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Common Surgical Diseases Second Edition Common Surgical Diseases An Algorithmic Approach to Problem Solving Second Edition Edited by Jonathan A. Myers, MD Assistant Professor of Surgery Director, Undergraduate Surgical Education Rush Medical College of Rush University Rush University Medical Center Chicago, IL 60612, USA Keith W. Millikan, MD Professor of Surgery Associate Dean, Surgical Sciences and Services Rush Medical College of Rush University Rush University Medical Center Chicago, IL 60612, USA Theodore J. Saclarides, MD Professor of Surgery Head, Section of Colon and Rectal Surgery Rush Medical College of Rush University Rush University Medical Center Chicago, IL 60612, USA Jonathan A. Myers, MD Keith W. Millikan, MD Assistant Professor of Surgery Professor of Surgery Director, Undergraduate Surgical Education Associate Dean, Surgical Sciences and Services Rush Medical College of Rush University Rush Medical College of Rush University Rush University Medical Center Rush University Medical Center Chicago, IL 60612, USA Chicago, IL 60612, USA Theodore J. Saclarides, MD Professor of Surgery Head, Section of Colon and Rectal Surgery Rush Medical College of Rush University Rush University Medical Center Chicago, IL 60612, USA ISBN 978-0-387-75245-7 e-ISBN 978-0-387-75246-4 Library of Congress Control Number: 2007937163 © 2008 Springer Science+Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper 9 8 7 6 5 4 3 2 1 springer.com This book is dedicated to my wife, Beth, for her infinite patience, love, and support, and to our son, Jack, for his never-ending curiosity and boundless energy. Jonathan A. Myers To my parents, John and Joan, for making it all possible. To my wife, Janet, for her never-ending understanding and support of my career and, finally, to my children, Keith, Michael, Kyle, Kameron, Samantha, and John, for inspiring my optimism for the future. Keith W. Millikan I dedicate this to the physicians and healers whose work and lives have been a constant source of inspiration for me and countless others. May their memory be eternal. Theodore, Neofytos, John, Cosmas, Damian, Panteleimon, Nektarios, Savas, Herman, Rose. Theodore J. Saclarides Acknowledgments We are grateful to Steven G. Economou and Alexander Doolas for their encouragement and tutelage over the last several decades. Our deepest gratitude to Eileen Pehanich for her untiring efforts in the completion of this work. Jonathan A. Myers Keith W. Millikan Theodore J. Saclarides vii Foreword The printing of the 2nd edition of Common Surgical Dis- Solving is not only for residents and students or the young eases: An Algorithmic Approach to Problem Solving attests surgeon but also for all physicians who deal with surgical to its usefulness and popularity. Dr. Steven Economou, who patients. After all, a nonspecialist may not know the intricacies wrote the first foreword, died on April 7, 2007, and despite his of decision making for a Whipple operation and may order prolonged and debilitating illness, he retained his cheerful and a percutaneous biopsy or an ERCP when, regardless of the optimistic nature. Those of us who have been mentored by this result, the patient may or may not be a surgical candidate. great human being hope to emulate, but will probably never Common surgical diseases are not the only topics. There are achieve, his Olympian deeds as a surgeon, author, teacher, and at least 20 general topics on preoperative and postoperative leader. I am very honored to have been asked by the authors to care. Drs. Myers, Millikan, and Saclarides have taken advan- write the foreword for the 2nd edition. tage of the many talented attending physicians and residents Years ago, the resident or medical student was commended at Rush University to write most of the chapters. The authors for making a long list of obscure differential diagnoses regardless themselves wrote numerous chapters on their specialty. All the of the remoteness from the patient’s problem. Of course, these chapters were reviewed, corrected, and edited by the authors diagnoses have to be excluded or confirmed by numerous and they have left their indelible character in the text. This investigations, which could be painful, time consuming, book belongs in the pocket of residents and students and on dangerous, and costly. One might say that having many diag- the desk of practicing physicians who deal with a wide range noses and performing many tests protects the physician from of patients. litigation. In fact, it will do the opposite if they are not appropriate Alexander Doolas, MD and complications arise. Medicine has turned from performing Rush Medical College of Rush University too many investigations to expeditious and concise “evidence- Rush University Medical Center based medicine.” The authors have predated this trend by a Chicago, IL few years and the printing of the 2nd edition is timely. Common Surgical Diseases: An Algorithmic Approach to Problem ix Contents Acknowledgments . vii Foreword . ix Contributors . xix Part I General Preoperative Considerations 1. Assessing Preoperative Cardiac Risk in Patients Undergoing Noncardiac Surgery. 3 David M. Rothenberg 2. Management of Preoperative Bleeding Disorders–Intraoperative Coagulopathy. 7 Jeffrey Shuhaiber and Jonathan Silverstein 3. Preoperative Nutritional Assessment/Intervention . 11 Janet D. Millikan 4. Transfusion Reactions. 15 Jennifer B. Manders 5. Asymptomatic Carotid Bruits . 19 Joseph D. Vijungco 6. General Operating Room Precautions . 23 Jonathan A. Myers Part II Trauma 7. Initial Assessment and Resuscitation of the Trauma Patient . 29 Frederic Starr 8. Head Trauma. 33 Laura B. Petrey 9. Management of the Difficult Airway . 37 Kimberly O. Nagy 10. Penetrating Neck Trauma . 41 Mark Falimirski xi xii Contents 11. Penetrating Chest Trauma. 45 Marie Crandall 12. Penetrating Abdominal Trauma . 49 James M. Waltenberger 13. Blunt Abdominal Trauma . 53 Marie Crandall 14. Pelvic Fractures. 57 Benjamin P. Crane 15. Traumatic Hematuria . 61 Carlos R. Estrada, Jr. 16. Knee Pain . 65 Anca Lamse and Charles A. Bush-Joseph 17. Shoulder Pain . 69 Anca Lamse and Charles A. Bush-Joseph 18. Hip Fractures. 73 Eric M. Berkson 19. Extremity Fractures. 75 Eric M. Berkson 20. Burns. 79 Laura J. Moore Part III Vascular Problems 21. Chronic Lower Extremity Ischemia . 85 Chad E. Jacobs 22. The Acute Cold Leg . 89 Peter Y. Wong 23. Myocardial Infarction . 93 Clifford J. Kavinsky and Paul W. McMullan 24. Abdominal Aortic Aneurysm . 97 Bernadette Aulivola Part IV Endocrine Disorders 25. Solitary Thyroid Nodule and Cancer . 103 Christine A. Chu and William B. Inabnet 26. Cushing’s Syndrome . 107 David Baldwin, Jr. 27. Hyperthyroidism . 111 Subhash Patel Contents xiii 28. Hypercalcemia . 115 Michael D. Addis and William B. Inabnet 29. Insulinoma. 119 Geoffrey B. Thompson 30. Zollinger Ellison Syndrome . 123 Anthony W. Kim and Harry M. Richter, III 31. Surgical Hypertension: Evaluation and Treatment . ..