MRCS Revision Guide: Trunkand Thorax

Cambridge University Press 978-0-521-14551-0 - MRCS Revision Guide: Trunk and Thorax Mazyar Kanani and Leanne Harling Index More information

Index

abdomen, surgical approaches to, 64–66 management, 99–100 abdominal aorta, 79 markers, 97 and abdominal aortic aneurysms, modified Glasgow criteria, 97 74–79 scoring systems, 98 anatomy, 53–54 Ranson criteria, 98–99 bifurcation, 53 severe attacks, features, 99 abdominal aortic aneurysms (AAAs), adenoma–carcinoma sequence, 120 74–79 adrenal arteries, 53 aetiology, 74–76 advancement flap asymptomatic, 76 in fissure in ano treatment, 128 development, risk factors, 76 mucosal, 132 diagnosis, 76–77 afterload expansion, physiological decrease, 16 mechanisms, 76 definition, 14–15 formation sites, 74 airway management, mechanisms, 21–27 infrarenal airways, definitive, 21 endovascular technique, 79 alimentary canal, embryological origin, 49 transperitoneal approach, 78 alveolar air, 26 prevalence, 74 alveolar dead space, 25 rupture, 77–78 alveolar gas equation, 26 rupture risk, size factors, 77 alveolar ventilation, 25 surgical approaches, 78–79 alveoli, and lung deflation, 27 symptoms, 77 Amsterdam criteria, revised, 120–121 abdominal wall, 73 anal canal layers, 48 length of, 54 abdomino-perineal resection (APER), lymphatic drainage, 55 136–137 anal cancer, 134–136 acute appendicitis, 117–118 anal malignancies, 134–137 acute lower gastrointestinal haemorrhage anatomical dead space, 25 secondary to diverticular aneurysmal dilatation, of aorta, disease, 111 classification, 74 acute pancreatitis aneurysms, 30–31 aetiology, 96 see also abdominal aortic aneurysms antibiotic therapy, 100 (AAAs); thoracic aortic clinical features, 97 aneurysms (TAAs) complications, 100 angle of Louis, anatomy, 13 diagnosis, serum amylase in, 97 anorectal junction, anatomy, 54 162

© in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-14551-0 - MRCS Revision Guide: Trunk and Thorax Mazyar Kanani and Leanne Harling Index More information

Index 163

anterior abdominal wall, 47–48 bi-level positive airways pressure anterior thoracotomy, 28–29 (BIPAP), 23 antibiotic therapy, in acute pancreatitis, 100 bilateral anterior sternotomy antrectomy, 85–86 see clamshell incision anus, 137 biliary colic, clinical features, 92 anatomy, 54–55 biliary disease, diagnosis, 92–93 aorta biliary leaks, classification, 94 aneurysmal dilatation, classification, 74 biliary tree, 105 see also abdominal aorta bilirubin, 91–92 aortic pressure waveform, dicrotic notch, Billroth procedures, 85–86 17–18 biological agents, in colonic cancer aortic valve, anatomy, 10 management, 124 APC gene, 120 bipolar diathermy, 3 appendectomy, 118–119 black pigment stones, 91 appendix, 117–119 bladder, 61–62 see also acute appendicitis bladder cancer, 144–147 applied surgical anatomy bladder malignancies, 144–147 thorax, 9–13 blood pressure (BP), 14 trunk, 58 homeostatic control mechanisms, 19 applied surgical physiology blood volume, and central venous cardiovascular, 14–27 pressure, 21 thorax, 14–27 bloodless fold of Treves, 117 trunk, 63 blunt abdominal trauma, diagnosis, 106 aquaporin 2, 19 blunt splenic trauma, conservative arcuate line, 48 treatment, 106 aromatase inhibitors, 44 Borrmann classification, for gastric arterial pressure waveform, 18–19 cancer, 86 asepsis, 5–6 Bosniak classification system, 143 Atlanta classification system, 99 Botulinum toxin (Botox), in fissure atrial kick, 18 in ano treatment, 128 atrial natriuretic peptide (ANP), 19 breast atrio-ventricular nodal artery, 10 benign diseases, 38 atrio-ventricular node (AVN), benign and malignant diseases, 46 anatomy, 10 breast cancer, 39–43 axilla, sentinel node biopsy, 45 distant metastases, 43–46 axillary clearance, 45–46 non-surgical management, 43–44 axillary nodes, classification, 45 surgical treatment, 44–45 axillary ultrasound, breast cancer breast carcinoma see breast cancer investigations, 42 breast cysts, clinical features, 39 breast lumps banding, in haemorrhoid treatment, 129 aetiology, 38 baroreceptors, 19 differential diagnosis, age factors, 38 benign prostatic hypertrophy (BPH) investigations, 41 prevalence, 150 malignancy features, 39 zones, 147 breathing, mechanisms, 21–27

164 Index

bronchi, 13 colonoscopy, 110 brown pigment stones, 91–92 in colonic malignancy diagnosis, 122 bundle of His, anatomy, 11 in ulcerative colitis, 114 colorectal cancer Calot’s triangle, anatomy, 57 and familial adenomatous Camper’s fascia, 47 polyposis, 121 Campylobacter-like organism (CLO) incidence, 119 test, 82 TNM staging system, 124 carbon dioxide colorectal malignancies, 119–126 partial pressure, 26 colostomy, and ileostomy compared, 66 carcinoembryonic antigen (CEA), 104 common bile duct (CBD), 57–58 cardiac cycle, 17–21 common hepatic artery, 50 cardiac output (CO), 14 continence, maintenance mechanisms, increase, measures, 16 60–61 and myocyte stretch, 16 continuous positive airways pressure cardiovascular system, applied surgical (CPAP), 22 physiology, 14–27 controlled mandatory ventilation catgut sutures, 1 (CMV), 22 central venous pressure (CVP), coronary artery dominance, 9 20–21 coronary circulation, 17–21 Charcot’s triad, 92 Crohn’s disease, 115–116 chemotherapy and ulcerative colitis compared, bladder cancer treatment, 147 111–112 breast cancer management, 43 CT pneumocolon, 122 colonic cancer management, 124 CT scanning with IV contrast, chest X-rays, thoracic aortic dissection thoracic aortic dissection investigations, 32 investigations, 33 chlorhexidine, 5 CT-KUB, 139 cholecystectomy, 93 Cullen’s sign, 97 see also laparoscopic cholecystectomy cholesterol stones, 91 Dalton’s law of gases, 25 chronic pancreatitis, 100–102 dead space, 25 circumcision, 155 DeBakey classification, 31, 32 clamshell incision, 29 deep inferior epigastric perforator closed haemorrhoidectomy, 129–130 (DIEP), flap, 46 coeliac axis, 53 deep inguinal ring, 67 coeliac trunk, anatomy, 49–50 defecation, 60–61 colon definitive airways, 21 mesenteric support, 52 Denonviller’s fascia, 53 sites for diverticulae, 109 dentate line, anatomy, 54–55 colonic cancer, 123–126 diagnostic peritoneal lavage (DPL), colonic malignancies, 121–122 106–107 colonic neoplasia, aetiology, 119–120 diaphragm, 34–37 colonic tumours, surgical resection, diaphragmatic herniae, 34–37 complications, 126 see also hiatus herniae

Index 165

diathermy, 3–5 Ethilon sutures, 1 see also bipolar diathermy; monopolar ethylene oxide, 6 diathermy excitation–contraction coupling, 15 dicrotic notch, in aortic pressure expiratory positive airways pressure waveform, 17–18 (EPAP), 23 disinfection, and sterilization expiratory reserve volume (ERV), 25 compared, 5 external anal sphincter distal pancreatectomy, 104 anatomy, 54 diverticulae, 109 neurological supply, 55 diverticular disease, 109–115 external oblique muscle, 47 acute lower gastrointestinal extra-corporeal shock wave lithotripsy haemorrhage secondary to, (ESWL), 140 management, 111 extra-hepatic biliary tree, anatomy, 57 aetiology, 109 complications, 109–110 false aneurysms, 30 definition, 109 familial adenomatous polyposis (FAP), 121 diagnosis, 110 FAST see focused assessment for management, 110 sonography in trauma presentation, 110 (FAST) prevalence, 109 2-FDG (2-fluoro-2-deoxy-d-glucose) diverticulitis, recurrence, 111 PET-CT, 122 diverticulosis, perforation secondary to, femoral canal, borders, 71 classification, 111 femoral herniae, 71–72 double contrast barium enema fibroadenomas, 38–39 (DCBE), 122 Finney procedure, 85 ductal carcinoma in situ (DCIS), 40 fissure in ano, 127–128 Dukes staging system, for colonic fistula in ano, 130–132 cancer, 123 see also peri-anal fistulae dumping syndrome, 88 fistula plug, in fistula in ano treatment, duodenal ulceration, 80–86 132 Helicobacter pylori infection, flexible sigmoidoscopy, 122 80–81 2-fluoro-2-deoxy-d-glucose (2-FDG) pain characteristics, 81 PET-CT, 122 focused assessment for sonography in ECG waveform, and cardiac cycle, 17 trauma (FAST), 106–107 echocardiography, thoracic aortic foramen of Winslow see epiploic foramen dissection investigations, 33 foregut, 49–51 elastance, 27 Frank–Starling relationship, 15 endoanal ultrasound (EAUS), in anal functional residual capacity (FRC), 23 cancer diagnosis, 135 fusiform aneurysms, 30 endoscopic therapies, for ulcer bleeding, 83–84 gallbladder, 57 endovascular aneurysm repair gallbladder cancer, 95–96 (EVAR), 79 gallbladder malignancy, 95–96 epiploic foramen, 49 gallstone disease, 91–94

166 Index

gallstone pancreatitis, scoring systems, see also diaphragmatic herniae; femoral Ranson criteria, 98 herniae; hiatus herniae; inguinal gallstones herniae; paraumbilical herniae; and gallbladder malignancy umbilical herniae development, 95 hiatus herniae, 35–37 types of, 91–92 highly selective vagotomy (HSV), 85 gamma radiation, for sterilization, 6 Hinchey scoring system, 111 gases, Dalton’s law of, 25 hindgut, anatomy, 52–53 gastrectomy, total, procedure-specific horizontal fissure, 12 complications, 88 hormonal receptors, in breast cancer gastric cancer, 86–88 tumour progression, 43 gastric ulceration, 80–86 hormonal therapy, breast cancer benign, sites for, 82 management, 44 pain characteristics, 81 genetic mutations, and pancreatic ileal pouch–anal anastomosis (IPAA), 115 cancer, 103 ileostomy, and colostomy compared, 66 genitourinary system, 155 ilioinguinal nerve, 68 Glasgow criteria, modified, 97 implant reconstruction, 46 Gleason scoring system, 148–149 infection, in operating theatres, risk Goligher classification, 128–129 reduction systems, 6 gonadal arteries, 53 inferior mesenteric artery (IMA), Goodsall’s rule, 130 51–53 Grey-Turner’s sign, 97 inflammatory bowel disease (IBD), 111–112 haemorrhoidal artery ligation operation see also Crohn’s disease; ulcerative (HALO), 130 colitis (UC) haemorrhoidectomy, 129–130 infrarenal aortic aneurysms, 74 haemorrhoidopexy, stapled, 130 inguinal canal, 67–68 haemorrhoids, 55, 128–130 inguinal hernia repair ‘Halstead’ radical mastectomy, 44 laparoscopic, 69 Hartmann’s pouch, 57 nerve risks, 70–71 Hasselbach’s triangle, 68 options, 69–70 Hasson technique, 6–7 Lichtenstein technique, 68–69 heart inguinal herniae, 67–71 anatomical position, 9 inguinal ligament, midpoint, 67 Starling’s law of, 14–17 injection sclerotherapy, in haemorrhoid heart rate (HR), 14 treatment, 129 Heineke–Miculicz procedure, 85 inspiratory positive airways pressure Helicobacter pylori (IPAP), 23 in duodenal ulceration, 80–81 inspiratory reserve volume (IRV), 25 eradication therapy, 83 internal anal sphincter, 54–55 and peptic ulcer disease, 80 internal iliac artery, branches, 53–54 tests, 82 internal oblique muscle, 47–48 herniae intra-thoracic pressure, and central laparoscopic repair, complications, 70 venous pressure, 21

Index 167

intravenous uretograms (IVUs), 139 liver, 105 intrinsic reflex, 61 anatomy, 56–58 invasive ductal carcinoma (IDC), 40 divisions, anatomical vs. functional, 57 invasive lobular carcinoma, 41 lobes, vascular supplies, 57 isovolumetric contraction, 17 posterior, peritoneal reflections, 56 Ivor–Lewis oesophagectomy, 89–90 surface markings, 57 lobular carcinoma in situ (LCIS), 41 jaundice, and bilirubin levels, 92 Lockwood approach, to femoral hernia Jenkin’s rule, 66 repair, 71 juxtarenal aortic aneurysms, 74 Lotheissen approach, to femoral hernia repair, 71–72 K-ras oncogene, 120 lower oesophageal sphincter (LOS), 60 Karydakis procedure, 134 lumbar triangle of Petit, 48 kidney stones see renal calculi lumbar vertebrae, pelvic metastases, 54 kidneys, 155 lung compliance, 26–27 KUB (kidney–ureter–bladder) lung deflation, alveoli and, 27 radiography, plain, 139 lung fissures, surface markings, 12 lungs laparoscopic appendectomy, blood supply, 13 complications, 118 surface markings, 12 laparoscopic cholecystectomy, 94 lymph nodes laparoscopic prostatectomy, 149 and anal cancer, 136 laparoscopic staging, in gastric cancer, 88 and breast cancer, 42–43 laparoscopy and gastric cancer, 87 basics, 6–8 Lynch syndrome, 120 contraindications, 8 hernia repair, complications, 70 McEvedy approach, to femoral hernia inguinal hernia repair, 69 repair, 72 nerve risks, 70–71 McKeown oesophagectomy, 90 options, 69–70 magnetic resonance imaging (MRI) pneumoperitoneum, 6–7 in anal cancer diagnosis, 135 vs. open surgery, 7–8 breast cancer investigations, 41 laparotomy, indications, 107 thoracic aortic dissection Laplace’s law, 27, 76 investigations, 33 large bowel, 126 marginal artery of Drummond, lateral sphincterotomy, in fissure in ano anatomy, 52 treatment, 128 mastectomy, 44–46 latissimus dorsi flap, 46 Mayo technique, 72–73 lay open, in fistula in ano treatment, 132 mean arterial pressure (MAP), left coronary artery, course of, 10 definition, 18 left thoraco-abdominal oesophagectomy, mechanical ventilation 90 complications, 23 lesser sac, 49 indications, 21 Lichtenstein technique, 68–69 Meckel’s diverticulum, 117 Limberg procedure, 134 median sternotomy, 28–29

168 Index

mediastinoscopy, chest access during, 29 open repair of abdominal aortic mediastinum, 37 aneurysms (oAAA), 78 mesh repair, 73 and endovascular aneurysm repair metallic sutures, 1 compared, 79 micturition, 61–63 open surgery, vs. laparoscopy, 7–8 mid inguinal point, 67 open and laparoscopic midgut, 51–52 uretolithotomy, 141 midline laparotomy incisions, 65–66 operating theatres, infection risk minute ventilation, 25 reduction, 6 mitral valve, anatomy, 10 OptiView ports, 7 mixed cholesterol and pigment stones, 92 orchidectomy, 152 modified radical mastectomy, 44 testicular cancer vs. acute torsion, monoclonal antibody therapy, breast 154–155 cancer management, 44 orchidopexy, 152 monopolar diathermy, 3 oversewing, peptic ulcers, 85 contraindications, 5 oxygen MRI see magnetic resonance imaging partial pressure of, 26 (MRI) oxygenation, improvement methods, 22–23 mucosal advancement flap, in fistula in ano treatment, 132 p53, 120 muscle stimulation, diathermy and, 3 pacemakers myocardial contractility, increase, 16 and diathermy, 5 myocyte stretch, and cardiac output, 16 pan-proctocolectomy with end ileostomy, 114–115 natural sutures, 1 pancreas, 105 needles, types of, 2 blood supplies, 58 neo-adjuvant therapy, for renal cancer, pancreatic cancer, 102–104 124–125 pancreatic malignancy, 102–105 nephrolithiasis, medical treatment pancreaticoduodenectomy, 104 options, 140 pancreatitis, 96–102 nephron sparing surgery, 144 see also acute pancreatitis; chronic NHS Bowel Cancer Screening pancreatitis Programme (UK), 123 paraumbilical herniae, 72–73 Nissen’s fundoplication, techniques, 37 parietal cell vagotomy, 85 nuclear scanning, breast cancer Park’s classification, 131–132 investigations, 42 partial nephrectomy, 144 nylon sutures, 1 partial pressure, 26 ‘Patey’ radical mastectomy, 44 oblique fissure, 12 pelvic metastases, spread, 54 oblique sinus, anatomy, 9 pelvic venous system, anatomy, 54 oesophageal cancer, 88–90 peptic ulcer disease oesophagus, 90 aetiology, 80 omental bursa see lesser sac complications, clinical features, 81 Onuf’s nucleus, 63 diagnosis, 81–82 open haemorrhoidectomy, 129 elective surgery, 85–86

Index 169

pharmacological management, 82–83 preload, definition, 14 surgical interventions, indications, 84 pressure control, and ventilation, 22 peptic ulcers, oversewing, 85 pressure support ventilation (PSV), peracetic acid, 6 22, 23 percutaneous nephrolithotomy, 141 Pringle’s manoeuvre, 58 peri-anal fistulae, 131–132 Prolene (polypropylene) sutures, 1 pericardium, reflections, 9 prostate, 147–151 peritoneal cavity prostate cancer access to, 65 distant metastases, sites of, 150 anatomy, 49 Gleason scoring system, 148–149 PET see positron emission tomography histological subtypes, 147 (PET) lifetime risks, 147 photocoagulation, in haemorrhoid non-surgical management, 149 treatment, 129 presentation, 148 phrenic nerve, anatomy, 11 screening, 148 physiological responses sites of, 147 to standing up, 16 prostate-specific antigen (PSA), to Valsalva manoeuvre, 16 147–148 piles haemorrhoids see prostatectomy pilonidal disease, 133–134 laparoscopic, 149 pilonidal sinus, pathogenesis, 133 robotic, 149 pilonidal sinus excision, radical prostatectomy complications, 134 see also pyloroplasty, 85 plain kidney–ureter–bladder (KUB) radiography, 139 radiation, for sterilization, 6 pleura, 12 radical cystectomy (RC), 146 pneumoperitoneum, 6–7 radical mastectomy, 44 polyamide sutures, 1 polydioxanone (PDS) sutures, 1 radical nephrectomy, 143–144 polyglactin sutures, 1 radical prostatectomy, 149–150 polypropylene sutures, 1 radiofrequency ablation and pontine micturition centre, 62–63 cryotherapy, 144 portal vein, anatomy, 51 radiotherapy porto-systemic anastamosis, sites of, 51 bladder cancer treatment, 147 positive end expiratory pressure breast cancer management, 43 (PEEP), 23 colonic cancer management, 124 positron emission tomography (PET) Ranson criteria, 98–99 breast cancer investigations, 42 receptive relaxation, 62 colonic malignancy diagnosis, 122 recto-anal inhibitory reflex, 61 posterior descending artery (PDA), 9 rectum, 137 posterior thoracotomy, 28 blood supplies, 53 posterolateral thoracotomy, 28 lymphatic drainage, 53 posture, and central venous pressure, 21 peritoneal relations to, 52 pouch of Douglas, 53 rectus abdominis, 48 povidone iodine, 5 rectus sheath, structures within, 48

170 Index

recurrent laryngeal nerve, anatomy, seton placement, in fistula in ano 11–12 treatment, 132 renal arteries, 53 silk sutures, 1 renal calculi, 138–141 simple mastectomy, 44 renal cancer sino-atrial nodal artery, 10 metastases, sites of, 142 sino-atrial node (SAN), 10 neo-adjuvant therapy, 124–125 skeletal muscle pump, and central venous and varicoceles, 142 pressure, 21 renal cell carcinomas, 142–144 skin preparation, 5–6 renal cysts, classification, 143 small bowel, 90 renal malignancies, 142–144 sphincter renal stone disease, 139 mechanisms, 62 external anal sphincter; renal stones see renal calculi see also renin-angiotensin-aldosterone (RAA) internal anal sphincter; lower system, 19–20 oesophageal sphincter (LOS) spinal cord reflexes, in defecation, 61 resection spirometry, traces, 23–25 in Crohn’s disease surgery, 116 spleen, 108 abdomino-perineal resection see also peritoneal attachments, 58 (APER); transurethral resection splenectomy of bladder tumours (TURBT); procedures, 108 transurethral resection of the total splenectomy prostate (TURP) see also splenic artery, branches, 50 residual volume (RV), 23 splenic trauma restorative proctocolectomy with ileal blunt, 106 pouch-anal anastomosis, 115 grading systems, 107 retrograde intrarenal surgery (RIRS), 141 splenectomy, 108 right coronary artery (RCA), 9–10 surgical interventions, indications, 107 rigid sigmoidoscopy, 122 standing up, physiological responses, 16 robotic prostatectomy, 149 Stanford classification, 31 Rockall score, 84 stapled haemorrhoidopexy, 130 Starling’s law of the heart, 15–17 saccular aneurysms, 30 steel sutures, 1 saline drop test, 7 sterilization, 5–6 saliva, 59 stoma formation, 66–67 Scarpa’s fascia, 47 stomach, 90 selective oestrogen receptor modulators blood supplies, 50 (SERMs), 44 stomas, 66–67 semicircular line of Douglas, 48 Strasberg classification, 94 semilunar line, 48 stricturoplasty, 116 sentinel node biopsy, 45 stroke volume (SV), 14 serum amylase, in acute pancreatitis subtotal colectomy and ileorectal diagnosis, 97 anastomosis, 115 serum lipase, in acute pancreatitis superior mesenteric artery (SMA), 51–53 diagnosis, 97 suprarenal aortic aneurysms, 74

Index 171

surfactants, and lung compliance, 26–27 in gallbladder cancer, 95–96 surgical approaches in pancreatic cancer, 104 to abdomen, 64–66 in renal cell carcinomas, 143 to abdominal aortic aneurysms, 78–79 in testicular tumours, 154 to chest, 29 total extra-peritoneal (TEP) repair, to colonic cancer, 125–126 69–70 to fissure in ano, 128 total lung capacity, 23 to fistula in ano, 132 total pancreatectomy, 104 to gallbladder malignancy, 96 total splenectomy to haemorrhoids, 129–130 complications, 108 to oesophageal cancer, 89–90 trans-hiatal oesophagectomy, 90 to open appendectomy, 118 transabdominal pre-peritoneal (TAPP) to pancreatic cancer, 104 repair, 69 to renal calculi, 140–141 transperitoneal approach, to infrarenal to testicular torsion, 152 abdominal aortic aneurysms, 78 to thoracic cavity, 28–29 transpyloric plane of Addison, 50–51 to ulcerative colitis, 114–115 transurethral resection of bladder surgical scrub solutions, 5 tumours (TURBT), 145–146 sutures, 1–2 transurethral resection of the prostate swallowing, 59–60 (TURP), 150 synchronized intermittent mandatory transurethral resection (TUR) ventilation (SIMV), 22 syndrome, 150 synthetic sutures, 1 transverse rectus abdominis muscle systemic vascular resistance (SVR), 14 (TRAM), 46 transverse sinus, anatomy, 9 testicular cancer, 153–155 transversus abdominis, 48 testicular malignancies, 153–155 trastuzumab, 44 testicular torsion, 151–152 triangle of doom, 70 orchidectomy, 154–155 triangle of pain, 70 testicular tumours, 153–154 triple test, 41 thoracic aorta, disorders of, 30 true aneurysms, 30 thoracic aortic aneurysms (TAAs), 74 truncal vagotomy, 85 dissecting, 31 trunk thoracic aortic dissection, 31–33 applied surgical anatomy, 58 thoracic cavity applied surgical physiology, 63 surgical approaches to, 28–29 thoraco-abdominal aortic aneurysms, 74 ulcerative colitis (UC) thoracolaparotomy, 29 aetiology, 112 thorax autoantibodies, 112 applied surgical anatomy, 9–13 colonoscopic screening, 114 applied surgical physiology, 14–27 and Crohn’s disease compared, tidal volume (TV), 23 111–112 TNM staging system extracolonic manifestations, 113 in breast cancer, 42–43 histological features, 113 in colorectal cancer, 124 macroscopic features, 113

172 Index

ulcerative colitis (UC) (cont.) urinary tract malignancies, 142–144 management, 113 bladder, 144–147 prevalence, 112 urothelial tumours, 144–147 surgery, 114 surgical approaches, elective, 114–115 vagotomy, 85–86 ulcers vagus nerve, anatomy, 11 benign vs. malignant, 82 Valsalva manoeuvre, 16–17 visible bleeding, endoscopic therapies, varicoceles, and renal cancer, 142 83–84 venous tone, and central venous see also duodenal ulceration; gastric pressure, 21 ulceration; peptic ulcer disease ventilation ultrasound alveolar, 25 axillary, 42 basic modes of, 22 endo-anal, 139 mechanisms, 21–27 in renal stone disease diagnosis, 139 minute, 25 umbilical herniae, 72–73 non-invasive methods, 22–23 see also paraumbilical herniae see also mechanical ventilation United States Pharmacopeia (USP), Veress needles, 7 suture sizes, 2 Vicryl/Vicryl Rapide (polyglactin) upper gastrointestinal tract malignancies, sutures, 1 86–88 vital capacity (VC), 23 urea breath testing, 82 volume control, and ventilation, 22 ureteroscopic lithotripsy (URS), 140–141 urinary calculi see renal calculi Whipple’s procedure, 104 urinary tests, in bladder cancer complications, 105 diagnosis, 145 wide local excision (WLE), 44