دانلود کتاب Basic Science for the MRCS: A Revision Guide for Surgical Trainees

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Front Cover Basic Sciencefor the MRCS: A revision guide for surgical trainees Copyright Preface Acknowledgements Contents Section I: Anatomy Chapter 1: The thorax Development Heart and great vessels Heart (Fig. 1.1) Great vessels (Fig. 1.2) Fetal circulation (Fig. 1.3) Congenital anomalies Malposition Left-to-right shunt Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Eisenmenger's syndrome Right-to-left shunt (cyanotic) Fallot's tetralogy Other congenital anomalies Coarctation of the aorta Abnormalities of valves The diaphragm (Fig. 1.4) Clinical points Thoracic cage Ribs Atypical ribs First rib Second rib Tenth rib Eleventh and twelfth ribs Clinical points Rib fractures Coarcation of the aorta Cervical ribs Costal cartilages Sternum Manubrium Relations Body Relations Xiphoid Clinical points Intercostal spaces (Fig. 1.5) Clinical points Trachea (Fig. 1.6) Relations In the neck In the thorax Bronchi (Fig. 1.6) Clinical points Anatomy of tracheostomy The lungs Right lung Left lung Roots of the lungs Bronchopulmonary segments (Fig. 1.7) Blood supply Right pulmonary artery Left pulmonary artery Bronchial arteries Pleura Surface anatomy of pleura and lungs Pleura Lungs Clinical points Nerve supply of pleura Clinical points The diaphragm (Fig. 1.8) Nerve supply Anatomy of respiration Thoracic breathing Abdominal breathing Inspiration Expiration The heart (Fig. 1.9) Chambers of heart Right atrium Right ventricle Left atrium Left ventricle Fibrous skeleton of the heart Conducting system Blood supply of heart (see Fig. 1.9) Right coronary artery Left coronary artery Variations Venous drainage (see Fig. 1.9) Nerve supply of heart Clinical point Pericardium Fibrous Relations Serous Oblique and transverse sinuses (Fig. 1.10) Transverse sinus Oblique sinus Clinical points Surface anatomy of heart Mediastinum (Fig. 1.11) Superior mediastinum Anterior mediastinum Middle mediastinum Posterior mediastinum The mediastinal surfaces (Figs 1.13 and 1.14) The angle of Louis Chapter 2: The abdomen, pelvis and perineum Development Development of the gut Foregut Midgut (Fig. 2.2) Clinical points Anal canal The kidneys and ureter (Fig. 2.4) Development anomalies Bladder and urethra Bladder Urethra Clinical points Testis Clinical points Anterior abdominal wall Superficial fascia of abdominal wall Clinical points Abdominal wall muscles (Fig. 2.7) Rectus abdominis External oblique Internal oblique Transversus abdominis Nerve supply of abdominal muscles Rectus sheath (see Fig. 2.7) Clinical points The anatomy of abdominal incisions Midline Subcostal (Kocher's) Gridiron incision (muscle-splitting) Paramedian incision Pararectus incision (Battle incision) Inguinal canal Relations Deep inguinal ring Superficial inguinal ring Spermatic cord Femoral canal Surgical anatomy of hernias Peritoneal cavity Greater sac of peritoneum Lesser sac (omental bursa) Relations Epiploic foramen (Foramen of Winslow; Fig. 2.10) Clinical points Subphrenic spaces Clinical points Posterior abdominal wall Outline placeholder Psoas major Quadratus lumborum Iliacus Clinical points Abdominal aorta (Fig. 2.11) Outline placeholder Common iliac artery External iliac artery Internal iliac artery Inferior vena cava Lumbar sympathetic chain Clinical points Pelvic floor and wall Outline placeholder Levator ani Origin Insertion Nerve supply Actions Coccygeus Origin Insertion Nerve supply Action Pelvic fascia Perineum Urogenital triangle (the anterior perineum) Superficial perineal pouch Perineal body The posterior (anal) perineum Ischiorectal fossa Clinical points Penis Root Glans Body Corpora cavernosa Corpus spongiosum Urethra Male urethra Prostatic urethra Membranous urethra Spongy urethra Clinical points Female urethra The vulva Scrotum Clinical points Testis and epididymis Blood supply Lymphatic drainage Coverings of the testis Clinical points Vas deferens (ductus deferens) Abdominal viscera Oesophagus Cervical Thoracic Abdominal Blood supply Nerve supply Microscopic structure Clinical points Stomach Relations Blood supply Lymphatic drainage (Fig. 2.18) Nerve supply Structure of the gastric mucosa (Fig. 2.19) Clinical points Duodenum First part Second part Third part Fourth part Blood supply of the duodenum Clinical points Small intestine Large intestine Caecum Ascending colon Transverse colon Descending colon Sigmoid colon Taenia coli Appendices epiploicae Appendix Clinical points Rectum Relations Blood supply of the large intestine (Fig. 2.20) Lymphatic drainage of the large intestine Anal canal Anal sphincters Rectal examination Liver Porta hepatis Peritoneal relations of the liver (Fig. 2.23) Functional anatomy of the liver Hepatic veins Extrahepatic biliary system (Fig 2.26) Gall bladder Blood supply (Fig. 2.27) Clinical points The portal venous system (Fig. 2.29) Clinical points Pancreas Relations Structure Blood supply Lymphatics Spleen Relations Blood supply Clinical points Kidneys Relations (Figs 2.31 and 2.32) Blood supply Lymphatic drainage Clinical points Ureter Blood supply Clinical points Suprarenal glands Relations Blood supply Structure Bladder Relations Blood supply Lymphatic drainage Nerve supply Cystoscopy Prostate Relations Blood supply Seminal vesicles Uterus (Fig 2.33) Relations Blood supply (Fig. 2.34) Lymphatic drainage Fallopian tubes Broad ligament Vagina Relations Blood supply Lymphatic drainage Ovary Relations Blood supply Lymphatic drainage Vaginal examination Chapter 3: The upper limb and breast The pectoral girdle The bones of the upper limb Scapula (Fig. 3.1) Clavicle Humerus (Fig. 3.2) Radius and ulna (Fig. 3.3) The carpus (Figs 3.4 and 3.7) Metacarpals and phalanges Joints of the upper limb Shoulder joint (Fig. 3.5) Muscles acting on shoulder joint The shoulder girdle Sternoclavicular joint Acromioclavicular joint Rotator cuff Movements of shoulder girdle Clinical points Elbow joint (Fig. 3.6) Wrist joint (Fig. 3.7) Joints of the hand Carpometacarpal joint Thumb Metacarpophalangeal joints Interphalangeal joints Muscles controlling the hand Long flexors Long extensors Extensor expansion (Fig. 3.8) Small muscles of the hand Interossei Lumbricals Muscles of the thumb Long muscles Short muscles (thenar eminence) Muscles of the little finger (hypothenar eminence) Muscle actions Veins of the upper limb Superficial veins Cephalic vein Basilic vein Veins at the elbow Clinical points Deep veins Arteries of the upper limb (Fig. 3.9) Axillary Brachial artery Radial artery Ulnar artery Brachial plexus (Fig. 3.10) Roots (5) Trunks (3) Divisions (6) Cords (3) Nerves Branches of the brachial plexus Roots Trunks Cords Lateral Medial Posterior Nerves of the upper limb Axillary Radial nerve Musculocutaneous nerve Median nerve Ulnar nerve Anatomy of nerve lesions Brachial plexus Erb's (Erb-Duchenne) paralysis Klumpke's paralysis Axillary nerve Radial nerve Median nerve Ulnar nerve Spaces of the hand Pulp spaces of fingers (Fig. 3.11) Bursae of the hand and synovial tendon sheaths (Fig. 3.12) Palmar spaces Midpalmar space Thenar space Palmar aponeurosis Specialised areas of the arm Axilla Antecubital fossa Carpal tunnel (Fig. 3.13) Anatomical snuffbox Structures around the wrist joint Lymphatics of the upper limb Axillary lymph nodes Distribution of dermatomes and cutaneous nerves in the upper limb The breast Blood supply Lymphatic drainage Male breast Clinical points Chapter 4: The lower limb The pelvic girdle The hip bone (os innominatum) (Fig. 4.1) Ilium Pubis Ischium The sacrum (Fig. 4.2) Coccyx Joints and ligaments of the pelvis (Figs 4.3 and 4.4) Symphysis pubis Sacro-iliac joints Gluteal region (Fig. 4.5) Gluteus maximus Origin Insertion Nerve supply Actions General points Gluteus medius Origin Insertion Nerve supply Action Gluteus minimus Origin Insertion Nerve supply Action Tensor fasciae latae Origin Insertion Nerve supply Action Piriformis Origin Insertion Nerve supply Actions Obturator internus Origin Insertion Nerve supply Gemelli (superior and inferior) Origin Insertion Nerve supply Quadratus femoris Origin Insertion Nerve supply Greater and lesser sciatic foramina Greater sciatic foramen Boundaries Structures passing through the foramen include: Lesser sciatic foramen Boundaries Structures passing through the foramen include: Clinical points Bones of the leg and foot The femur (Fig. 4.6) Blood supply of the femoral head Clinical points The patella Clinical points The tibia (Fig. 4.7) Clinical points The fibula (Fig. 4.7) Clinical points Bones of the foot (Fig. 4.8) The tarsal bones Talus Calcaneum Cuboid Navicular Cuneiforms Metatarsals Femoral triangle (Fig. 4.9) Outline placeholder Boundaries Floor Roof Contents Femoral sheath Femoral canal Femoral ring Inguinal lymph nodes The adductor canal (subsartorial canal, hunter's canal) The popliteal fossa (Fig. 4.10) Arteries of the lower limb (Figs 4.11 and 4.12) Femoral artery Profunda femoris Popliteal artery Posterior tibial artery Anterior tibial artery Clinical points The veins of the lower limb Great (long) saphenous vein Small (short) saphenous vein Clinical points Leg compartments Thigh Lower leg Anterior compartment Posterior compartment of the leg Lateral compartment of the leg (peroneal compartment) The nerves of the lower limb Lumbar plexus (Fig. 4.13) Femoral nerve Obturator nerve Sacral plexus (Fig. 4.14) Branches: Muscular Superior gluteal Inferior gluteal Pudendal nerve Sciatic nerve Tibial nerve Common peroneal nerve Deep peroneal nerve Superficial peroneal nerve Cutaneous nerve supply of the leg (Fig. 4.15) Dermatomes of the leg (Fig. 4.16) Tendon reflexes of the lower limb Clinical points Nerve injuries Sciatic nerve Tibial nerve Common peroneal nerve Joints Hip joint (Fig. 4.18) Articular surfaces Capsule Ligaments Synovium Nerve supply Movements Relations Clinical points Knee joint (Figs 4.19 and 4.20) Articular surfaces Capsule Ligaments Synovium Intra-articular structures Nerve supply Movements Clinical points Tibiofibular joint Ankle joint (Fig. 4.22) Articular surfaces Capsule Ligaments Movements Relations Clinical points Foot joints Arches of the foot Medial longitudinal arch (Fig. 4.24) Lateral longitudinal arch Transverse arch Ligaments Chapter 5: The head, neck and spine Development Branchial arches The tongue Development of the face Cleft lip (`hare´ lip; Fig. 5.1) Cleft palate (Fig. 5.2) Inclusion dermoids Development of the thyroid Clinical points Parathyroids Development of the spine Types of spina bifida Spina bifida occulta Spina bifida manifesta Growth of spinal cord and vertebral column Clinical points Head Face Mandible Sensory nerve supply of the face (Fig. 5.5) Dermatomes of the head and neck (Fig. 5.6) Facial musculature The muscles of mastication Muscles of facial expression Clinical points Blood vessels of the face Arteries Veins The scalp Cranial cavity Cranial vault (Fig. 5.7) Cranial fossae (Fig. 5.8) Anterior cranial fossa Middle cranial fossa Posterior cranial fossa Base of the skull Orbit and eyeball The bony orbit (Fig. 5.10) Structures entering and leaving the orbit The contents of the orbit The eyeball (Fig. 5.11) Fibrous coat Vascular coat Choroid Ciliary body Iris Neural Contents of the eyeball (Fig. 5.13) Lens Aqueous humour Vitreous body Orbital muscles Outline placeholder Four recti Superior oblique Inferior oblique Nerve supply Movements of the eyeball Eyelids Conjunctiva Lacrimal apparatus The ear External ear Auricle (Fig. 5.14) External auditory meatus Middle ear Tympanic cavity Lateral wall Medial wall Posterior wall Anterior wall Floor Roof Tympanic membrane (eardrum) (Fig. 5.15) The ossicles Auditory tube (Eustachian tube) Inner ear (Fig. 5.16) Features of the inner ear The nose and paranasal air sinuses The nose External nose (Fig. 5.18) Nasal cavity Roof Floor Medial wall (nasal septum) Lateral wall Conchae Meatuses Openings Mucous membrane Olfactory nerve Blood supply Paranasal air sinuses Maxillary sinus Clinical points Nerve supply Lymphatic drainage Ethmoidal air cells (sinuses) Frontal sinus Sphenoidal sinus The muscles of mastication Outline placeholder Masseter Origin Insertion Action Temporalis Origin Insertion Action Lateral pterygoid Origin Insertion Action Medial pterygoid Origin Insertion Action Temporomandibular joint Clinical points Floor of the mouth and tongue (Fig. 5.20) Floor of the mouth Lingual nerve Hypoglossal nerve The tongue Structure Blood supply Lymphatic drainage Nerve supply Clinical points Salivary glands Parotid gland (serous gland) Relations Parotid duct (Stensen's duct) Submandibular gland (mixed serous and mucous gland) Relations Clinical points The sublingual gland (mucous gland) The neck The fascial compartments of the neck Investing fascia Prevertebral fascia Pretracheal fascia Carotid sheath The triangles of the neck (Fig. 5.21) Anterior triangle Muscles attached to the hyoid bone Blood vessels of the anterior triangle (Fig. 5.22) Common carotid artery Internal carotid artery External carotid artery Internal jugular vein Internal jugular vein cannulation The thyroid gland Relations (Fig. 5.23) Blood supply Arterial Venous Clinical points Parathyroid glands Clinical points The larynx (Figs 5.24 and 5.25) Epiglottis Thyroid cartilage Cricoid cartilage Arytenoid cartilages Corniculate cartilage Cuneiform cartilage Cricothyroid membrane (cricovocal membrane) Vestibular fold Vocal cord Rima glottidis Three compartments of the larynx Piriform fossa Muscles of the larynx Actions Blood supply Lymphatic drainage Nerve supply Superior laryngeal nerve Recurrent laryngeal nerve Clinical points Pharynx (Fig. 5.25) Nasopharynx Oropharynx Blood supply Lymphatic drainage Clinical points Laryngopharynx (hypopharynx) Structure of the pharynx Mucosa Muscles of the pharynx The constrictor muscles Innervation of the pharynx Posterior triangle Contents Surface marking of accessory nerve Clinical points Cervical plexus (Fig. 5.27) Superficial branches Deep branches Infrahyoid muscles The phrenic nerve Course of the phrenic nerve Root of neck (Fig. 5.28) Suprapleural membrane (Sibson's fascia) Subclavian artery Subclavian vein Brachial plexus Thoracic duct Clinical points Stellate ganglion Clinical points Lymph nodes of the head and neck Superficial nodes Deep lymph nodes Vertical chain Circular chain Clinical points Spine Vertebral column Basic vertebral pattern (Fig. 5.29) Neural arch Body Cervical vertebrae (Fig. 5.30) Thoracic vertebrae (Fig. 5.31) Lumbar vertebrae (Fig. 5.32) Sacrum and coccyx Intervertebral joints (Fig. 5.33) Clinical points Chapter 6: The nervous system The brain Cerebral hemispheres (Figs 6.1 and 6.2) Cerebral cortex (Figs 6.1 and 6.2) Frontal lobe Parietal lobe Temporal lobe Occipital lobe Clinical points Basal ganglia Midbrain Pons Medulla Cerebellum Clinical points Spinal cord Clinical points Internal structure of spinal cord (Fig. 6.7) The tracts of the spinal cord (Fig. 6.8) Descending tracts Ascending tracts Blood supply of the spinal cord Clinical points Outline placeholder Outline placeholder Complete transection of spinal cord Incomplete spinal cord injury (Fig. 6.10) The meninges Dura mater Falx cerebri Tentorium cerebelli Falx cerebelli Diaphragma sellae Arachnoid mater Subarachnoid cisterns Pia mater Production and circulation of CSF Blood supply to the brain (see Fig. 5.22) Vertebral arteries Basilar artery Branches Internal carotid arteries Branches Middle cerebral artery Circle of Willis (Fig. 6.11) Venous drainage of brain Dural venous sinuses (Fig. 6.12) Superior sagittal sinus Inferior sagittal sinus Straight sinus Transverse sinus Sigmoid sinus Confluence of sinuses Occipital sinus Cavernous sinus (Fig. 6.13) Clinical points Cranial nerves I. Olfactory nerve Clinical points II. Optic nerve (Fig. 6.14) Clinical points III. Oculomotor nerve Clinical points IV. Trochlear nerve Clinical points V. Trigeminal nerve Trigeminal ganglion Ophthalmic division Maxillary division Pterygopalatine ganglion Mandibular division Otic ganglion Submandibular ganglion Clinical points VI. The abducent nerve Clinical points VII. Facial nerve Clinical points VIII. Vestibulocochlear (auditory) nerve Clinical points IX. Glossopharyngeal nerve Clinical points X. Vagus nerve Clinical points XI. Accessory nerve Clinical points XII. Hypoglossal nerve Clinical points Peripheral nervous system Spinal nerves and their distribution (Fig. 6.7) Spinal nerves Cervical plexus Brachial plexus Lumbar plexus Sacral plexus Upper and lower motor neurons Dermatomes Motor root values and peripheral nerve supply of important muscle groups Tendon and abdominal reflexes Autonomic nervous system Sympathetic nervous system Origin of sympathetic outflow Sympathetic trunk Distribution of pre- and postganglionic fibres Head and neck Upper limb Lower limb Abdominal and pelvic viscera Parasympathetic nervous system SECTION II: PHYSIOLOGY Chapter 7: General physiology Homeostasis Nervous system Hormonal system Thermoregulation Heat production Heat loss Regulation of body temperature Peripheral thermoreceptors Reflex vasoconstriction Reflex vasodilatation Receptors on internal surfaces Body temperature Core temperature Peripheral temperature Abnormal temperature regulation Fever (pyrexia) Heatstroke Hypothermia Factors affecting thermoregulation Fluid balance and fluid replacement therapy Body water Functions of the kidney Diuresis Water diuresis Osmotic diuresis Water balance Regulation of total body water Disturbances of total body water content Water depletion Water intoxication Electrolyte disorders Sodium Regulation of sodium Renal Extrarenal Sodium excess Sodium depletion Potassium Hyperkalaemia Hypokalaemia Acid-base balance Carbonic acid-bicarbonate system Disturbances of acid-base balance Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Mixed acid-base disorders Interpretation of acid-base changes Anion gap Fluid balance and fluid replacement therapy Fluid balance in the uncomplicated patient Change in fluid and electrolyte requirements in response to surgery and trauma Fluid and electrolyte problems in surgical patients Blood and plasma Gastrointestinal losses Intraperitoneal fluid loss Septicaemia Excessive insensible fluid loss Colloid and crystalloid solutions Types Uses Albumin Dextran Gelatins Hydroxyethyl starch Choice of plasma expanders General problems of plasma expanders Crystalloids Common types Uses Oedema and lymphatic function Causes of oedema Obstruction to lymphatics Chapter 8: Respiratory system Introduction Components Function Airway function Mechanics of Ventilation Pulmonary ventilation Lung pressures (Fig. 8.1) Surfactant and surface tension (Fig. 8.2) Compliance (Fig. 8.3) Respiratory muscles Work of breathing (Fig. 8.4) Regional variations in ventilation (Fig. 8.5) Clinical physiology Pneumothorax Spontaneous (primary) pneumothorax Spontaneous (secondary) pneumothorax Traumatic (closed) pneumothorax Tension pneumothorax Open pneumothorax or `sucking´ chest wound Pulmonary assessment Lung volumes (Box 8.1) Dead space and alveolar ventilation rate Peak expiratory flow rate (PEFR) Closing capacity Flow-volume and volume-time curves Diffusion capacity Pulmonary blood flow Structure of the lung Regulation of pulmonary blood flow Regional variations in pulmonary blood flow Cardiac output and pulmonary vascular resistance Ventilation and perfusion Clinical physiology Pulmonary embolus Pleural effusion Pulmonary oedema Adult respiratory distress syndrome Gas diffusion and exchange Gas diffusion Gas exchange (Table 8.1) Gas transport (Fig. 8.11) Oxygen transport Carbon dioxide transport Regulation of Respiration Neurological regulation Chemical regulation Hypoxia and respiratory failure Hypoxia and hypoxaemia Respiratory failure Clinical physiology Response to hypoxia Acute Chronic Oxygen therapy and mechanical ventilation Oxygen therapy Mechanical ventilation Indications Intermittent positive pressure ventilation (IPPV) Complications Chapter 9: Cardiovascular system Cardiac muscle Cardiac action potential (Fig. 9.1) Phase 0 Phase 1 Phase 2 Phase 3 Phase 4 Excitation/contraction coupling Generation and conduction of cardiac impulse Generation of cardiac output Phases of the cardiac cycle (Fig. 9.2) Outline placeholder Phase IVc Phase I Phase IIa Phase IIb Phase III Phase IVa Phase IVb Intracardiac pressures Heart sounds Outline placeholder First heart sound Second heart sound Third heart sound Fourth heart sound Venous pulse (Fig. 9.4) a-wave c-wave v-wave x-descent y-descent Coronary circulation Cardiac output (co) Regulation of cardiac output Starling's law of the heart (Fig. 9.5) Factors modifying cardiac output 1. Contractility 2. Preload 3. Afterload Measurement of cardiac output Fick method Thermodilution Dye dilution Doppler ultrasound Blood pressure Control of blood pressure (general systemic blood pressure) Factors determining arterial blood pressure Control of local blood pressure and blood flow Peripheral resistance (systemic vascular resistance; SVR) Monitoring the circulation ECG Blood pressure Central venous pressure Pulmonary capillary wedge pressure (pulmonary artery occlusion pressure; PAOP) Pulse oximetry Cardiac output Urine output Echocardiography Echo Doppler Cardiovascular support Outline placeholder Ventilate Infusion Pump Pharmacological support Adrenaline Noradrenaline Isoprenaline Dopamine Dobutamine Dopexamine Vasodilators Phosphodiesterase inhibitors Chapter 10: Gastrointestinal system Functions Nervous and hormonal regulation within the GI tract Nervous regulation Hormones and neurotransmitters Oral cavity, pharynx and oesophagus Chewing Saliva Swallowing Oesophageal sphincter Stomach Gastric mucosa Gastric secretion Gastric acid (Fig. 10.1) Pepsinogen secretion Mucus secretion Intrinsic factor secretion Regulation of gastric secretion Gastric motility Storage Mixing and propulsion Clinical physiology Vomiting Treatment of peptic ulceration Medical treatment Surgical treatment Post-gastrectomy syndromes Effects of vagotomy Small intestine Small intestine mucosa Absorption (Table 10.1) Carbohydrates (Fig. 10.3) Fats (Fig. 10.4) Protein (Fig. 10.5) Fluids and electrolytes Vitamins Iron Calcium Small intestinal motility Clinical physiology Physiological effects of duodenal resection Physiological effects of terminal ileal resection Pancreas Exocrine secretions Fluid component Enzyme component Proteolytic enzymes Amylase Lipolytic enzymes Regulation of exocrine secretions Cephalic Gastric Intestinal Endocrine secretions Clinical physiology Physiological effects of pancreatic resection Liver and gall bladder Liver Bile production (Fig. 10.6) Metabolic functions Carbohydrate metabolism Protein metabolism Lipid metabolism Protein synthesis Vitamin D activation Detoxification Vitamin and mineral storage Phagocytosis Haemopoiesis Clinical physiology Jaundice Prehepatic jaundice Hepatocellular jaundice Cholestatic jaundice Gall bladder Clinical physiology Physiological effects of cholecystectomy Large bowel Water absorption Colonic flora Large intestinal motility Defecation Clinical physiology Diarrhoea Osmotic Secretory Inflammatory Abnormal motility Constipation (Box 10.1) Nutrition Requirements Regulation Chapter 11: Urinary system Components Functions Structure Renal blood supply Renal circulation Regulation of renal blood flow Glomerulus (Fig. 11.1) Microscopic structure Glomerular filtration Proximal convoluted tubule Loop of Henle Countercurrent multiplier mechanism (Fig. 11.2) Distal convoluted tubule and collecting ducts Regulation of NA+ and water reabsorption Antidiuretic hormone Renin-angiotensin-aldosterone system (RAS) Atrial natriuretic peptide (ANP) Ion and nutrient reabsorption Potassium Calcium and phosphate Hydrogen and bicarbonate (Fig. 11.3) Glucose and amino acids Urea Glomerular filtration rate (GFR) and renal plasma flow Measuring GFR Measuring renal plasma flow Micturition Clinical physiology Bladder function and spinal injury Hormone production Renin Erythropoietin 1α-hydroxylase Chapter 12: Endocrine system Introduction Pituitary and hypothalamic function Control of pituitary function Anterior pituitary Posterior pituitary Anterior pituitary hormones Adrenocorticotrophic hormone (ACTH) Thyroid-stimulating hormone (TSH) Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) Prolactin Growth hormone (GH) Posterior pituitary hormones Oxytocin Antidiuretic hormone Clinical physiology Pituitary disorders Increased hormone secretion Decreased hormone secretion Thyroid function Anatomy Synthesis of thyroid hormone (Fig. 12.1) Clinical physiology Antithyroid drugs Secretion and transport of thyroid hormone Effects of thyroid hormone Clinical physiology Thyroid disorders Hyperthyroidism Hypothyroidism Sick euthyroid syndrome Calcium and phosphate regulation Calcium Regulation of calcium balance Parathormone Vitamin D Calcitonin Regulation of phosphate balance Clinical physiology Disorders of calcium and phosphate balance Hypoparathyroidism Hyperparathyroidism Vitamin D deficiency Hypocalcaemia Hypercalcaemia Hypophosphataemia Hyperphosphataemia Adrenal function Cortex Synthesis and excretion Actions of the adrenal cortex hormones Aldosterone Cortisol Androgens Medulla Clinical physiology Disorders of adrenal function Addison's disease Hyperaldosteronism Cushing's disease/syndrome Adrenogenital syndrome Phaeochromocytoma Growth hormone Clinical physiology Disorders of growth hormone secretion Gigantism Acromegaly Endocrine function of the pancreas Insulin Carbohydrate metabolism Protein metabolism Lipid metabolism Glucagon Carbohydrate metabolism Lipid metabolism Somatostatin Effects of other hormones on glucose regulation Glucocorticoids Growth hormone Thyroid hormone Catecholamines Clinical physiology Disorders of the endocrine pancreas Diabetes mellitus Acute Chronic Pancreatic endocrine tumours Hormonal response to trauma/surgery Chapter 13: Nervous and locomotor systems Introduction Components Functions Central nervous system Cerebral blood flow (Fig. 13.1) Autoregulation Myogenic Metabolic Neural control of cerebral blood flow Local control of cerebral blood flow Cerebrospinal fluid Blood-brain barrier (Fig. 13.2) Brainstem death Preconditions for the diagnosis of brainstem death Exclusion criteria for the diagnosis of brainstem death Brainstem death tests Space-occupying lesions and raised intracranial pressure Raised intracranial pressure (ICP) (Fig. 13.3) Post-operative confusion Peripheral nervous system (PNS) Conduction and transmission Action potentials (Fig. 13.5) Propagation of action potentials Synaptic transmission Neurotransmitters Pain and sensation Drug modulation of pain Autonomic nervous system (ANS) (Fig. 13.8) Sympathetic nervous system Parasympathetic nervous system Functions of the autonomic nervous system Locomotor system Skeletal muscle physiology Structure of skeletal muscle Skeletal muscle classification Sliding filament hypothesis (Fig. 13.9) Excitation contraction coupling Neuromuscular transmission Locomotion Spinal cord reflexes Muscle stretch reflex (Fig. 13.10) Golgi tendon organ reflex Withdrawal reflex (Fig. 13.11) Control of locomotion Cerebral cortex Brainstem Cerebellum Basal ganglia Bone physiology Bone formation and reabsorption SECTION III: PATHOLOGY Chapter 14: Cellular injury Mechanisms of cellular injury Cell death Necrosis Coagulative necrosis Colliquative necrosis Caseous necrosis Gangrenous necrosis Fibrinoid necrosis Fat necrosis Apoptosis Function of apoptosis Mediators of apoptosis p53 bcl-2 fas (CD 95) Caspases Morphological features of apoptosis Diseases of increased apoptosis Diseases of decreased apoptosis The process of healing Regeneration and repair Cell renewal Repair Granulation tissue Clinical problems with organisation and wound contraction Organisation Wound contraction Injuries to specific tissues Skin Skin anatomy (Fig. 14.1) Incised wound (surgical incision)-healing by first intention Tissue loss-healing by second intention Abnormalities of skin healing Keloid Hypertrophied scar Anatomy of repair of defects Reconstructive ladder (Fig. 14.3) Grafts Skin grafts Mechanism of skin graft take Split-thickness skin grafts (Fig. 14.4) Full-thickness skin grafts (Fig. 14.5) Flaps Classification Local flaps Transposition flap (Fig. 14.9A) Rotation flap (Fig. 14.9B) Advancement flap (Fig. 14.9C) Z-plasty (Fig. 14.9D) Free flaps (Fig. 14.10) Radial forearm flap Anterolateral thigh flap Deep inferior epigastric perforator (DIEP)/transverse rectus abdominis myocutaneous (TRAM) flap Bone Factors affecting bone healing Liver Kidney Cardiac muscle Neural tissue Peritoneum Gastrointestinal tract Mucosal erosions Mucosal ulcers Gastrointestinal anastomoses Factors affecting wound healing Local Systemic Injury due to ionising radiation Mode of action Effects on tissues Effect on individual tissues Bone marrow Skin Intestines Gonads Lung Kidney Whole body irradiation Ultraviolet light Therapeutic irradiation Radical applications Adjuvant radiotherapy Palliative radiotherapy Fractionation of dose Response modifiers Injury due to burns Types of burn Thermal Electrical Chemical Causes of burns Predisposing medical conditions Burn injury response Local response (Fig. 14.11) Systemic response Carbon monoxide effects Assessing a burn The extent of body surface area burnt (Fig. 14.12) The depth of the burn (Fig. 14.13) Chapter 15: Disorders of growth, morphogenesis and differentiation Growth Cell turnover Cell cycle Phases of the cell cycle (Fig. 15.1) Other factors involved in the cell cycle Control of cell division Therapeutic interruptions of cell cycle (Fig. 15.2) Factors affecting growth Genetic factors Hormones Nutrition Blood supply Oxygen supply Nerve supply Growth factors Increased growth Physiological hypertrophy and hyperplasia Pathological hypertrophy Pathological hyperplasia Atrophy Physiological (Box 15.1) Pathological Decreased growth (hypoplasia) Differentiation Control of differentiation Morphogenesis Congenital disorders of differentiation and morphogenesis Chromosomal abnormalities affecting whole chromosomes Chromosomal abnormalities affecting parts of chromosomes Single gene alterations Functional aspects of developmental disorders Anomalies of organogenesis Agenesis (aplasia) Atresia Hypoplasia Dysgenesis (dysplasia) Ectopia (heterotopia) Acquired disorders of differentiation and growth Metaplasia Dysplasia Polyps Pathological processes causing polyps Symptoms of polyps Examples of polyps Neoplasia Chapter 16: Inflammation Classification Acute inflammation Causes of acute inflammation Macroscopic signs and symptoms of acute inflammation Stages of acute inflammation Changes in vessel calibre Increased vascular permeability Formation of cellular exudate Chemical mediators of acute inflammation Plasma factors Complement system Kinin system Coagulation system Fibrinolytic system Role of macrophages Role of lymphatics Role of neutrophil polymorphs Special types of inflammation Outline placeholder 1. Serous 2. Catarrhal 3. Fibrinous inflammation 4. Haemorrhagic inflammation 5. Suppurative inflammation 6. Membranous inflammation 7. Pseudomembranous inflammation 8. Necrotising inflammation Effects of acute inflammation Beneficial effects (exudate) Harmful effects (release of lysosomal enzymes) Sequelae of acute inflammation Resolution Conditions favouring resolution Sequence of events leading to resolution Suppuration Organisation Circumstances favouring organisation Sequence of organisation Progress to chronic inflammation Systemic effects of inflammation Chronic inflammation Features of chronic inflammation Causes of chronic inflammation Primary chronic inflammation Progression from acute inflammation Recurrent episodes of acute inflammation Transplant rejection Macroscopic appearances of chronic inflammation Granulomatous disease Outline placeholder Epithelioid histiocytes Types of giant cell Causes of granulomatous disease Chapter 17: Thrombosis, embolism and infarction Thrombosis Causes of thrombosis Damage to vessel wall Arterial thrombosis Venous thrombosis Alterations in blood flow Alterations of the constituents of the blood Stages in the development of thrombosis Fate of thrombi Embolism Thromboembolism Venous thromboembolism Arterial thromboembolism Gas embolism Fat embolism Tumour emboli Amniotic fluid embolism Foreign body embolism Therapeutic embolism Non-thromboembolic vascular insufficiency Atheroma Torsion Spontaneous vascular occlusion `Steal´ syndrome External pressure occlusion Ischaemia, infarction and gangrene Ischaemia Causes General Local Severity of ischaemia Infarction Sequence of events Systemic effects of infarcts Low-flow infarction Gangrene Specific forms of gangrene Chapter 18: Neoplasia Classification of tumours Behavioural classification Histogenetic classification Major categories of tumour origin Differentiation Nomenclature of tumours Epithelial tumours Benign tumours Malignant tumours Carcinoma in situ Connective tissue tumours Teratomas Embryonal tumours (blastomas) Apudomas and carcinoid tumours Mixed neoplasm Hamartomas Poorly named tumours (misnomas!) Tumour growth patterns Histological pattern Carcinogenesis Chemicals Radiation Viruses Hormones Bacteria, fungi, parasites Other agents Host factors and carcinogenesis Race Diet Inherited predisposition Age Gender Premalignant disease Carcinogenic process Multistep theory Genetics of cancer Evidence for genetic alterations causing cancer Genetic mechanisms in carcinogenesis Oncogenes Tumour suppressor genes Examples of tumour suppressor genes Rb gene and retinoblastoma p53 tumour suppressor gene Behaviour of tumours Invasion Clinical consequences of local invasion Metastasis Steps in the metastatic cascade Routes of metastasis Lymphatic Haematogenous Transcoelomic Seeding or implantation at surgery Clinical effects of tumours Local Systemic Effects of metastases Paraneoplastic effects Humoral Immunological Metabolic effects Others Tumour markers Tumour dependency Breast Prostate Thyroid Prognosis of tumours Tumour staging Dukes' classification TNM classification Other staging Screening Screening programmes Breast Cervix Chapter 19: Immunology Immunity Innate immunity Adaptive immunity Essential features of the immune system Specificity Diversity Memory Recruitment of other defence mechanisms Antigen Humoral immunity Antibody production Cell-mediated immunity Major histocompatibility complex antigens (MHC) The structure of the immune system Lymph nodes (Fig. 19.2) Spleen Mucosa-associated lymphoid tissue (MALT) The immune response (summary) Complement Immune deficiency Primary immune deficiency Secondary immune deficiency Hypersensitivity reactions Type I Type II Type III Type IV Type `V´ (not part of the original Gell & Coombs classification) Autoimmunity Possible mechanisms of autoimmunity Genetic factors Antigenic abnormality Immune dysregulation Organ transplantation Types of graft Major histocompatibility complex (MHC) HLA class I: coded at A, B, C loci Class II Immunological pathology of graft rejection (Fig. 19.5) Afferent phase Efferent phase Clinical rejection Hyperacute Accelerated acute Acute rejection Chronic rejection Transplant tolerance Immunosuppression Immunosuppressive drugs Immunosuppressive drugs Corticosteroids Antiproliferative drugs Calcineurin inhibitors (CNI) Other drugs Sirolimus (rapamycin) and everolimus Antilymphocyte globulin (ALG) and antithymocyte globulin (ATG) Monoclonal antibodies Drugs under evaluation Side-effects of immunosuppression Infection Neoplasia Graft-vs-host disease Chapter 20: Haemopoietic and lymphoreticular system Haemopoiesis Red blood cell (erythrocyte) Reticulocytes Anaemia Blood loss Haemolysis Clinical features of haemolytic states Sickle cell anaemia Hereditary spherocytosis (congenital acholuric jaundice) Impairment of red cell formation/function Classification of anaemia Polycythaemia White blood cells (leucocytes) Types of white blood cell Neutrophils Lymphocytes Monocytes Eosinophils Basophils Changes in white cells in disease Leucocytosis Leucopenia Neutropenia Platelets Haemostasis Vasoconstriction Platelet activation Adherence Aggregation Platelet plug Coagulation mechanism Fibrinolytic system Assessment of coagulation system Platelet count Bleeding time Whole-blood clotting time Prothrombin times (PT) Activated partial thromboplastin time (APTT) Kaolin-cephalin clotting time (KCCT) Thrombin time (TT) Fibrin degradation products (FDPs) Disorders of haemostasis Platelet disorders Thrombocytopenia Abnormal platelet function Blood vessel wall abnormalities Disorders of coagulation Congenital coagulation disorders Haemophilia A von Willebrand's disease Acquired disorders of coagulation Vitamin K deficiency Liver disease Disseminated intra-vascular coagulation (DIC) Natural anticoagulants Antithrombin III Protein C and Protein S Anticoagulant drugs Heparin Warfarin Lymphoid system Lymph nodes Normal structure and function Cortex Paracortex Medulla Lymphatic system Obstruction to lymphatics (lymphoedema) Primary lymphoedema Secondary lymphoedema Lymphadenopathy Spleen Internal structure (Fig. 20.3) White pulp Red pulp Functions of the spleen Filtering function Immunological function Disorders of the spleen Hypersplenism Primary hypersplenism Splenomegaly Effects of splenectomy Haematological effects Post-splenectomy sepsis Thymus Disorders of the thymus Thymic tumours Blood groups ABO system (Table 20.2) Principles of grouping and cross-matching Rhesus group Rhesus incompatibility Blood products (Fig. 20.4) Whole blood Red cell concentrates Indications for blood transfusion Platelet concentrates Indications for platelet transfusion Administration Granulocytes Fresh frozen plasma (FFP) Indications for FFP transfusion Administration Cryoprecipitate Indications for cryoprecipitate transfusion Factor VIII concentrate Complications of blood transfusion Haemolytic transfusion reactions Immediate Delayed Reaction to white blood cells Infection Complications of massive blood transfusion Autologous blood transfusion Chapter 21: Basic microbiology Sources of surgical infection Endogenous infection Normal body flora Commensal organisms Prevention of endogenous infection Exogenous infection Methods of spread of infection Sources of wound contamination Prevention and control of hospital-acquired infection Control of staphylococcal outbreaks Methicillin-resistant Staphylococcus aureus (MRSA) Risk factors for colonisation Clinical presentation Infection control Management Carriers Patients with MRSA Surgically important micro-organisms Gram-positive cocci Staphylococci Antibiotic sensitivity Streptococci and enterococci Lancefield group A Antibiotic sensitivity Lancefield group D Antibiotic sensitivity Viridans streptococci Streptococcus pneumoniae (pneumococcus) Antibiotic sensitivity Gram-positive rods Outline placeholder Clostridium difficile Gram-negative cocci Gram-negative bacilli Facultative anaerobes (enterobacteria, coliforms) Escherichia coli Klebsiella Proteus Salmonella Shigella Yersinia Other enterobacteria Antibiotic sensitivity Aerobic Gram-negative bacilli Outline placeholder Pseudomonas aeruginosa Antibiotic sensitivity Anaerobic Gram-negative bacilli Outline placeholder Bacteroides Antibiotic sensitivity Other Gram-negative bacilli Outline placeholder Campylobacter Haemophilus influenzae Antibiotic sensitivity Pasteurella multocida Helicobacter pylori Pathophysiology of sepsis Systemic inflammatory response syndrome (SIRS) Systemic inflammatory response syndrome and multi-organ dysfunction syndrome (MODS) Primary precipitating event Inflammatory response Stage I Stage II Stage III Clinical definition of sepsis syndrome Clinical effects of sepsis syndrome Septic shock (refractory shock) Multi-organ dysfunction syndrome Factors leading to multi-organ failure Clinical picture of multi-organ dysfunction Respiratory Cardiovascular Renal Hepatic Gastrointestinal tract Cerebral Haematological Metabolic Principles of treatment of sepsis syndrome Surgical sepsis Skin infections Boils, styes and carbuncles Erysipelas Cellulitis Acute pyogenic cellulitis Anaerobic cellulitis Fournier's gangrene Meleney's gangrene Lymphangitis and lymphadenitis Gas gangrene Clinical features Diagnosis Treatment Prevention Tetanus Clinical features Diagnosis Prevention Treatment Preventative Treatment in suspected case Abscesses Surgical site infection (SSI) Operating environment Theatre layout Air flow in theatre Minimising infection from operating theatre personnel Prevention of infection Principles of asepsis and antisepsis Risk factors contributing to sepsis Wound infection Classification of wounds Factors influencing the development of wound sepsis Preoperative skin preparation Skin shaving Skin preparation Occlusive adhesive drapes Disinfection Efficacy Examples of disinfectants Sterilisation Physical Heat Moist heat (autoclave) Dry heat Irradiation Filtration Chemicals Ethylene oxide Glutaraldehyde Formaldehyde Modern antibiotic usage Commonly used antibiotics Penicillins Benzyl penicillin Phenoxymethyl penicillin (penicillin V) Flucloxacillin Amoxicillin and ampicillin Co-amoxiclav (Augmentin) Piperacillin Precautions when administering penicillins Cephalosporins Cefradine and cefalexin Cefuroxime Cefotaxime and ceftazidime Precautions when administering cephalosporins Sulphonamides and trimethoprim Co-trimoxazole (sulfamethoxazole+trimethoprim) Trimethoprim Macrolides Erythromycin and clarithromycin Aminoglycosides Gentamicin Amikacin Precautions when administering aminoglycosides Quinolones Ciprofloxacin Other antibiotics and microbials Metronidazole Tetracycline and doxycycline Fusidic acid Vancomycin Teicoplanin Carbapenems Antibiotics in surgery Principles of antibiotic therapy Selection of antibiotic Treatment with a combination of antibiotics Route of administration Duration of therapy Dosage Penetration of tissue Hypersensitivity Drug toxicity Superinfection Prophylactic antibiotics Antibiotic resistance Acquiring resistance Spreading resistance Chromosomal mutation causing an altered protein Genes on transmissible plasmids Transposons Predictable sensitivity Clinical factors leading to the emergence of resistant strains Surgery and blood-borne viruses Outline placeholder Hepatitis B Clinical presentation Serology Hepatitis C Clinical presentation Serology Outcome HIV Natural history HIV tests HIV indicator diseases Precautions in Hepatitis B, Hepatitis C and HIV patients Universal precautions Special precautions Immunisation Hepatitis B Management of sharps injuries Post-exposure prophylaxis Hepatitis B Hepatitis C HIV CJD and vCJD Chapter 22: System-specific pathology Nervous system Head injury Missile injury to the brain Non-missile injury to brain Primary brain damage Secondary brain damage Outcome of non-missile head injury Intracranial haemorrhage Extracerebral Extradural haemorrhage Subdural haemorrhage Subarachnoid haemorrhage Intracerebral haemorrhage Diffuse petechial haemorrhages Raised intracranial pressure Hydrocephalus Cerebral ischaemia Brain shift and herniation Systemic effects Clinical manifestations of raised intracranial pressure Cerebral abscess Complications Tumours of the nervous system Outline placeholder Astrocytoma Glioblastoma multiforme Medulloblastoma Ependymomas Oligodendrogliomas Meningiomas Acoustic neuroma Secondary tumours Clinical features of CNS tumours Pituitary tumours Secretory tumours (e.g. prolactinoma) Non-secretory tumours Spinal cord injuries Open injuries Closed injuries Complete transection of spinal cord Incomplete spinal cord injury (see Fig. 6.10) Peripheral nerve injuries Wallerian degeneration Musculoskeletal system Osteomyelitis Acute osteomyelitis Chronic osteomyelitis Septic arthritis Fractures Complications of fractures Immediate Early Local General Late Delayed union Non-union Mal-union Reflex sympathetic osteodystrophy Avascular necrosis of bone Myositis ossificans Osteoarthritis Pathological fractures General Local Compartment syndrome Arthritis Osteoarthritis Rheumatoid arthritis Gout Neuropathic arthritis (Charcot's joint) Bone tumours Primary malignant tumours Secondary malignant tumours Benign tumours Osteoma (`ivory´ osteoma) Osteoid osteoma Chondroma Fibroma and fibrous dysplasia Bone cysts Primary malignant tumours Osteosarcoma (osteogenic sarcoma) Osteoclastoma (giant cell tumour) Ewing's tumour Chondrosarcoma Fibrosarcoma Myeloma Secondary bone malignancy Metabolic bone disease Rickets and osteomalacia Osteoporosis Hyperparathyroidsim Paget's disease of bone Lung tumours Primary carcinoma of the lung Aetiology Classification of lung cancer Clinical features Primary Complications Prognosis Other primary lung tumours Pneumothorax Pleural effusions Lung infections Outline placeholder Mode of infection Predisposing conditions Bronchopneumonia Lobar pneumonia Aspiration pneumonia Atypical pneumonia Legionnaires´ disease Chest infections in the immunocompromised Pneumocystis carinii Fungi Viruses Bronchiectasis Empyema Organisms Complications Lung abscess Breast disorders Benign tumours Fibroadenoma Duct papilloma Adenoma Connective tissue tumours Carcinoma of the breast Risk factors Aetiological mechanisms Non-invasive carcinomas Invasive carcinomas Gross features Paget's disease of the nipple Spread of breast carcinoma Prognostic factors Phylloides tumour Inflammatory conditions Acute pyogenic mastitis Tuberculosis Actinomycosis Mammary duct ectasia Fat necrosis Proliferative conditions of the breast Gynaecomastia Breast cancer in men Cardiovascular system Atherosclerosis Lesions of atherosclerosis Fatty streaks Gelatinous plaques Fibrolipid plaques (Fig. 22.1) Complicated plaques Risk factors Pathogenesis Ischaemic heart disease Outline placeholder Angina of effort Acute coronary syndrome (unstable angina and acute myocardial infarction) Subendocardial (partial thickness or non-Q-wave infarct) Transmural infarction (full thickness or Q-wave infarct) Pathological consequences of acute transmural infarct Sudden cardiac death Ischaemic cardiomyopathy Aneurysms True aneurysms Congenital aneurysms `Berry´ aneurysms Acquired aneurysms Atheromatous aneurysms Abdominal aortic aneurysm Mycotic aneurysms Syphilitic aneurysms Dissecting aneurysm (acute aortic dissection) False aneurysm (pulsating haematoma) Arteriovenous aneurysms General complications of aneurysms Endocrine system Thyroid disease Goitre Hyperthyroidism Clinical features of thyrotoxicosis Hypothyroidism Clinical features of myxoedema Hashimoto's thyroiditis Carcinoma of the thyroid gland Clinical presentation Adrenal disorders Medulla Cortex Hyperfunction of the adrenal cortex Cushing's syndrome Hyperaldosteronism Conn's syndrome (primary hyperaldosteronism) Secondary hyperaldosteronism Hypersecretion of sex steroids Hypofunction of the adrenal cortex Acute insufficiency Chronic insufficiency (Addison's disease) Tumours of the adrenal cortex Adenoma Carcinoma Genitourinary system Gynaecological causes of acute abdominal pain Pelvic inflammatory disease Acute pelvic inflammatory disease Sequelae Chronic pelvic inflammatory disease Ovarian disease Ovarian cysts Ovarian tumours Epithelial tumours Germ cell tumours Sex-cord stromal tumours Metastatic tumours Clinical presentation of ovarian tumours Ectopic pregnancy Endometriosis Clinical features Fibroids Fibroleiomyoma Complications Endometrial carcinoma Spread Urinary tract calculi Types of calculi Precipitating factors Sites Renal pelvis Bladder Ureteric and urethral stones Clinical effects Urinary tract infections (UTIs) Acute pyelonephritis Pathogenesis Clinical features Complications Chronic pyelonephritis Clinical features Cystitis Aetiology Clinical features Sterile pyuria Urinary tract tuberculosis Clinical features Tumours of the urinary tract Kidney Benign neoplasms Cortical adenoma Angiomyolipoma Malignant renal tumours Wilms´ tumour Renal cell carcinoma (hypernephroma, Grawitz tumour) Aetiology Clinical presentation Spread Prognosis Transitional cell carcinoma of renal pelvis Aetiology Clinicopathological features Bladder tumours Aetiology Transitional cell carcinoma Clinical features Staging and grading Squamous cell carcinoma Clinicopathological features Conditions of the urethra Urethral obstruction Urethritis Gonococcal urethritis Course and complications Non-gonococcal (non-specific urethritis) Tumours Viral condyloma Transitional cell carcinoma Conditions of the penis Congenital lesions Hypospadias Epispadias Inflammation and infections Balanoposthitis Phimosis Paraphimosis Balanitis xerotica obliterans Genital herpes Genital warts Tumours of the penis Invasive squamous carcinoma Conditions of the prostate Prostatitis Acute suppurative prostatitis Chronic non-specific prostatitis Benign prostatic hypertrophy Complications Carcinoma of the prostate Aetiology Clinicopathological types Clinical (symptomatic) carcinoma Latent (incidental) carcinoma Spread Clinical presentation and features Prognosis Gastrointestinal system Carcinoma of the oesophagus Causes Types Spread Prognosis Peptic ulcer disease Acute peptic ulceration Chronic peptic ulceration Complications of peptic ulcer Carcinoma of the stomach Aetiology Pathogenesis Classification Early Advanced Hepatobiliary disorders Jaundice Gall bladder Gallstones (cholelithiasis) Aetiology Types of stone Pathological consequences of gallstones Acute cholecystitis Chronic cholecystitis Mucocoele Empyema Cholesterolosis Pancreatitis Acute pancreatitis Pathogenesis Biochemical changes Complications Prognosis Chronic pancreatitis Carcinoma of the pancreas Aetiology Clinical features Prognosis Portal hypertension Intestinal fistulae Small bowel fistulae High-output fistulae Low-output fistulae Disorders of colon and rectum Polyps Adenomas Inflammatory polyps (pseudopolyps) Hamartomas Metaplastic polyps Malignant epithelial polyps Familial polyposis coli (familial adenomatous polyposis-FAP) Gardner's syndrome Colorectal cancer Progression of adenoma to carcinoma (see Fig. 18.1) Aetiology Molecular basis for development of colorectal cancer Site Spread Complications Prognosis Carcinoid tumours Carcinoid syndrome Inflammatory bowel disease Crohn's disease Aetiology Appearances Macroscopic Microscopic Complications Extra-gastrointestinal manifestations Ulcerative colitis Aetiology Appearances Macroscopic Microscopic Complications Extragastrointestinal manifestations Diverticular disease Pathogenesis Complications SECTION IV: APPENDIX Appendix: OSCE scenario answers OSCE Scenario answer 1.1 OSCE Scenario answer 1.2 OSCE Scenario answer 2.1 Initial pain Localised pain OSCE Scenario answer 2.2 OSCE Scenario answer 3.1 OSCE Scenario answer 3.2 OSCE Scenario answer 4.1 OSCE Scenario answer 4.2 OSCE Scenario answer 5.1 OSCE Scenario answer 5.2 OSCE Scenario answer 6.1 OSCE Scenario answer 6.2 OSCE Scenario answer 7.1 OSCE Scenario answer 7.2 OSCE Scenario answer 8.1 OSCE Scenario answer 8.2 OSCE Scenario answer 9.1 OSCE Scenario answer 9.2 OSCE Scenario answer 10.1 OSCE Scenario answer 10.2 OSCE Scenario answer 11.1 OSCE Scenario answer 11.2 OSCE Scenario answer 12.1 OSCE Scenario answer 12.2 OSCE Scenario answer 13.1 OSCE Scenario answer 13.2 OSCE Scenario answer 14.1 History Examination Investigations Management OSCE Scenario answer 14.2 OSCE Scenario answer 15.1 OSCE Scenario answer 15.2 History Examination Features Investigations Management OSCE Scenario answer 16.1 History Examination Investigations OSCE Scenario answer 16.2 OSCE Scenario answer 17.1 Examination Investigations OSCE Scenario answer 17.2 OSCE Scenario answer 18.1 OSCE Scenario answer 18.2 OSCE Scenario answer 19.1 Symptoms Signs OSCE Scenario answer 19.2 OSCE Scenario answer 20.1 Questions Investigations Possible further investigations OSCE Scenario answer 20.2 OSCE Scenario answer 21.1 Investigations Management OSCE Scenario answer 21.2 OSCE Scenario answer 22.1 Histopathologically Clinically OSCE Scenario answer 22.2 Medical Surgical OSCE Scenario answer 22.3 Types of pneumothorax Causes Treatment OSCE Scenario answer 22.4 OSCE Scenario answer 22.5 OSCE Scenario answer 22.6 OSCE Scenario answer 22.7 Pre-hepatic jaundice Hepatic jaundice Post-hepatic/cholestatic jaundice Index