
Schein's Common Sense Emergency Abdominal Surgery
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- SCHEIN'S COMMON SENSE: EMERGENCY Abdominal Surgery
- Title Page
- Copyright
- Contents
- Contributors
- Editors' note
- Preface
- Reviews of previous editions
- A sample of testimonials posted on amazon...
- PART I: General considerations
- Chapter 1: General philosophy: Moshe Schein, Paul N. Rogers, Ari Leppäniemi, Danny Rosin and Jonathan E. Efron
- The 'best' management of an abdominal emergency
- General philosophy
- The inflamed patient
- Evidence
- Chapter 2: A brief history of emergency abdominal surgery: Harold Ellis
- Appendicitis
- The ruptured spleen
- Intestinal obstruction
- Perforated peptic ulcer
- Ruptured ectopic pregnancy
- Envoi
- PART II: Before the operation
- Chapter 3: The acute abdomen: Moshe Schein, Paul N. Rogers, Ari Leppäniemi, Danny Rosin and Jonathan E. Efron
- The problem
- The acute abdomen: management menus and clinical patterns
- Who should look after the 'acute abdomen' and where?
- Chapter 4: Rational diagnostic procedures: Moshe Schein, Paul N. Rogers, Ari Leppäniemi, Danny Rosin and Jonathan E. Efron
- Blood tests
- Chest X-ray (CXR)
- Plain abdominal X-ray (AXR)
- Abdominal ultrasound (US)
- Abdominal computed tomography
- A word of caution
- Contrast studies: barium vs. water-soluble contrast
- Unnecessary tests
- Diagnostic laparoscopy
- Chapter 5: Abdominal imaging: Moshe Schein and Hans Ulrich Elben
- Plain abdominal X-ray (AXR)
- Computed tomography in abdominal emergencies
- How to read and interpret the abdominal CT for an 'acute abdomen'
- Final words from Moshe.
- Chapter 6: Optimizing the patient: James C. Rucinski
- Why is pre-operative optimization necessary?
- What are the goals of optimization?
- Who needs optimization?
- Measurement of the severity of illness
- How I do it?
- Oxygenation
- Restoration of volume
- Measurement of effectiveness of treatment
- Urine output
- Invasive monitoring
- Laboratory
- Blood and blood products
- Suggested steps in volume optimization
- When is enough enough?
- So finally to recap.
- Chapter 7: Pre-operative antibiotics: Moshe Schein
- When should you start antibiotics?
- Which antibiotics to use?
- To sum it up
- Chapter 8: Family, ethics, informed consent and medicolegal issues: James C. Rucinski
- Salesmanship
- Illustrate the problem
- The family
- Ethical problem solving
- Medicolegal considerations
- Avoid selling autopsies under anesthesia (AUA)
- Concluding remarks
- Chapter 9: Before the flight: pre-op checklist: Moshe Schein, Paul N. Rogers, Ari Leppäniemi, Danny Rosin and Jonathan E. Efron
- The surgeon's checklist
- PART III: The operation
- Chapter 10: The incision: Moshe Schein, Paul N. Rogers, Ari Leppäniemi, Danny Rosin and Jonathan E. Efron
- At what level must the midline incision start and how long should it be?
- When should you extend the incision into the thorax?
- Knife or diathermy?
- Pitfalls
- Chapter 11: Abdominal exploration: finding what is wrong: Moshe Schein, Paul N. Rogers, Ari Leppäniemi, Danny Rosin and Jonathan E. Efron
- Abdominal exploration
- Intraperitoneal blood
- Primary survey
- Secondary survey
- Intraperitoneal contamination or infection
- The direction and practicalities of exploration
- Use your common sense
- What about retractors?
- Additional points: grading the severity of injury
- Chapter 12: The laparoscopic approach to emergency abdominal surgery: Danny Rosin
- General principles
- Potential advantages
- Potential flaws
- Setting the scene
- Technique
- Procedures
- Chapter 13: Peritonitis: classification and principles of treatment: Moshe Schein and Roger Saadia
- Nomenclature
- Classification of peritonitis
- Management (secondary peritonitis)
- Aggressive modalities of management
- Need for peritoneal cultures?
- Chapter 14: The intestinal anastomosis (and stomata): Mark Cheetham, Moshe Schein, Paul N. Rogers, Ari Leppäniemi, Danny Rosin and Jonathan E. Efron
- 1. The intestinal anastomosis: Moshe Schein, Paul N. Rogers, Ari Leppäniemi, Danny Rosin, Jonathan E. Efron
- The ideal anastomosis
- Pros and cons
- The choice of anastomotic technique: international perspective
- Our recommendations
- The edematous bowel
- How we do it
- A few more words on staplers
- Testing the anastomosis
- When not to perform an anastomosis?
- So let us leave you with this...
- 2. Intestinal stomata: Mark Cheetham
- The emergency stoma: why and when
- How to make an emergency stoma
- Making a stoma - general principles
- End colostomy
- Loop colostomy
- End ileostomy
- Loop ileostomy
- Mucous fistula
- Ileocolostomy (double-barrel)
- Jejunostomy
- 'Blow-hole' colostomy and cecostomy
- Making a stoma in a fat person
- Postoperative care of a stoma
- Stoma ischemia
- High-output stoma
- Mucocutaneous separation
- Other stoma complications
- Final remarks
- Chapter 15: Esophageal emergencies: Brandon H. Tieu and John G. Hunter
- Esophageal perforation
- Etiology
- Some basics.
- Diagnostic work-up
- Management
- A few more basics.
- Perforations that permit a trial of conservative therapy
- Perforations that need operative intervention
- The operation: acute injuries and primary surgical repair
- Transendoscopic therapy
- Perforations: difficult clinical scenarios
- So the key points are.
- Esophageal foreign body ingestion or obstruction
- Key points.
- Chapter 16: Diaphragmatic emergencies: Danny Rosin
- Diaphragmatic hernia
- Diaphragmatic trauma
- Gastric volvulus in a paraesophageal hernia
- Chapter 17: Upper gastrointestinal bleeding: Moshe Schein
- How common are operations for UGIB?
- What about bleeding esophageal varices?
- The problem
- Presentation
- Key issues: Is the hemorrhage 'serious'? When should you be alarmed?
- Stratification
- Approach
- What to do if you are taking care of the bleeding patient?
- How to proceed?
- Emergency endoscopy for UGIB
- Endoscopic management
- Post-endoscopy decision-making
- Conservative treatment
- The management of rebleeding
- Angiographic transarterial management?
- Operative management
- Specific sources of bleeding
- To recap.
- Chapter 18: Perforated peptic ulcer: Moshe Schein
- Natural history
- Diagnosis
- Philosophy of treatment
- Management
- Final words.
- Chapter 19: Acute pancreatitis: Ari Leppäniemi
- Natural history
- Clinical presentation and diagnosis
- Estimation of severity and classification
- The 4-week approach to the management of acute pancreatitis
- Indications and timing for interventions
- Treatment
- Let me conclude with some Finnish wisdom.
- Chapter 20: Gallbladder and biliary emergency surgery: Danny Rosin, Moshe Schein and B. Ramana
- 1: The acute gallbladder: Danny Rosin and Moshe Schein
- Acute cholecystitis
- Diagnosis
- Management
- The operation
- 2. Bile duct emergencies: Danny Rosin
- Obstructive jaundice
- Acute ('ascending') cholangitis
- 3. Biliary pancreatitis: B. Ramana
- Chapter 21: Small bowel obstruction: Moshe Schein and Danny Rosin
- The dilemma
- Definitions
- Clinical features
- Imaging
- Management
- Special circumstances
- Prognosis
- Chapter 22: Acute abdominal wall hernias: Paul N. Rogers
- Acute groin hernia
- Incisional/ventral hernias
- Chapter 23: Acute appendicitis: Roland E. Andersson
- 1. Acute appendicitis: Roland E. Andersson
- Diagnosis
- Treatment
- 2. Laparoscopic appendectomy: Danny Rosin
- Why laparoscopy?
- Why not laparoscopy?
- How to do it?
- Chapter 24: Acute mesenteric ischemia: Moshe Schein and Paul N. Rogers
- The problem
- Assessing the problem
- Computed tomography
- Mesenteric angiography
- Non-operative treatment
- Operative treatment
- Adjunctive vascular procedures
- To anastomose or not?
- Second-look operations?
- Mesenteric venous thrombosis
- To sum up.
- Chapter 25: Hepatic emergencies: Erik Schadde
- The 'liver patient' - chronically diseased hepatic parenchyma
- Liver trauma
- Emergencies arising from hepatic lesions
- To sum up.
- Chapter 26: Inflammatory bowel disease and other types of colitis: Bashar Safar and Jonathan Efron
- A few words on medical therapy
- When to operate? Severe colitis, fulminant colitis, and toxic colitis-megacolon
- The operation for severe colitis, fulminant colitis, or toxic megacolon
- Emergency surgery for Crohn's disease (CD)
- Clostridium difficile colitis (CDC - pseudomembranous colitis)
- Neutropenic enterocolitis
- Ischemic colitis
- Final words
- Chapter 27: Colonic obstruction: Jonathan E. Efron
- Clinical approach
- Differential diagnosis
- Management
- Volvulus of the colon
- Acute colonic pseudo-obstruction (Ogilvie's syndrome)
- To recap.
- Chapter 28: Acute diverticulitis: Jonathan E. Efron
- Diverticular emergencies
- What causes acute diverticulitis (surgical pathology)?
- Simple diverticulitis
- Complicated diverticulitis
- Pericolonic abscesses (Hinchey I & II)
- A few points on percutaneous drainage
- Peritonitis (Hinchey III & IV)
- The operations
- A few words about fistulas.
- Other forms of acute diverticulitis
- Final thoughts
- Chapter 29: Massive lower GI bleeding: Jonathan E. Efron
- Initial presentation - what to do in the emergency room?
- Where to go from the emergency room?
- Colonoscopy
- Radiology
- Operating room
- Specific etiologies of LGIB
- Summary of our approach
- Chapter 30: Anorectal emergencies: Jonathan E. Efron
- Anal fissures
- Hemorrhoids
- Perianal abscess
- Postoperative problems after anal operations
- Patients' position and choice of anesthesia for anal operations
- Acute incarcerated full-thickness rectal prolapse
- Trauma to the rectum and anus
- Rectal foreign bodies
- Necrotizing perineal infections (Fournier's gangrene)
- Chapter 31: Surgical complications of endoscopy: Ahmad Assalia and Anat Ilivitzki
- Some basic points
- Complications of upper gastrointestinal endoscopy
- Complications of percutaneous endoscopic gastrostomy (PEG)
- Complications of endoscopic retrograde cholangiopancreatography(ERCP)
- Complications of colonoscopy
- To re-cap
- Chapter 32: Abdominal trauma: Roger Saadia
- 1. Penetrating abdominal trauma
- General principles
- Abdominal stab wounds
- Abdominal stab wounds: when to observe? How to investigate?
- Abdominal gunshot wounds - dogma versus modern imaging
- Difficult scenarios: the CT scan reigns supreme
- What to do when CT scanning is not available?
- To recap.
- 2. Blunt abdominal trauma
- Differences between blunt and penetrating trauma
- Adjunctive diagnostic tests
- Non-operative management of solid organ injuries in blunt trauma
- When to operate in blunt trauma?
- To summarize
- 3. Operative management of individual organ injuries
- Diaphragm
- Liver and biliary tree
- Spleen
- Pancreas
- Kidney, ureter and bladder
- Stomach
- Duodenum
- Small bowel
- Colon
- Rectum
- Intra-abdominal vascular injuries
- Retroperitoneal hematomas
- Management of blunt traumatic pelvic hematomas
- The abbreviated trauma laparotomy (damage control)
- To sum up.
- Chapter 33: The abdominal compartment syndrome: Ari Leppäniemi and Moshe Schein
- Risk factors for IAH and ACS
- Pathophysiology of IAH and ACS
- When to suspect IAH?
- Diagnosis of IAH
- More definitions
- How common is IAH?
- Prevention
- Treatment
- Chapter 34: Abdominal aortic emergencies: Paul N. Rogers
- Presentation
- Atypical presentation
- The diagnostic dilemma
- Who should have an operation?
- The operation
- Endovascular repair
- Free intraperitoneal hemorrhage
- Aortic occlusion
- Chapter 35: Gynecological emergencies: Moshe Schein
- Acute abdominal pain in the fertile woman
- Ectopic pregnancy
- Ovarian cysts
- Pelvic inflammatory disease (PID)
- Vaginal tears
- Acute abdominal pain in the pregnant women
- Trauma in pregnancy
- The 'postpartum' period
- Chapter 36: Abdominal emergencies in infancy and childhood: Wojciech J. Górecki
- General approach to pediatric abdominal pain
- Clinical patterns of the acute abdomen in children
- Specific pediatric emergencies
- Pediatric abdominal injuries
- Special situations
- Chapter 37: Urological emergencies:Jack Baniel
- Acute renal colic
- Torsion of testis
- Acute retention of urine
- Urological trauma
- Chapter 38: Abdominal emergencies in the Third World: Robin Kaushik, Graeme Pitcher and Craig Joseph
- 1. Abdominal emergencies in Asia: Robin Kaushik
- Abdominal tuberculosis
- Amoebiasis
- Parasitic infestations of the abdomen
- 2. Abdominal emergencies in Africa: Graeme Pitcher and Craig Joseph
- Intussusception - lethal and delayed
- Appendicitis: neglected perforation still a fatal disease
- Ascaris infestations
- Leiomyopathy
- HIV-related abdominal emergencies
- Traditional 'witch doctor' enemas
- Sigmoid volvulus and ileosigmoid knotting
- Typhoid fever
- Sickle cell disease (SCD)
- To recap
- Chapter 39: Abdominal drainage: Moshe Schein and Paul N. Rogers
- What is the current practice?
- Common situations during which drains may be used
- Solid indications for drainage
- The 'optimal' drain
- Regional differences in practice
- What is behind the persisting enthusiasm for drains in Asia and East Europe?
- Final words.
- Chapter 40: Abdominal closure: Moshe Schein and Danny Rosin
- Principles of closure
- Final point.
- Chapter 41: Before landing: Moshe Schein
- PART IV: After the operation
- Chapter 42: Postoperative care: Moshe Schein
- Know your patient
- Touch/examine your patient
- Treat the pain
- Do not 'crucify' your patient in the horizontal position
- Decrease the plastic and rubber load
- Obtain postoperative tests selectively
- Realize that the problem usually lies at the operative site
- Temperature is not a disease
- do not treat it as such
- Avoid poisoning your patient with antibiotics
- Be frugal with blood-product transfusions
- Do not drown your patient in salty water
- Do not starve or over-feed your patient
- Recognize and treat postoperative intra-abdominal hypertension
- Prevent deep vein thrombosis (DVT) and pulmonary embolism
- Be the leader and take responsibility
- Analyze your care
- Chapter 43: Nutrition: James C. Rucinski
- Starvation
- Assessment of need for nutritional support
- Enteral versus parenteral nutrition
- Enteral nutrition
- Parenteral nutrition
- Control of hyperglycemia
- Measurement of effectiveness of nutritional support
- So what should you do?
- 'Routine' oral feeding
- Final words.
- Chapter 44: Postoperative antibiotics: Moshe Schein
- The issue
- Duration of postoperative administration
- Chapter 45: Postoperative ileus vs. intestinal obstruction: Moshe Schein
- Definitions and mechanisms
- Ileus
- Early postoperative mechanical intestinal obstruction
- Diagnosis
- Prevention and management
- Specific considerations
- Prevention
- Chapter 46: Intra-abdominal abscesses: Moshe Schein
- Definition and significance
- Classification and pathogenesis
- Microbiology
- Clinical features
- Diagnosis
- Antibiotics
- Conservative treatment
- Drainage
- Practical approach
- Failure of PC drainage: when to 'switch over' to surgical drainage?
- Surgical management of intra-abdominal abscesses
- And to sum up.
- Chapter 47: Anastomotic leaks and fistulas: Moshe Schein
- Scenario 1: the obvious leak
- The controversy
- The role of non-operative management
- The role of early operative management
- Suggested approach to early leaks/postoperative intestinal fistulas
- What to do during an emergency relaparotomy?
- Conservative management
- Gimmicks or no gimmicks
- Fistulas associated with a large abdominal wall defect
- Scenario 2: you suspect a leak but do not see one
- Chapter 48: Relaparotomy and laparostomy for infection: Roger Saadia, Moshe Schein and Danny Rosin
- 1. Relaparotomy: Roger Saadia and Moshe Schein
- Definitions
- Relaparotomy 'on demand'
- Postoperative peritonitis
- 'Planned' (electively staged) relaparotomy
- The conduct of a relaparotomy
- The leaking intestine
- Drains
- When to stop 'planned' relaparotomies
- Are 'planned' relaparotomies beneficial?
- 2. Laparostomy: Roger Saadia and Moshe Schein
- Indications
- Technical considerations of laparostomy
- Terminating the laparostomy
- Antibiotics
- Is laparostomy beneficial?
- In sum.
- 3. Laparoscopic abdominal re-exploration: Danny Rosin
- Postoperative conditions treated by laparoscopy
- Technique
- Chapter 49: Wound management: Moshe Schein
- Definitions and the spectrum
- Prevention
- Antibiotics
- Non-closure or delayed closure of the wound
- Management
- Chapter 50: In the aftermath and the M & M meeting: Moshe Schein
- The morbidity & mortality meeting
- Financial morbidity
- The SURGINET
- Before we close.
- Index
- Back Cover
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