Fistula 30
Median Mental Sinus 33
Sequestrum 34
Preauricular Sinus 35
D. Infectious Diseases 36
Surgical Infection 36
Cellulitis 37
Erysipelas 38
Erysipeloid Disease 39
Lymphangitis 39
Abscess 40
Bacteraemia 45
Septicaemia 45
Pyaemia 45
Metastatic and Pyaemic Abscess 46
Boil (Furuncle) 46
Hidradenitis
Suppurativa 46
Carbuncle 47
Pott’s Puffy Tumour 48
Pyogenic Granuloma (Granuloma Pyogenicum) 49
Impetigo 49
Scrum Pox 49
Tetanus 49
Gas Gangrene 52
Tuberculosis 54
Leprosy 55
Syphilis (Great Pox) (French Disease) 56
Actinomycosis 56
Madura Foot (Mycetoma Pedis) 57
Rabies (Hydrophobia) 58
Rabies in Dogs 60
Anthrax 61
Nosocomial and Opportunistic Infections 61
Hiv Infection and Aids (Acquired
Immunodeficiency Syndrome) 62
Necrotising Fasciitis 65
Acute Pyomyositis 67
Surgical Site Infection (Ssi) 67
E. Swellings 71
Lipoma 71
Cysts 74
Dermoids 75
Sebaceous Cyst (Wen, Epidermoid Cyst) 79
Glomus Tumour 82
Papilloma 83
Warts 84
Fibroma 84
Bursae 85
Semimembranosus Bursa 86
Morrant Baker’s Cyst 87
Lymph Cyst (Lymphatic
Cyst) 88
Lymphangioma 88
Calcinosis Cutis 89
Neuroma 89
Neurofibroma 90
Neurilemmoma (Schwannoma) 92
Ganglion 93
Chordoma 93
Epignathus 93
f. Electrolyte and Nutrition 95
Normal Physiology 95
Water Loss (Volume Loss) 95
Water Excess (Ecf Volume Excess) 95
Ecf Loss 96
Ecf Excess 96
Hyponatraemia 96
Hypernatraemia 97
Hypokalaemia 97
Hyperkalaemia 98
Hypermagnesaemia 98
Hypomagnesaemia 98
Acid-Base Balance 98
Metabolic Alkalosis 99
Respiratory Alkalosis 99
Metabolic
Acidosis 99
Respiratory Acidosis 100
Anion Gap 100
Fluid Therapy 100
Nutrition 101
Gastrostomy 103
Jejunostomy 104
Total Parenteral Nutrition (Tpn) 104
Refeeding Syndrome 106
Obesity and Morbid Obesity 106
Different
Surgeries 107
G. Shock 111
Shock 111
Stages of Shock 112
Effects of Shock 112
Clinical Features of Shock 115
Investigations in
Shock 115
Central Venous Pressure (Cvp) 116
Pulmonary Capillary Wedge Pressure (Pcwp) 116
Systemic
Inflammatory Response Syndrome (Sirs) 117
Multiple Organ Dysfunction Syndrome (Mods) 117
Oxygen
Therapy 118
Topical O2-Therapy 118
Cardiac Arrest 118
H. Haemorrhage and Blood Transfusion 121
Haemorrhage 121
Blood Transfusion 124
Blood Substitutes 126
Massive Blood Transfusion 126
Autologous
Blood Transfusion 127
Artificial Blood 127
Erythropoietin 127
Tourniquets 127
Disseminated Intravascular
Coagulation (Dic) 128
Mechanism of Blood Coagulation (Haemostasis) 129
I. Burns 130
Burns 130
Management of Burns 134
Eschar 136
Contracture in Burn Wound 137
Electrical Burns 139
Inhalation Injury 141
Chemical Burns 141
SRB's Manual of Surgery
J. Trauma 143
Triage 143
Spinal Injury 145
Neck Injuries 146
Bullet Injuries 146
Blast Injuries 147
Penetrating Injuries 148
Abdominal Trauma 148
Blunt Trauma of Abdomen 150
Duodenal Injury 152
Pancreatic Injury 153
Small
Bowel Injury 153
Colonic Injury 154
Liver Injury 154
Splenic Injury 154
Renal Injury 154
U rinary Bladder
Injury 154
Abdominal Compartment Syndrome 154
Seatbelt Injuries 155
K. Hand and Foot 156
Hand 156
Hand Infections 157
Acute Paronychia 160
Chronic Paronychia 161
Apical Subungual Infection 161
Terminal Pulp Space Infection (Felon) 161
Infection of Web Spaces 162
Deep Palmar Space
Infection 162
Space of Parona Infection 164
Acute Suppurative Tenosynovitis 164
Compound Palmar
Ganglion 165
Orf 166
Milker’s Nodes 166
Hand Injuries 166
Dupuytren’s Contracture 168
Volkmann’s Ischaemic
Contracture 168
Syndactyly 169
Mallet Finger (Base Ball Finger) 170
Heberden’s Nodes 170
Spina Ventosa 170
Foot 170
Callosity 170
Corn 171
Plantar Fasciitis (Policeman’s Heel) 172
Ingrowing Toe Nail 172
Onychogryphosis 172
Onychomycosis 172
Athlete’s Foot 172
Hallux Valgus 173
L. Arterial Diseases 174
Surgical Anatomy of Thoracic Outlet 174
Arteries of Upper Limb 175
Arteries of Lower Limb 175
Arterial
Diseases 175
Intermittent Claudication 175
Rest Pain 176
Limb Ischaemia 176
Pregangrene 177
Gangrene 177
Different Levels of Arterial Obstruction 178
Other Features of Poor Circulation 178
Investigations for Arterial
Diseases 179
Diseases of the Arteries 182
Atherosclerosis 182
Thromboangiitis Obliterans (Tao) Syn. Buerger’s
Disease 184
Takayasu’s Pulseless Arteritis 188
Raynaud’s Phenomenon 188
Temporal Arteritis 190
Treatment
of Arterial Diseases 190
Subclavian Steal Syndrome 196
Acute Arterial Occlusion 196
Traumatic Acute Arterial
Occlusion 197
Embolism 197
Reperfusion Injury 199
Saddle Embolus 200
Embolectomy 200
Fat Embolism 201
Air Embolism 201
Therapeutic Embolisation 201
Caisson’s Disease or Decompression Disease 202
Aneurysm 202
Mycotic Aneurysm 203
Abdominal Aneurysm 203
Abdominal Aortic Aneurysm 204
Peripheral
Aneurysm 208
Carotid Artery Aneurysm (Extracranial) 209
Dissecting Aneurysm 209
Erythromelalgia/
Erythralgia 210
Livedo Reticularis 210
Polyarteritis Nodosa 210
Scleroderma/Systemic Sclerosis 211
Acrocyanosis
(Crurum Puellarum Frigidum) 211
Gangrene 211
Diabetic Foot and Diabetic Gangrene 213
Trophic
Ulcer 214
Bedsores (Decubitus Ulcer) (Pressure Sores) 214
Frostbite 215
Ainhum 215
Endovascular
Surgeries 215
U pper Limb Ischaemia 216
Arterial Substitutes 220
M. Vascular Lesions and Hamartoma 221
Vascular Anomalies 221
Haemangioma 221
Vascular Malformations 225
Cirsoid Aneurysm 225
Arteriovenous
Fistula (Avf) 225
Campbell de Morgan Spots 229
Parry-Romberg Disease 229
Hamartomata 229
N. Venous Diseases 230
Anatomy of Veins of Lower Limb 230
Physiology of Venous Blood Flow in Lower Limb 231
Deep Vein
Thrombosis (Dvt) 231
Varicose Veins 235
Venous Ulcer (Gravitational Ulcer) 249
Compression Therapy for
Varicose Veins 251
Thrombophlebitis 251
Klippel-Trenauny Syndrome 252
Anticoagulants 252
Heparin 252
Low Molecular Weight Heparin (Lmwh) 252
Oral Anticoagulants 253
Warfarin 253
Direct Thrombin
Inhibitors 253
Antiplatelet Drugs 253
Pulmonary Embolism 254
O. Lymphatics 255
Surgical Anatomy 255
Lymphangiography 257
Isotope Lymphoscintigraphy 257
Lymphoedema 257
Lymphomas 264
Hodgkin’s Lymphoma (Hl) 265
Non-Hodgkin’s Lymphoma (Nhl ) 269
Malt Lymphoma
(Maltoma) 270
Burkitt’s Lymphoma (Malignant Lymphoma of Africa) 270
Cutaneous T Cell Lymphoma 270
Chylous
Ascites 271
Chylothorax 271
Chyluria 271
Sarcoidosis 272
P. Peripheral Nerves 273
Peripheral Nerve Injuries 273
Tinel’s Sign 275
Brachial Plexus Injuries 275
Causalgia 275
Median Nerve
Injury 276
Carpal Tunnel Syndrome 276
U lnar Nerve Injury 278
Claw Hand 278
Radial Nerve Injury 279
Common Peroneal Nerve Injury 280
Foot Drop 280
Medial Popliteal Nerve Injury 281
Axillary Nerve Injury 281
Long Thoracic Nerve Injury (Nerve of Bell) 281
Meralgia Paraesthetica 281
Q. Neoplasm 282
Definition 282
Dysplasia 283
Carcinoma in Situ 284
Aetiologic Factors 284
Spread of Malignant
Tumours 284
Grading of Tumour 285
Staging of the Tumour 285
Paraneoplastic Syndromes 286
Investigations
for Neoplasm 286
Management Strategy for Cancers 291
R. Skin Tumours 293
Anatomy 293
Classification of Skin Tumours 293
Skin Adnexal Tumours 294
Dermatofibroma (Sclerosing Angioma
or Subepithelial Benign Nodular Fibrosis) 296
Dermatofibrosarcoma Protuberans 296
Keratoacanthoma (Molluscum
Sebaceum) 296
Rhinophyma (Potato Nose) (Bottle Nose) 297
Seborrhoeic Keratosis (Seborrhoeic Wart, Basal
Cell Papilloma) 298
Squamous Cell Carcinoma (Epithelioma) (Khangri Cancer) (Chimney Cancer) 299
Marjolin’s
Ulcer 302
Basal Cell Carcinoma (Rodent Ulcer) 303
Turban Tumour 306
Naevi 306
Melanoma 308
xvii
Contents
S. Sarcomas 318
Sarcoma 318
Liposarcoma 325
Fibrosarcoma 326
Malignant Fibrous Histiocytoma (Mfh) 326
Leiomyosarcoma 327
Rhabdomyosarcoma 327
Chondrosarcoma 327
Haemangiosarcoma 328
Lymphangiosarcoma 328
Synovial Sarcoma 328
Malignant Peripheral Nerve Sheath Tumour (Mpnst) 328
Kaposi’s Sarcoma 328
T. Amputations 330
Amputation 330
Complications of Amputations 337
Prosthesis 339
U. Reconstruction 340
Graft 340
Skin Grafts 340
Flaps 344
Tendon 351
Tendon Repair 351
Tendon Transfer 352
Tendon Graft 352
V. Transplantation 353
Preoperative Evaluation 353
Organ Procurement 354
Renal Transplantation 354
Immunosuppressive
Agents 355
Liver Transplantation 357
Bone Marrow Transplantation 359
Pancreatic Transplantation 359
Small
Bowel Transplantation 359
Dialysis 359
Cimino Fistula (Cimino-Brescia) 360
W. Stings and Bites 362
Snake Bite 362
Spider Bite 362
Bee Bite 363
Mammalian Bite 363
X. Pain 364
Gate Control Theory 364
2. Faciomaxillary Diseases 367
Diseases of the Palate 367
Orthopantomogram (Opg) 367
Cleft Lip and Cleft Palate 368
Maxillofacial Injuries 372
Primary
Care (Early Care) in Maxillofacial Injuries 374
Fracture Middle Third Area 375
Zygomatic Complex Fracture 376
Fracture
of the Mandible 378
Dislocation of the Mandible 380
Preauricular Sinus 380
Jaw Tumours 381
Epulis (Greek—Means
Upon Gum) 382
Ameloblastoma (Adamantinoma, Eve’s Disease, Multilocular Cystic Disease of the Jaw) 383
Dentigerous Cyst
(Follicular Odontome) 384
Dental Cyst (Radicular Cyst, Periapical Cyst) 385
Osteomyelitis of Jaw 385
Alveolar
Abscess (Dental Abscess) 386
Fibrous Dysplasia of Bone/Jaw 386
Cherubism (Cherub—Angelic Being) 388
3. Oral Cavity 389
Ranula 389
Sublingual Dermoids 390
Stomatitis 390
Cancrum Oris (Noma) 391
Syphilitic Lesions of Oral Cavity 392
Leukoplakia 392
Erythroplakia 393
Oral Submucosal Fibrosis 393
Premalignant Conditions of Oral Cavity 394
Oral and Upper Aerodigestive Cancers 394
Cheek 396
Carcinoma Cheek/Buccal Mucosa 396
Lip 408
Neoplasm of
Lip 410
Carcinoma Lip 410
Tongue 414
Tongue Ulcers 415
Benign Tumours of Tongue 416
Tongue Fissure 416
Glossitis 416
Tongue Tie 417
Carcinoma Tongue 417
Carcinoma of Posterior One-Third/Base of the Tongue 422
Nasopharyngeal Carcinoma 423
Maxillary Tumours 424
Malignant Tumours of Tonsil 426
Carcinoma Hard
Palate 427
Laryngeal Tumours 427
Malignant Tumours of Larynx 427
Trismus 430
4. Salivary Glands 431
Anatomy 431
Saliva 434
Sialography 434
Salivary Calculus and Sialadenitis 435
Sialosis 437
Sialectasis 437
Recurrent
Childhood Parotitis 438
Parotid Abscess (Suppurative Parotitis) 438
Parotid Fistula 438
Sjögren’s Syndrome 439
Mikulicz Disease 440
Salivary Neoplasms 440
Pleomorphic Adenoma (Mixed Salivary Tumour) 441
Adenolymphoma
(Warthin’s Tumour, Papillary Cystadenolymphomatosum) 444
Oncocytoma (Oxyphil Adenoma) 445
Basal Cell
Adenoma 445
Mucoepidermoid Tumour 445
Adenoid Cystic Carcinoma (10% of Salivary Tumours) 446
Acinic Cell
Tumour 446
Malignant Mixed Tumour (Mmt ) 446
Adenocarcinoma of Salivary Glands 446
Squamous Cell Carcinoma
of Salivary Glands 447
Submandibular Salivary Gland Tumours 447
Management of Malignant Salivary Tumours 447
Minor Salivary Gland Tumours 450
Parotid Lymphoma 451
Parotidectomy 451
Frey’s Syndrome (Auriculotemporal
Syndrome, Gustatory Sweating)
(Lucie Frey—Polish Surgeon—1932) 452
Facial Nerve Injury (Lower Motor Nerve Lesion,
Surgically Related) 453
5. Neck 455
Anatomy of Lymphatics of Head and Neck 455
Thoracic Outlet Syndrome (Tos) 456
Cervical Rib 457
Branchial
Cyst 459
Branchial Fistula 460
Pharyngeal Pouch 462
Laryngocele 463
Cystic Hygroma (Cavernous Lymphangioma) 464
Ludwig’s Angina 465
Parapharyngeal Abscess 466
Retropharyngeal Abscess 466
Subhyoid
Bursitis 467
Carotid Body Tumour (Potato Tumour, Chemodectoma, Nonchromaffin Paraganglioma) 468
Torticollis
(Wry Neck) 469
Sternomastoid Tumour 469
Tuberculous Lymphadenitis 470
Cold Abscess 474
Secondaries in Neck
Lymph Nodes 475
Chemotherapy for Head and Neck Cancers 482
6. Thyroid 484
Development 484
Anatomy 484
Physiology 486
Congenital Anomalies 486
Thyroid Function Tests 489
Fnac of
Thyroid 489
Classification of Goitre 490
Diffuse Hyperplastic Goitre 491
Multinodular Goitre (Mng) 491
Discrete Thyroid
Nodule 494
Solitary Thyroid Nodule 494
Retrosternal Goitre 497
Thyrotoxicosis and Hyperthyroidism 499
Radioactive
xviii
SRB's Manual of Surgery
Iodine 508
Thyroid Neoplasms 509
Differentiated Thyroid Carcinoma (Dtc) 509
Papillary Carcinoma of Thyroid (Pct) 510
Follicular Carcinoma of Thyroid (Fct) 512
Anaplastic Carcinoma of Thyroid 515
Medullary Carcinoma of Thyroid
(Mct) 518
Malignant Lymphoma 519
Hashimoto’s Thyroiditis (Struma Lymphomatosa) 519
De-Quervain’s Subacute
Granulomatous Thyroiditis 519
Riedel’s Thyroiditis (0.5% Common) 520
Thyroid Incidentaloma 520
Thyroidectomy 521
Emil Theodor Kocher 526
Kocher’s Test 526
Hypothyroidism 526
Recurrent Laryngeal Nerve
Palsy 527
7. Parathyroids and Adrenals 531
Anatomy 531
Calcium 531
Hyperparathyroidism (Hpt) 532
Parathyroidectomy 534
Men Syndrome (Mea
Syndrome) 536
Apudomas 536
Hypoparathyroidism 537
Tetany 537
Adrenals 538
Adrenal Cortical
Tumours 538
Adrenocortical Carcinoma 539
Cushing’s Syndrome 539
Conn’s Syndrome 540
Virilising Syndrome
or Adrenogenital Syndrome 540
Neuroblastoma 540
Pheochromocytoma 542
8. Breast 544
Anatomy 544
Mammography 547
Aberration of Normal Development and Involution (Andi) of the Breast 548
Fibroadenoma 548
Fibrocystadenosis (Fibrocystic Disease of the Breast/Mammary Dysplasia/Cyclical Mastalgia with
Nodularity) 551
Sclerosing Adenosis 552
Phyllodes Tumour (Cystosarcoma Phyllodes/Serocystic Disease of
Brodie) 552
Mastalgia (“Pain in the Breast”) 553
Traumatic Fat Necrosis 554
Galactocele 554
Mastitis 555
Antibioma 558
Duct Ectasia 558
Mondor’s Disease 558
Tuberculosis of the Breast 559
Breast Cysts 559
Galactorrhoea 560
Gynaecomastia (Greek—Women Breast) 560
Duct Papilloma 562
Zuska-Atkins Disease 563
Mammary
Fistula of Atkins 563
Carcinoma Breast 563
Management of Early Carcinoma Breast 586
Advanced Carcinoma
Breast 590
Prognostic Factors in Carcinoma Breast 592
Prophylactic Mastectomy 593
Carcinoma of Male
Breast 593
Breast Reconstruction 594
Breast Implants 596
Nipple Retraction 597
9. Peritoneum 599
Anatomy 599
Physiology 599
Acute Peritonitis 600
Primary Peritonitis 600
Secondary Peritonitis 600
Tertiary
Peritonitis 600
Spontaneous Bacterial Peritonitis (Sbp) 605
Sclerosing Peritonitis 606
Biliary Peritonitis 606
Postoperative
Peritonitis 606
Other Forms of Peritonitis 607
Pelvic Abscess 607
Subphrenic Spaces and Subphrenic
Abscess 608
Mesenteric Cysts 611
Mesenteric Panniculitis 612
Acute Mesenteric Lymphadenitis 612
Mesenteric
Malignancy 612
Mesenteric Trauma 613
Peritoneal Malignancy 613
Omental Cyst 614
Omental
Torsion 614
Omental Tumour 614
10. Abdominal Tuberculosis 615
Abdominal Tuberculosis 615
Ileocaecal Tuberculosis 616
Ileal Tuberculosis 621
Peritoneal Tuberculosis 621
Tuberculous
Mesenteric Lymphadenitis 624
Ano-Recto-Sigmoidal Tuberculosis 626
Tuberculosis of the Omentum 626
11. Liver 627
Surgical Anatomy of Liver 627
Liver Function Tests (Lft) 628
Alfa-Feto Protein (Afp) 628
Liver Biopsy 629
Liver
Injury 629
Infections of Liver 631
Liver Tumours 642
Liver Cysts 649
Portal Hypertension 651
Oesophageal
Varices 654
Portal Hypertensive Gastropathy 661
Ascites 661
Ascites in Portal Hypertension 663
Budd-Chiari’s
Syndrome 664
Hepatic Failure 664
Hepatic Encephalopathy 665
Hepatorenal Syndrome 665
Hepatic Resection 665
Portal Biliopathy 668
12 Gallbladder 669
Surgical Anatomy 669
Oral Cholecystogram (Ocg
Graham-Cole Test) 670
Iv Cholangiogram 671
Endoscopic
Retrograde Cholangio-pancreatography (Ercp ) 671
Percutaneous Transhepatic Cholangiography (Ptc) 672
Magnetic Resonance Cholangio-pancreatography
(Mrcp ) 673
Radioisotope Scan Study 673
Peroperative
Cholangiogram 673
Postoperative T-Tube Cholangiogram 673
Congenital Anomalies of Gallbladder 673
Choledochal Cysts 675
Caroli’s Disease 677
Biliary Atresia 677
Gallstones 679
Acute Cholecystitis 684
Acute Acalculous Cholecystitis 686
Empyema Gallbladder 687
Mucocele of the Gallbladder 688
Chronic
Cholecystitis 688
Cholecystoses 689
Dissolution Therapy for Gallstones 690
Choledocholithiasis 690
Sump
Syndrome 694
Courvoisier’s Law 694
Surgical Jaundice (Obstructive Jaundice) 695
Cbd Strictures (Biliary
Strictures) 697
Sclerosing Cholangitis 699
Gallbladder Polyp 699
Benign Biliary Papilloma 699
Carcinoma
Gallbladder 699
Cholangiocarcinoma (Bile Duct Carcinoma) 702
Klatskin Tumour 702
Biliary Fistulas 703
Gallstone Ileus 703
Hemobilia 704
White Bile 705
Cholecystectomy 705
Laparoscopic Cholecystectomy 706
Single
Incision Laparoscopic Surgery (Sils) in Cholecystectomy 708
Bile Duct Injuries 708
Post-cholecystectomy
Syndrome 709
Biliary Dyskinesia 710
13. Spleen 711
Surgical Anatomy 711
Functions of the Spleen 711
Splenunculi 712
Splenic Injury (Rupture Spleen) 712
Splenomegaly 716
Hereditary Spherocytosis 716
Immune Haemolytic Anaemia 717
Thalassaemia (Mediterranean Anaemia/
Cooley’s Anaemia/Erythroblastic Target Cell Anaemia) 718
Sickle Cell Disease 718
Idiopathic (Immune) Thrombocytoxix
Contents
penic Purpura (Itp) 718
Thrombotic Thrombocytopenic Purpura (Ttp) 720
Splenectomy 720
Overwhelming Postsplenectomy
Infection (Opsi) 722
Splenic Artery Aneurysm 722
Splenic Abscess 723
Hypersplenism 723
Splenic
Cyst 724
14. Pancreas 725
Anatomy 725
Serum Amylase 726
Magnetic Resonance Cholangio-pancreatography (Mrcp ) 727
Pancreatitis 727
Acute Pancreatitis 727
Complications of Acute Pancreatitis 732
Pseudocyst of Pancreas 734
Chronic Pancreatitis 738
Pancreatic Tumours 746
Exocrine Pancreatic Tumours 746
Carcinoma Pancreas 747
Endocrine Pancreatic
Tumours 755
Insulinomas 756
Gastrinomas 757
Glucagonomas 758
Zollinger-Ellison Syndrome 758
Cystic
Fibrosis 758
Annular Pancreas 759
Ectopic (Accessory) Pancreatic Tissue 759
Pancreatic Divisum 759
Pancreatic
Calculus 760
Pancreatic Ascites 760
Pancreatic Fistulae 760
Pancreatic Abscess 761
Pancreatic Necrosis 761
Pancreatic
Trauma 762
Cystic Lesions of Pancreas 763
Exocrine Pancreatic Disease 763
15. Retroperitoneal Space 764
Anatomy of Retroperitoneum 764
Retroperitoneal Fibrosis 764
Retroperitoneal Swellings 765
Retroperitoneal
Tumours 766
Psoas Abscess 769
16. Differential Diagnosis of Mass Abdomen 771
Mass in the Right Hypochondrium 773
Mass in the Epigastrium 775
Mass in the Left Hypochondrium 778
Mass in
the Lumbar Region 778
Mass in the Umbilical Region 780
Mass in the Right Iliac Fossa 780
Mass in the Left Iliac
Fossa 781
Mass in the Hypogastrium 781
17. Abdominal Wall and Umbilicus 784
Diseases of the Umbilicus 784
Omphalitis 784
U mbilical Granuloma 786
Anomalies of Vitellointestinal Duct 786
Umbilical
Sinus 787
U mbilical Adenoma (Raspberry Tumour) 787
U mbilical Fistula 788
Patent Urachus 788
Burst Abdomen
(Abdominal Dehiscence) (Acute Wound Failure) 788
Abdominal Wall Tumours 791
Desmoid Tumour 791
Exomphalos
(Omphalocele) 792
Gastroschisis (Belly Cleft) 793
Rectus Sheath Haematoma 794
Abdominal Wall Abscess 794
Meleney’s Progressive Synergistic Bacterial Gangrene of Abdominal Wall 795
Diverication of Recti (Diastasis Recti) 796
18. Hernia 797
Hernia 797
Aetiology 797
Parts of Hernia 798
Classification of Hernia 799
Inguinal Hernia 800
Surgical Anatomy
of Inguinal Canal 800
Classification of Inguinal Hernia (Earlier) 802
Newer Classification of Hernia 803
Indirect
(Oblique) Inguinal Hernia 803
Direct Hernia 811
Malgaigne Bulging 817
Incarcerated Hernia 817
Strangulated
Hernia 817
Sliding Hernia (Hernia-En-Glissade) 820
Pantaloon Hernia (Double Hernia, Saddle Hernia, Romberg
Hernia) 821
Infantile Hernia 821
Femoral Hernia 822
Ventral Hernia 824
Incisional Hernia 825
U mbilical
Hernia 829
Paraumbilical Hernia (Supra- and Infraumbilical Hernia) 831
Epigastric Hernia (Fatty Hernia of Linea
Alba) 831
Spigelian Hernia 833
Obturator Hernia 834
Richter’s Hernia 834
Lumbar Hernia 835
Phantom
Hernia 835
Sciatic Hernia 836
Complications of Hernia Surgery 836
Parastomal Hernia 836
Different Types of
Hernia 837
19. Oesophagus 838
Anatomy 838
Lower Oesophageal Sphincter (Los) 839
Dysphagia 840
Contrast Study of Oesophagus 841
Oesophagoscopy 842
Oesophageal Endosonography 842
Gastro-oesophageal Reflux Disease (Gord/Gerd) 842
Hiatus
Hernia 847
Rolling Hernia (Paraoesophageal Hernia) 848
Reflux Oesophagitis 848
Barrett’s Oesophagus (Norman
Barrett, British, 1950) 849
Barrett’s Ulcer 849
Oesophageal Motility Disorders 849
Achalasia Cardia (Cardiospasm) 850
Plummer-Vinson Syndrome (Paterson-Kelly Syndrome) 853
Corrosive Stricture of Oesophagus 854
Schatzki’s
Rings 856
Boerhaave’s Syndrome 856
Mallory-Weiss Syndrome 856
Tracheo-oesophageal Fistula 857
Oesophageal
Diverticulum 857
Carcinoma Oesophagus 858
Benign Tumours of the Oesophagus 866
Oesophageal Perforation 867
Foreign Body Oesophagus 867
20. Stomach 869
Anatomy 869
Blood Supply of Stomach 870
Nerve Supply of Stomach 870
Histology 870
Lymphatic Drainage of
Stomach 871
Duodenum 871
Gastric Physiology 871
Gastric Function Tests 872
Gastrin 873
Barium Meal
Study 873
Gastroscopy 874
Helicobacter Pylori 875
Congenital Hypertrophic Pyloric Stenosis 876
Gastritis 877
Acute Peptic Ulcer (Duodenal or Gastric Ulcer) 878
Gastric Ulcer 879
Duodenal Ulcer 882
Pyloric Stenosis Due
to Chronic Duodenal Ulcer 885
Perforated Peptic Ulcer 887
Bleeding Peptic Ulcer 891
Haematemesis 893
Complications of Gastric Surgery 894
Trichobezoar (Rapunzel Syndrome) 898
Chronic Duodenal Ileus (Wilkie’s
Syndrome) 898
Durban’s Syndrome 899
Acute Gastric Dilatation 900
Gastric Volvulus 900
Gastric Polyp 901
Menetrier’s
Disease 901
Duodenal Diverticula 902
Carcinoma Stomach 902
Gastric Lymphoma 915
Gastric Sarcomas 916
Gastrointestinal
Stromal Tumours (Gist) 917
Pyloroplasty 918
Gastrostomy 918
Gastrectomy 919
Gastrojejunostomy
(Gj) 920
Retrograde Jejunogastric Intussusception 920
Vagotomy 920
SRB's Manual of Surgery
21. Small Intestine 922
Anatomy 922
Meckel’s Diverticulum 923
Regional Enteritis (Crohn’s Disease) 925
Surgical Complications of
Typhoid 928
Surgical Complications of Roundworm (Ascaris Lumbricoides) 929
Pneumatosis Cystoides Intestinalis 931
Mesenteric Vessel Ischaemia 931
Necrotising Enterocolitis 934
Small Bowel Tumours 935
Benign Tumours
of Small Bowel 936
Malignant Tumours of Small Bowel 937
Carcinoid Tumour 939
Short Bowel Syndrome (Short
Gut Syndrome) 941
Massive Bowel Resection 941
Small Bowel Enema (Enteroclysis) 942
Capsule Endoscopy 942
Small Bowel Enteroscopy 943
Enteric/Gastrointestinal Fistula 943
22. Large Intestine 948
Anatomy 948
Hirschsprung’s Disease (Congenital Megacolon) 949
Diverticular Disease of the Colon 951
U lcerative
Colitis 954
Ischaemic Colitis 959
Pseudomembranous Colitis 960
Surgical Complications of Intestinal Amoebiasis 960
Tumours of Colon 961
Benign Tumours/Polyp of the Colon 961
Juvenile Polyps 961
Metaplastic/Hyperplastic
Polyp 961
Peutz-Jegher’s Polyp 962
Adenoma of Colon 962
Familial Adenomatous Polyp (Fap) 963
Gardner’s
Syndrome 964
Carcinoma Colon 964
Angiodysplasia of Colon 974
Ogilvie’s Syndrome 974
Colostomy 975
Stoma
Care 977
Stoma Appliances 978
Faecal Fistula 979
Preparation of Large Bowel for Surgery 980
Surgical
Pouches 980
Barium Enema 981
23. Intestinal Obstruction 983
Intestinal Obstruction: Types 983
Dynamic Obstruction 984
Duodenal Atresia 989
Small Intestine Atresia (Intestinal
Atresia) 990
Malrotation 991
Meconium Ileus 992
Intussusception (Iss ) 994
Volvulus 997
Sigmoid Volvulus
(Volvulus of Pelvic Colon) 997
Paralytic Ileus (Adynamic Intestinal Obstruction) 1000
Adhesions and Bands 1000
Internal
Hernias 1003
24. Appendix 1005
Surgical Anatomy 1005
Duplication of Appendix (Wallbridge Classification) 1005
Acute Appendicitis 1006
Incidental
Appendicectomy 1013
Appendicular Mass (Periappendicular Phlegmon) 1014
Appendicular Abscess 1015
Faecal
Fistula After Appendicectomy 1016
Mucocele of Appendix 1016
Neoplasms of the Appendix 1017
Laparoscopic
Appendicectomy 1017
25. Rectum and Anal Canal 1020
Anatomy 1020
Per-rectal Examination (Digital Examination of the Rectum) 1021
Proctoscopy (Kelly’s) 1022
Sigmoidoscopy 1022
Colonoscopy 1022
Carcinoma Rectum 1023
Solitary Ulcer Syndrome 1029
Rectal
Prolapse 1030
Anorectal Malformations (Arm) 1034
Pilonidal Sinus/Disease (Jeep Bottom
Driver’s Bottom) 1036
Piles/
Haemorrhoids 1038
Anal Fissure (Fissure-in-ano) 1046
Anorectal Abscess 1049
Fistula-in-ano 1051
Anorectal
Strictures 1056
Condyloma Acuminata 1057
Anal Intraepithelial Neoplasia (Ain) 1057
Malignant Tumours of Anal
Area 1057
Anal Margin Tumours 1058
Sacrococcygeal Teratoma 1058
Anal Incontinence 1059
Descending Perineal
Syndrome 1059
Proctitis 1060
Proctalgia Fugax 1060
Hidradenitis Suppurativa of Anal Region 1060
Pruritus
Ani 1060
Gastrointestinal Haemorrhage (Gi Bleed) 1061
26. Urology 1065
A. Kidney 1065
Anatomy of Kidney and Ureter 1065
Kidney—Anatomy 1065
U reter—Anatomy 1066
Plain X-ray—Kidney,
Ureter and Bladder (Kub) 1066
Intravenous Urogram (Ivu) 1067
Retrograde Pyelography (Rgp) 1068
Renal
Angiogram 1069
Micturating Cystourethrography (Mcu) 1069
Ascending Urethrogram 1069
Isotope Renography 1070
Cystoscopy 1071
Catheters 1071
Foley’s Catheter (Fredrick Eugene Basil Foley—American Urologist) 1072
Malecot’s Catheter 1073
Red Rubber Catheter 1073
Nephrostomy 1074
Suprapubic Cystostomy
(Spc) 1074
Haematuria 1075
Horseshoe Kidney 1076
Cystic Diseases of the Kidney 1076
Polycystic Kidney
Disease (Pckd) 1077
Duplication of Renal Pelvis and Ureter 1078
Retrocaval Ureter 1079
Ureterocele 1080
Injuries to Kidney 1080
Renal Tuberculosis 1081
Hydronephrosis (Hn) 1084
Pyonephrosis 1088
Carbuncle of
Kidney (Renal Carbuncle) 1088
Perinephric Abscess 1089
Renal Calculus 1089
U reteric Calculi 1094
Staghorn
Calculus 1097
Benign Tumours of Kidney 1098
Wilm’s Tumour (Nephroblastoma) 1099
Renal Cell Carcinoma
(Rcc) 1100
Approaches to Kidney (Surgical) 1104
B. Urinary Bladder 1105
Anatomy 1105
Ectopia Vesicae (Extrophy of the Bladder) 1106
U rachal Anomalies 1106
Vesical
Calculus 1106
Cystitis 1110
Recurrent Cystitis 1110
Interstitial Cystitis (Hunner’s Ulcer, Elusive Ulcer) 1110
Schistosoma
Haematobium (Endemic Haematuria, Urinary Bilharziasis) (Swimmer’s Itch) 1111
Thimble or Systolic
Bladder 1111
Bladder Tumours 1112
Transitional Cell Carcinoma (Tcc) 1112
Ureterosigmoidostomy 1115
Rupture
Bladder (Bladder Injury) 1115
Residual Urine 1116
Malakoplakia 1116
Neurogenic Bladder 1117
Vesicoureteric
Reflux 1117
Bladder Diverticula 1118
U rinary Diversion 1119
U rinary Fistulas 1120
C. Prostate 1121
Anatomy 1121
Acid Phosphatase 1121
Prostate Specific Antigen (Psa) 1121
Benign Prostatic Hyperplasia
(Bph) 1122
Prostatitis 1125
Bladder Outlet Obstruction (Boo) 1125
Carcinoma Prostate 1126
D. Urethra 1129
Anatomy 1129
U rethral Injury 1129
Rupture of Membranous Urethra and/or Prostatic Urethra (Posterior
Urethra) 1129
Rupture of Bulbous Urethra (Anterior Urethra) 1130
Stricture Urethra 1131
Hypospadias 1132
Epispadias 1133
Posterior Urethral Valve 1133
U rethral Calculi 1134
Urethritis 1135
Extravasation
of Urine 1135
Retention of Urine 1136
E. Penis 1138
Phimosis 1138
Paraphimosis 1139
Circumcision 1140
Balanoposthitis 1141
Chordee (Cordee) 1141
Priapism 1141
Peyronie’s Disease (Induratio-Penis Plastica) 1141
Ram’s Horn Penis 1142
Carcinoma Penis 1142
Buschke-
Lowenstein’s Tumour 1147
F. Scrotum 1148
Anatomy 1148
Fournier’s Gangrene 1148
Hydrocele 1149
Primary Vaginal Hydrocele 1150
Secondary Hydrocele 1151
Haematocele 1154
Pyocele 1155
Cyst of Epididymis 1155
Spermatocele 1156
Varicocele 1157
G. Testis 1160
Anatomy 1160
U ndescended Testis 1161
Ectopic Testis 1163
Retractile Testis 1164
Torsion of the
Testis 1164
Testicular Tumours 1165
Paratesticular Tumours 1170
Orchitis 1170
Epididymitis 1171
27. Neurosurgery 1172
Head Injuries 1172
Extradural Haematoma 1177
Subdural Haematoma 1178
Subarachnoid Haemorrhage
(Sah) 1179
Depressed Skull Fracture 1180
Hydrocephalus 1181
Intracranial Abscess 1182
Intracranial Aneurysms 1182
Intracranial Tumours 1183
Pituitary Tumours 1186
Craniopharyngiomas 1187
Spinal Dysraphism 1187
Meningocele 1188
Spina Bifida 1188
Intervertebral Disc Prolapse (Ivdp) 1189
Tuberculosis of Spine
(Caries Spine) 1190
Spinal Tumours 1193
28. Thorax 1194
Chest Injuries 1194
Fracture Ribs 1195
Flail Chest and Stove in Chest 1196
Pneumothorax 1197
Tension Pneumothorax 1197
Haemothorax 1198
Pleural Tap 1198
Bronchoscopy 1199
Empyema Thoracis 1199
Empyema
Necessitans 1200
Lung Abscess 1201
Intercostal Tube Drainage 1202
Shock Lung (Stiff Lung) 1203
Pulmonary
Embolism (Pe) 1203
Surgical Emphysema 1204
Lung Cysts 1204
Mediastinal Tumours 1205
Thymomas 1207
Pancoast Tumours (Superior Sulcus Tumour) 1208
Chest Wall Tumours 1208
Pericarditis 1209
Acute
Pericarditis 1209
Chronic Constrictive Pericarditis (Pick’s Disease) 1210
Pericardial Tap 1210
Cardiac
Tamponade 1210
Diaphragmatic Hernia 1211
Pulmonary Complications during Postoperative Period 1213
Surgical
Management of Pulmonary Tuberculosis 1214
Video Assisted Thoracoscopic Surgery (Vats ) 1214
Cardiac Surgery 1215
Anatomy 1215
Preoperative Assessment and Preparation of the Cardiac Patient 1216
Cardiopulmonary
Bypass 1217
Congenital Heart Diseases 1217
Patent Ductus Arteriosus (Pda)—10% 1217
Coarctation of
Aorta—5% 1218
Atrial Septal Defect (Asd)—7% 1218
Ventricular Septal Defect (Vsd)—15% 1219
Pulmonary
Stenosis 1219
Transposition of Great Vessels 1219
Tetralogy of Fallot 1220
Acquired Heart Disease 1220
Mitral
Regurgitation 1221
Aortic Stenosis 1221
Aortic Regurgitation 1221
Valve Replacement Surgery 1222
Ischaemic
Heart Disease (Ihd) 1222
Cardiac Pacemakers 1223
Postoperative Care 1223
29. Adjuvant Therapy 1224
Radiotherapy 1224
Chemotherapy 1227
Cell Cycle 1227
Antimalignancy Drugs 1227
Hormone Therapy in
Cancer 1227
Immunosuppression 1229
Immunotherapy 1229
Hybridoma 1229
Gene Therapy 1230
30. Anaesthesia 1231
Preoperative Assessment 1231
General Anaesthesia 1232
Anaesthetic Agents 1232
Oxygen 1232
Muscle Relaxants 1232
Reversal Agents 1232
Instruments in Anaesthesia 1232
Complications of General Anaesthesia 1234
Postoperative Care 1234
Monitoring the Postoperative Patient 1234
Regional Anaesthesia 1235
Topical
Anaesthesia 1235
Infiltration Block 1235
Field Block 1235
Nerve Block 1235
Intravenous Regional Anaesthesia (Bier’s
Block) 1235
Spinal Anaesthesia 1235
Saddle Block 1236
Epidural Anaesthesia 1236
Caudal Anaesthesia 1237
31. Advanced Imaging Methods 1238
Ultrasound 1238
Doppler 1240
Ct Scan 1240
Magnetic Resonance Imaging (Mri) 1242
Radionuclide Imaging 1243
Positron-Emission Tomography (Pet Scan) 1243
32. Operative Surgery 1244
A. Asepsis and Sterilisation 1244
Sterilisation 1244
Disinfection 1244
Antisepsis 1244
Asepsis 1244
Different Methods of Disinfection/
Sterilisation 1244
B. Instruments 1247
Cheatle’s Forceps 1247
Sponge Holding Forceps (Rampley’s) 1247
Mayo’s Towel Clip 1247
Artery Forceps
(Haemostat) 1247
Right Angle Forceps 1248
Kocher’s Forceps 1248
Allis’ Tissue Holding Forceps 1248
Babcock’s
Forceps 1248
Lane’s Tissue Holding Forceps 1249
Morant-Baker’s Appendix Holding Forceps 1249
Volkmann’s
Retractor 1249
Langenbeck’s Retractor 1249
Czerny’s Retractor (Hernia Retractor) 1249
Morris’ Retractor 1249
Deaver’s Retractor 1249
Doyen’s Retractor 1250
Self-retaining Retractor 1250
Single Hook Retractor 1250
Plain
Non-toothed Dissecting Forceps 1250
Toothed Dissecting Forceps 1250
Surgical Needles 1250
Needle
Holder 1251
Joll’s Thyroid Retractor 1251
Moynihan’s Occlusion Clamp 1251
Payr’s Crushing Clamp
(Gastric) 1251
Desjardin’s Choledocholithotomy Forceps 1251
Bake’s Dilator 1251
Sinus Forceps (Lister’s) 1252
Scissors 1252
Volkmann’s Scoop 1252
Tracheostomy Tube 1252
Drains 1252
Foley’s Catheter 1254
Malecot’s
Catheter 1254
Simple Red Rubber Catheter 1254
Lister’s Urethral Dilator 1254
Ryle’s Tube 1254
Infant Feeding
Tube 1255
Kehr’s ‘T’ Tube 1255
Proctoscope 1255
Flatus Tube 1255
C. Suture Materials 1256
Classification I 1256
Classification Ii 1257
Classification Iii 1257
Classification Iv 1257
Classification V 1257
D. Diathermy (Electrocautery 1258
Types 1258
E. Operative Procedure 1259
Abdominal Incisions 1259
Vasectomy 1260
Circumcision 1260
Hydrocele 1261
Inguinal Hernia 1261
Appendicectomy 1262
Thyroidectomy 1262
Tracheostomy 1263
Cryosurgery 1264
Lasers in Surgery
(Light Amplification Stimulated Emission of Radiation) 1265
Staplers in Surgery 1265
Nasojejunal Tube
Feeding 1266
Gossypiboma (Gossypium—Cotton Based in Latin) 1266
F. Laparoscopic Surgery 1267
Advantages of Laparoscopic Surgery 1267
Laparoscopic Cholecystectomy 1268
Laparoscopic Appendicectomy 1269
Advanced Laparoscopic Surgeries 1269
Diagnostic Laparoscopy 1270
Retroperitoneoscopy 1270
Natural Orifice Transluminal Endoscopic Surgery (Notes ) 1270
G. Dressings and Bandages 1272
Dressings 1272
Bandages 1272
H. Day Care Surgery 1274
Day Care Surgery 1274
Surgical Audit 1275
Surgeon and Law 1276
33. Miscellaneous 1277
A. Fascinating Signs in Surgery 1277
B. Triads in Surgery 1287
C. Misnomers in Surgery 1288
D. Triangles in Surgery 1289
E. Drugs at a Glance 1291
Antibacterials 1291
Sulfonamides 1291
Quinolones 1291
Penicillin 1292
Ampicillin/ Amoxycillin/ Talampicillin/ Pivampicillin 1292
Methicillin 1292
Cloxacillin/ Dicloxacillin/ Flucloxacillin 1292
Carbenicillin/ Ticarcillin 1292
Piperacillin/ Azocillin/ Mezlocillin 1292
Clavulanic Acid 1292
Sulbactum 1292
Tazobactum 1292
Carbapenem/Imipenem/Meropenem 1292
Lincomycin/Clindamycin 1292
Vancomycin/Teicoplanin 1293
Cephalosporins 1293
Macrolides 1293
Aminoglycosides 1293
Tetracyclines 1294
Chloramphenicol / Thiamphenicol 1294
Drugs For Tuberculosis 1294
Antiamoebic Drugs 1295
Important Antihelminthics 1295
Anticoagulants 1296
Other Drugs 1296
Appendix 1299
Further Reading 1303
Index 1305
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Untitled Document
PARAMOUNT'S MEDICAL
PARAMOUNT'S GENERAL
PARAMOUNT'S CHILDREN
PARAMOUNT'S ENGINEERING
BOOKS OF SUBSTANCE (DAWN BOOKS & AUTHORS)
MR AND MRS. JINNAH: THE MARRIAGE THAT SHOOK INDIA
JASMINE AND JOURNEYS: THE LIFE QUEST OF A SOUTH ASIAN WOMAN
THE SPY
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