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Revision Notes for the MRCS Viva Kanchana Sundaramurthy

PART 1: GENERAL PRINCIPLES
CHAPTER 1:General physiology
- Body fluid compartments
- Distribution of blood
- Starling's forces
- Crystalloids
- Fluid and electrolyte derangements
- Plasma proteins
  - Functions
    - Hereditary antiproteinase deficiencies
- Thermoregulation
- Blood pressure
- Acid–base balance
- Arterial blood gases (ABGs)
- Central venous pressure (CVP)
- Pulmonary capillary wedge pressure (PCWP)
- Cardiopulmonary bypass
CHAPTER 2:Critical care
- Metabolic response to injury
- Shock
- Sepsis
- Acute respiratory distress syndrome (ARDS)
- Systemic inflammatory response syndrome (SIRS)
  - Definition
- Multiple systems organ failure (MSOF)
CHAPTER 3:Trauma
- Trimodal distribution of death
- Prevention of trauma
- Approach to a severely injured patient
  - How does this approach differ from the usual approach to treat illness?
- Pre-hospital care
- Major incident triage
- Primary survey
- Secondary survey
  - History
  - Head-to-toe examination
- Summary of the approach to an injured patient
- Head injury
- Spinal cord injuries
- Peripheral nerve injuries
- Penetrating trauma
  - Energy transfer
    - Cavitation
  - Anatomical factors
- Blast injuries
  - Types of injuries
- Hypothermia
- Heat exhaustion
- Radiation injury
CHAPTER 4:General pathology
- Cell growth and development
  - Definitions
- Cell cycle
  - Definition
  - Phases
  - Restriction point
  - Cell types in relation to cell cycle
  - Duration of cell cycle
- Response of cell to damage
- Apoptosis
  - Definition
  - Events
  - Regulation (control) of apoptosis
- Inflammation
  - Acute inflammation
  - Chronic inflammation
  - Systemic effects of inflammation
- Chemotaxis
  - Definition
  - Mechanism
  - Control of chemotaxis
- Cytokines
  - Definition
  - Classification
  - Functions
- Cell injury
  - Definition
  - Causes
- Non-infective cellular injury
  - Definition
  - Morphology
  - Causes
  - Molecular basis of cell injury
- Giant cells
  - Definition
  - Classification
    - Normal giant cells
    - Abnormal giant cells
- Accumulations and depositions
  - Definition
  - Amyloid
  - Calcification
  - Hemochromatosis
- Amyloidosis
  - Definition
  - Types
  - Pathogenesis of secondary amyloidosis
  - Diagnosis
  - Treatment
- Calcification
- Haemochromatosis
  - Definition
  - Causes
  - Clinical features
- Thrombosis and clot formation
  - Definition
  - Stages of clot formation
  - Virchow's triad
  - Fate of thrombi
- Coagulation factors
  - Coagulation cascade
  - Tests for coagulation
- Embolism
  - Definition
  - Types
  - Thrombi
  - Gas embolism
  - Fat embolism
  - Tumour embolism
  - Amniotic fluid embolism
  - Foreign body embolism
  - Therapeutic embolisation
- Atheroma
  - Definition
  - Lesions
  - Risk factors
  - Pathogenesis
- Ischaemia
  - Definition
  - Causes
  - Factors that determine the severity of ischaemia
- Infarction
  - Definition
  - Sequence of events
  - Systemic effects
  - Infarction of specific organs
- Anaemia
  - Definition
  - Classification
  - Aetiological classification
    - Blood loss
    - Decreased red blood cell production or function
- Polycythaemia
  - Primary polycythaemia (normal erythropoietin)
  - Secondary polycythaemia
  - Relative polycythaemia
- Jaundice
  - Definition
  - Classification
- Hyperuricaemia
  - Definition
  - Pathogenesis
  - Causes
  - Complications
- Oedema
  - Definition
  - Classification
  - Causes
  - Mechanisms
- Rhabdomyolysis
  - Definition
  - Causes
  - Molecular pathophysiology
  - Complications
  - Clinical picture
  - Investigations
  - Treatment
  - Reperfusion injury (reperfusion syndrome)
- Ascites
  - Definition
  - Causes
  - Investigations on ascitic fluid
  - Transudative ascites
  - Exudative ascites
- Blood transfusion
  - Constituents of products for transfusion
    - Whole blood
  - Indications for transfusion
  - Complications
  - Massive blood transfusion
  - Alternatives to blood transfusion
    - Advantages
    - Agents
- Bleeding disorders
  - Inherited bleeding disorders
  - Acquired bleeding disorders
  - Vitamin K deficiency
  - Hepatic disease
  - DIC
- Tests for bleeding disorders
- Platelet disorders
  - Decreased number (thrombocytopenia)
  - Decreased function (thrombasthenia)
- Hypercoagulable states (thrombotic disorders)
  - Antithrombin III
  - Proteins C and protein S
CHAPTER 5:Immunology
- Hypersensitivity reactions
  - Gell and Coomb's classification – types
- Complement
- Immunoglobulins
  - Types of immunoglobulin
  - Structure and general function of immunoglobulins
- Autoimmune disease
- Immunodeficiency
- Immunosuppression
- Transplantation
- Individual organ transplantation
- Graft-versus-host reactions
CHAPTER 6:Neoplasia
- Cancer
  - Definition
  - Features of cancer cells
  - Epidemiological definitions
  - Chromosomal abnormalities associated with neoplasia
  - DNA abnormalities
  - Histological manifestations of cancer
- Classification of tumours
- Difference between benign and malignant neoplasms
- Complications of benign neoplasms
  - Obstruction
  - Pressure effects
  - Haemorrhage
  - Infection
  - Infarction
  - Ectopic hormone secretion
  - Electrolyte loss
  - Polycythaemia
- Tumour-like lesions
  - Hamartomas
  - Choristomas
- Epidemiology of cancer
  - Uses of cancer epidemiology by the surgeon
- Oncogenes
- Tumour suppressor genes
- Carcinogenesis
  - Definition of a carcinogen
  - Classification of carcinogens
  - Definition of carcinogenesis
  - Types of carcinogens
- Gompertzian pattern of tumour development
- Tumour markers
  - Definition
  - Uses
  - Types
  - Definitions related to tumour markers
  - Ideal tumour marker
- Screening
  - Definition
  - Criteria
  - Bias
  - Available screening programmes
  - Definitions related to screening
- Invasion and metastases
  - Invasion
  - Metastases
  - Common pattern of metastases
- Staging of tumours
  - Definition
  - Uses
  - Types
  - TNM staging
  - AJCC system – stages 0–4
  - Stage shift
- Grading of tumours
  - Definition
  - Types
  - Differentiation
  - Nottingham prognostic index (NPI)
- Specific staging systems
  - Melanoma
  - Colorectal carcinoma
- Biopsy
  - Definition
  - Types
  - Staining techniques
  - Frozen section biopsy
- Interpretation of fine-needle aspiration cytology
- Principles of surgery for malignant disease
  - Role
  - Selection of surgical procedure
  - Pre-operative preparation
  - Operative findings
  - Types of surgery
- Radiotherapy
  - Definition
  - Action
  - Fractionation
  - Radiotherapy planning
  - Radiotherapy as primary therapy
  - Radiotherapy as adjuvant therapy
  - Palliative radiotherapy
  - Treatment of systemic disease
  - Complications
- Immunotherapy
  - IL-2
  - Colony stimulating factors (CSFs)
  - IFN-alpha
- Hormonal therapy
- Chemotherapy
  - Types
  - Palliative chemotherapy
  - Curative chemotherapy
  - Adjuvant chemotherapy
  - Neo-adjuvant chemotherapy
  - Complications
- Paraneoplastic syndrome
  - Definition
  - Importance
  - Classification
  - Examples
  - Neoplasms associated with paraneoplastic syndrome
CHAPTER 7:Microbiology
- Surgically important micro-organisms
- Commensal organisms
- Exotoxins and endotoxins
- Source of surgical infections
- Risk of infection
- Principles of asepsis and antisepsis
- Commonly used antibiotics
- Principles of antibiotic prophylaxis
- Antibiotic resistance
  - Basic principles of control of resistant organisms
- Blood-borne viruses
- Universal precautions
- Immunisation
- Management of sharps injuries
- Disinfection
  - Definition
  - Examples
- Sterilisation
  - Definition
  - Methods
- Nosocomial infections
CHAPTER 8:Principles of surgery
- Incisions and wound closure
  - Principles of incision
  - Principles of closure
  - Individual incisions
  - Skin closure
- Peri-operative care
  - Risk factors adversely influencing peri-operative morbidity
  - Pre-operative assessment
    - How to perform a pre-operative assessment
  - Risk scoring systems
  - Disease-specific scoring systems
  - Injury scoring systems
  - Diabetic ulcer grading
  - Prognostic scoring systems for cancer
- Laboratory testing
- Imaging methods
  - Ultrasound
  - Computed tomography (CT)
  - Magnetic resonance imaging (MRI)
  - Nuclear scans
- Nutrition
  - Nutritional assessment
  - Body mass index (BMI)
  - Nutritional requirements
  - Purpose of nitrogen administration
  - Measurement of nitrogen balance
  - Enteral nutrition
  - Parenteral nutrition
- Associated medical conditions in a surgical patient
  - Aims of management
  - Cardiovascular disease
  - Respiratory disease
  - Endocrine dysfunction
  - Obesity
  - Blood disorders
  - Renal diseases
  - Liver disease
  - Alcoholism and drug abuse
  - AIDS
  - Patients with transplanted organs
  - Elderly patients
- Issues related to medications
- Decision-making in surgery
  - Processing information
  - Steps in decision-making
  - Acting on a decision
  - Personal audit
- Statistics
  - Definition
  - Components
- Clinical trials
  - Definition
  - Randomisation
  - Blinding
  - Ethics
  - Phases
- Audit
  - Definition
  - Medical audit
  - Clinical audit
  - Purpose of audit
  - Clinical effectiveness
  - The audit cycle
  - Educational benefits
  - Clinical audit committee
  - Techniques of audit
- Consent
  - Definition
  - Pre-requisites
  - To determine whether patient has understood
  - Ethical issues in specific situations
- Premedication
  - Definition
  - Anxiolytics
  - Drying secretions
  - Analgesics
- General anaesthesia
  - Definition
  - Phases
- Local and regional anaesthesia
  - Definition
  - Areas of block
  - Classification of nerve fibres according to their size and speed of conduction
  - Sensitivity to local anaesthesia
  - Local anaesthetics
  - Clinical applications
- Monitoring of anaesthetised patient
  - Components
  - Anaesthetic and respiratory monitoring
  - Cardiovascular monitoring
- Nerve injuries during anaesthesia
  - Causes
  - Predisposing positions
  - Nerves most commonly injured
  - Safeguards
- Post-operative monitoring
  - Immediate recovery phase
  - Other monitoring
  - Causes of post-operative hypoxia
  - Oxygen therapy
- Diathermy
  - Principles of diathermy
  - Effects
  - Monopolar diathermy
  - Bipolar diathermy
  - Safety
  - Diathermy burns
  - Concurrent pacemakers
  - Diathermy during laparoscopy
- Lasers
  - Definition
  - Lasing medium
  - Delivery system
  - Types
  - Clinical applications
  - Classification according to degree of hazard
  - Hazards
  - Safety measures
- Sutures and ligature materials
  - Ideal suture
  - Types of sutures
  - Factors for selecting a suture or ligature
  - Choice
  - Needles
  - Indications for using staples
- Tourniquets
  - Indications
  - Contraindications
  - Procedure
  - Complications and risks
- Wound healing
  - Definition
  - Steps
  - Factors with a deleterious effect on wound healing
  - Types of wound healing
  - Wound strength recovery
  - Wound fibrosis
  - Treatment of wound complications
- Principles of wound management
  - Pre-operative management
  - Operative management
  - Post-operative management
- Fracture healing
  - Cells involved in healing
  - Stages
  - Complications
- Healing of nervous tissue
  - CNS
  - Peripheral nervous system
- Day-care surgery
  - Definition
  - Benefits
  - Day-care unit
  - Selection of patients
  - Examples of day care operations
  - Operational policy
  - Pain management
- Endoscopic surgery and laparoscopy
  - Definition
  - Techniques
  - Morbidity of open surgical wounds
  - Advantages of minimal access surgery
  - Disadvantages of minimal access surgery
  - Stereoscopic imaging for laparoscopic surgery
  - Laparoscopic ultrasound
  - Training
  - Equipment
  - Conversion
  - Complications
  - Endoluminal minimal access surgery
- Interventional flexible endoscopy
  - Indications
PART 2: SYSTEM-SPECIFIC SURGERY
CHAPTER 9:Central nervous system
- Cerebral blood flow
- Intracranial pressure
- Raised intracranial pressure
- Hydrocephalus
- Glasgow Coma Scale (GCS)
- Epilepsy
  - Surgery for epilepsy
  - Types of surgery
- Meningitis
- Cerebral abscess
- Intracranial mass
  - Clinical presentations
- Intracranial haemorrhage
  - Intracerebral haemorrhage
    - Causes
  - Extracerebral haemorrhage
- Classification of cerebral tumours
  - Primary tumours
  - Secondary tumours
- Brainstem death
CHAPTER 10:Cardiovascular system
- Jugular venous pulse waves
- Cardiac cycle
  - Phases and events
- Cardiopulmonary bypass
- Fetal circulation
CHAPTER 11:Orthopaedics
- Soft tissue injuries
  - Definition
  - Types
  - Sprains
  - Strains
  - Contusions
  - Tendonitis
  - Bursitis
  - Treatment
- Pathophysiology of fractures
  - Types of fracture
- Complications of fractures
  - General complications
  - Early local complications
  - Late local complications
- Fracture healing
  - Stages
  - Histological stages
  - Factors affecting fracture healing
- Principles of fracture management
  - Stages of management
  - Indications for leaving a fracture unreduced
  - Types of reduction
  - Types of implants
  - Complications of internal fixation
- Femoral neck fractures
  - Aetiology
  - Classification
  - Blood supply to the femoral head
  - Intracapsular fractures
  - Extracapsular fractures
  - Subtrochanteric fractures
  - Treatment options for complications
- Bone and joint infections
  - Osteomyelitis
  - Septic arthritis
  - Management of osteomyelitis and septic arthritis
- Knee aspiration
  - Purpose
  - Indications
  - Contraindications
  - Technique
  - Complications
- Osteoarthritis
  - Definition
  - Types
  - Causative lesion
  - Pathological features
  - X-ray criteria for diagnosis
- Rheumatoid arthritis
  - Definition
  - Joints involved
  - Pathology
- Joint replacement
  - Definition
  - Types
  - Replacement material
  - Technique
  - Other techniques
  - Indications
  - Contraindications
  - Pre-operative work-up
  - Post-operative care
  - Complications
  - Prognosis
- Compartment syndrome
  - Definitions
  - Sites
  - Cause
  - Pathophysiology
  - Signs and symptoms
  - Diagnosis
  - Treatment
  - Complications
- Bone tumours
  - Primary tumours
  - Secondary tumours
  - Haemopoietic tumours
- Metabolic bone disease
- Low back pain and sciatica
  - Pathology
  - Clinical features
  - Treatment
  - Treatment of simple sciatica
- Cervical degenerative disease
  - Types
  - Differential diagnosis
  - Management
- Principles of hand trauma
  - Vascular injuries
  - Metacarpal and phalangeal fractures
  - Ligament injuries
  - Tendons
- Diseases of the foot
- Trigger finger
- Ganglion
- Carpal tunnel syndrome
- Dupuytren's disease
- Amputations
  - Types
  - Post-amputation problems
  - Principles
  - Technique
  - Below-knee amputations
  - Ray amputation
  - Symes amputation
  - Deciding the level of amputation
  - Sympathectomy
CHAPTER 12:Vascular system
- Peripheral vascular disease and limb ischaemia
- Signs and symptoms of lower limb arterial occlusion
  - General signs and symptoms
  - Clinical features according to level of arterial occlusion
- Occlusive carotid artery disease
- Renovascular disease
- Arterial embolism and acute limb ischaemia
- Aneurysms
- Aortic dissection
- Arterial trauma
- Varicosities
- Lipodermatosclerosis
- Varicose veins
- Venous ulcers
- Venous dermatitis
- Deep venous thrombosis (DVT)
- Pulmonary embolism
- Lymphoedema
CHAPTER 13:Skin
- Soft tissue infections
  - Cellulitis
  - Necrotising soft tissue infections
- Benign skin lesions
- Skin cancer
- Principles of skin cover
CHAPTER 14:Burns
- Pathophysiology
- Consequences of burns
- Systemic response to burns
- Initial clinical assessment of burns
- Management of burns
- Burn wound management
- Complications of burns
CHAPTER 15:Head and neck
- Congenital neck lumps
- Salivary gland disorders
CHAPTER 16:Respiratory system
- Surface anatomy and lung anatomy
  - Angle of Louis
  - Suprasternal notch
  - Third intercostal space
  - Oblique fissure
  - Horizontal fissure
  - Lobes and segments of the lung
- Dead space
  - Definition
  - Types
  - Importance
  - Factors increasing anatomical dead space
  - Factors increasing alveolar dead space
- Diaphragm
  - Nerve supply
  - Openings
- Respiration
  - Definition
  - Components
  - Main respiratory muscles
  - Accessory muscles
  - Diaphragmatic descent
  - Gas exchange
  - Intercostal muscles
  - Expiratory muscles
- Partial pressures
  - Definition
  - Gaseous composition of dry air
  - Atmospheric pressure
  - High altitude
  - Intrapleural pressure
  - Lung volumes and capacities
    - Lung capacities
  - Measurement of FRC
  - FEV–FEV1 ratio
  - Partial pressures of gases in various parts of the respiratory and circulatory systems (mmHg)
  - O2 partial pressures
  - CO2 partial pressures (kPa)
  - Pressure difference between the pulmonary capillaries and the oncotic pressure
  - Oxyhaemoglobin dissociation curve
  - Quaternary function of haemoglobin
  - O2 tension
  - O2 cascade
- CO2 transport
  - Steps in CO2 transport
  - Haldane effect
  - Transport of CO2
  - Changes in pCO2 along the respiratory tree
- Arterial blood gases
  - Normal values at a body temperature of 37 °C
  - Interpretation
- Compliance of the lung
  - Definitions
  - Surfactant
  - Factors affecting compliance
  - Elastance
- Pulmonary blood flow
- Ventilation–perfusion (V–Q) ratio
  - Normal variation
  - Normal value
  - Factors affecting the V–Q ratio
- Control of respiration
  - Aim
  - Sensors
  - Controllers
  - Effectors
  - Central control
  - Quiet breathing
  - Chemical regulation
  - Receptors within the lungs
  - Receptors outside the lungs
- Arterial O2 saturation
  - Arterial partial pressure of O2 (paO2)
  - Arterial saturation of O2 (SaO2)
  - O2 delivery
  - Tissue oxygenation
- Other (non-ventilatory) functions of the lung
  - Defence mechanisms
  - Metabolic and endocrine functions
- Valsalva manoeuvre
  - Definition
  - Examples
  - Phases
  - Uses of the Valsalva manoeuvre
- Chronic obstructive pulmonary disease (COPD)
  - Definition
  - Causes
  - Mechanisms
  - Clinical types
- Respiratory failure
  - Definition
  - Types
  - Causes
  - In COPD
  - Mechanisms of respiratory failure
- Stridor
  - Definition
  - Anatomy and pathophysiology
  - Classification
  - Aetiology
- Acute respiratory distress syndrome (ARDS)
  - Definition
  - Causes
  - Clinical presentation
  - Phases
- Fat embolism
  - Incidence
  - Clinical features
  - Diagnosis
- Aspiration syndromes
  - Causes
  - Factors predisposing to post-operative aspiration
  - Factors increasing the sensitivity of response to aspiration of gastric contents
  - Protective manoeuvres at intubation
  - Aspiration of liquids
  - Aspiration of solids
- Hospital-acquired pneumonia
- Lung abscess
- Atelectasis
  - Definition
  - Aetiology
  - Physiological consequences
  - Absorption atelectasis
  - Post-operative atelectasis
- Post-operative respiratory insufficiency
  - Definition
  - Risk factors
  - Causes
  - Evaluation and management
  - Treatment
- Ventilatory support
  - Definition
  - Indications
  - Types of ventilators
  - Aims of assisted ventilation
  - Benefits of ventilation
  - Modes of ventilation
  - Weaning
- Flail chest
  - Definition
  - Signs and symptoms
  - Sources of massive haemothorax in flail chest
  - Treatment
- Lung cancer
  - Associated factors
  - Molecular biological aspects
  - Important pathological types
  - Spread
  - Clinical features
  - Diagnosis
  - Staging
  - Management
- Pleura
  - Pleural effusion
    - Mechanisms
  - Empyema
  - Pneumothorax
  - Haemothorax
  - Empyema thoracis
  - Pyopneumothorax
  - Pneumothorax
- Pneumonia
  - Definition
  - Types
  - Pathological types
  - Legionnaire's disease
- Intercostal drainage
  - Indications
  - Preparation
  - ‘Safe triangle’
  - Insertion of the drain
  - After insertion of the drain
  - Findings
  - Massive pleural effusion
  - Water-seal drainage
  - Removal
- Complications of thoracic operations
  - General complications
  - Organ-specific complications
CHAPTER 17:Endocrine system
- Thyroid gland
- Parathyroid gland
- Multiple endocrine neoplasia (MEN) syndromes
- Pituitary gland
  - Cushing's disease
  - Ectopic ACTH syndrome
- Acromegaly
  - Features
  - Diagnosis
- Adrenal gland
- Insulinoma
- Gastrinoma
- Carcinoid tumour
- Rare endocrine tumours
CHAPTER 18:Lymphoreticular system
- Splenic functions
- Splenomegaly
- Splenectomy
CHAPTER 19:Gastrointestinal system
- Gastrointestinal physiology
  - Gastrointestinal innervation
  - Gastric motility and emptying
  - Regulation of gastric motility and secretion
  - Factors preventing oesophagogastric reflux
- Diagnosis of oesophageal disorders
  - Typical symptoms
  - Atypical clinical features
  - Investigations for oesophageal disease
- Gastrointestinal motility waves
  - Distal two thirds of stomach
  - Small intestine
  - Colon
  - Rectum
- Gastro-oesophageal reflux disease
  - Factors that resist reflux and damage
  - Factors that promote reflux and damage
  - Clinical features
  - Classification
  - Complications
  - Treatment
- Oesophageal motility disorders
  - Classification
  - Achalasia
  - Diffuse oesophageal spasm
  - ‘Nutcracker’ oesophagus
- Oesophageal foreign body
- Oesophageal carcinoma
  - Causes
  - Classification
  - Spread
  - Prognosis
  - Macroscopic types
  - Associated oncogenes and tumour-suppressor genes
  - Clinical features
  - Investigations
  - TNM staging
  - Treatment
- Oesophageal diverticula
  - Classification
  - Clinically important diverticula
  - Zenker's diverticulum
  - Other diverticula
- Peptic ulcer
  - Definition
  - Sites
  - Classification and aetiology
  - Complications
- Carcinoma of the stomach
  - Aetiology and associations
  - Classification
  - Prognosis
  - Microscopic classification
  - Spread
  - Staging
  - Complications
- Sequelae of gastric surgery
- Peristalsis
  - Definition
  - Constituents
  - Polypeptides involved
- Ileus
  - Causes
  - Effects
  - Return of peristalsis after laparotomy
  - Treatment of adynamic ileus
- Gut hormones
  - Classification
  - Gastrin
  - Cholecystokinin
  - Secretin
  - Gastric inhibitory peptide (GIP)
  - Vasoactive intestinal peptide (VIP)
  - Other gastrointestinal hormones
- Functions of the liver
  - Energy sources and supply
  - Synthesis and metabolism of nitrogenous compounds
  - Lipoprotein synthesis and lipid metabolism
  - Control of blood coagulation and fibrinolysis
  - Detoxification of harmful metabolites and drugs
  - Metabolism of haem and bile pigments
  - Enterohepatic circulation
  - Bile secretion causes fat absorption
  - Immune surveillance by Kupffer cells
  - Haemopoiesis
- Extrahepatic (enteropathic) circulation of bile salts
- Portal hypertension
  - Causes
  - Portal vein pressure
  - Sites of portosystemic anastomosis
  - Associations of portal hypertension
- Gallstones
  - Types
  - Aetiology
  - Consequences of gallstones
  - Treatment options
- Obstructive jaundice
  - Definition
  - Aetiology
  - Investigations
  - Complications
  - Pre-operative preparation
- Biliary strictures
  - Benign strictures
  - Malignant strictures
- Functions of the pancreas
  - Exocrine functions
  - Endocrine functions
- Acute pancreatitis
  - Definition
  - Aetiology
  - Pathogenesis
  - Consequences
  - Clinical signs
  - Biochemical changes
  - Plain abdominal X-ray findings
  - Classification according to severity
  - Ranson's criteria for severity prediction
  - Other severity scores
  - Other markers
  - Management
  - Complications
  - Prognosis
- Chronic pancreatitis
  - Definition
  - Causes
  - Pathology
  - Gross appearance
  - Management
  - Complications
  - Surgical treatment
- Carcinoma of the pancreas
  - Pathological classification
  - Aetiology
  - Clinical features
  - Investigations
  - Surgical treatment
- Consequences of terminal ileal resection
  - Malabsorption pattern: terminal ileopathy
  - Common causes of terminal ileopathy
  - Management
- Ulcerative colitis
  - Definition
  - Aetiology
  - Pathology
  - Complications
  - Treatment
  - Complications of ileostomy
- Crohn's disease
  - Definition
  - Sites
  - Characteristics
  - Aetiology
  - Pathology
  - Complications
  - Clinical syndromes
  - Tests for disease activity
- Difference between ulcerative colitis and Crohn's disease
  - Treatment
- Diverticulosis of the colon
  - Definition
  - Sites
  - Pathology
  - Aetiology
  - Complications
  - Differential diagnosis
  - Clinical features
  - Diagnosis
  - Treatment
- Colonic polyps
  - Definition
  - Types
  - Classification
  - Malignant potential of adenoma
  - Specialised polyps
  - Complications
  - Aetiology
  - Treatment options
  - Hamartomatous polyps
  - Peutz-Jeghers syndrome
  - Juvenile polyps
- Colorectal carcinoma
  - Aetiology
  - Genetics
  - Distribution within the colon and rectum
  - Staging
  - Spread
  - Complications
  - Investigations
  - Surgical treatment
  - Chemotherapy
  - Radiotherapy
- Faecal incontinence
  - Causes
  - Investigations
  - Treatment
- Haemorrhoids
  - Definition
  - Anal cushions
  - Clinical features
  - Grades
  - Investigation
  - Complications
  - Treatment
- Rectal prolapse
  - Definition
  - Classification
  - Aetiology
  - Clinical features
  - Diagnosis
  - Complications
  - Treatment
- Perianal sepsis and fistula-in-ano
  - Aetiology
  - Pathogenesis
  - Classification of fistula
  - Intersphincteric fistulae
  - Trans-sphincteric fistula
  - Suprasphincteric fistula
  - Clinical features
  - Diagnosis
  - Treatment
- Fissure-in-ano
  - Definition
  - Causes
  - Aetiology
  - Clinical features
  - Diagnosis
  - Treatment
- Pilonidal sinus and abscess
  - Definition
  - Aetiology
  - Clinical features
  - Treatment
- Pruritus ani
  - Definition
  - Aetiology
  - Clinical features and assessment
  - Treatment
- Anal cancer
  - Classification
  - Spread
  - Aetiology
  - Clinical features
  - Investigations
  - Treatment
CHAPTER 20:Renal system
- Anatomy and physiology of the kidneys
  - Proximal convoluted tubules
  - Loop of Henle
  - Distal convoluted tubule
  - Collecting ducts
  - Control of reabsorption
- Functions of the kidneys
  - Elimination (excretion) of metabolic waste products
  - Maintenance and regulation
  - Glucose synthesis
  - Hormone production
- Renin–angiotensin mechanism
- Renal autoregulation
  - Physical factors
  - Physical factors that regulate tubular function
  - Neuroendocrine factors
- Summary of regulation of renal function
- Countercurrent mechanism
  - Countercurrent multiplier
  - Countercurrent exchanger
  - Net effect
- Haematuria
  - Classification
  - Causes
  - Investigations
- Urinary tract infection
  - Clinical features
  - Organisms
  - Investigations
  - Persistent urinary tract infection
- Urinary stone disease
  - Precipitating factors
  - Types of calculi
  - Clinical features
  - Sites of impaction
  - Investigations
  - Treatment
- Tumours of the urinary tract
  - Renal tumours
  - Carcinoma of the renal pelvis
  - Urothelial tumours
  - Carcinoma of the prostate
  - Carcinoma of the testis
  - Carcinoma of the scrotum
  - Carcinoma of the urethra
  - Carcinoma of the penis
- Infections and inflammations of the testis and epididymis
  - Epididymitis
  - Orchitis
- Other non-malignant testicular swellings
- Testicular torsion
  - Pathology
  - Anatomical abnormalities that predispose to torsion
  - Clinical features
  - Treatment
- Scrotal skin conditions
  - Necrotising fasciitis (Fournier's gangrene)
  - Carcinoma of the scrotum
- Urinary retention
  - Definition
  - Signs and symptoms
  - Sequelae
  - Causes
  - Investigations
  - Treatment
- Benign prostatic hyperplasia (BPH)
  - Clinical diagnosis
  - Risk factors
  - Pathophysiology
  - Management
- Carcinoma of the prostate
  - Aetiology
  - Pathology
  - Screening
  - Diagnosis
  - Staging
  - Signs and symptoms of metastatic disease
  - Treatment options
- Other prostatic disorders
  - Prostatitis
- Acute renal failure
  - Definition
  - Causes
  - Differentiation of pre-renal ARF and renal ARF
- Renal replacement therapy
  - Indications in acute renal failure
  - Types
  - Patterns of therapy
  - Complications of dialysis
- Urological trauma
  - Renal trauma
  - Ureteric trauma
  - Bladder injuries
  - Urethral injuries
  - Injuries to the external genitalia
CHAPTER 21:Paediatric surgery
- Principles of paediatric and neonatal surgery
- Neural tube defects
- Congenital heart disease
- Diaphragmatic hernia
- Congenital anomalies of the gastrointestinal system
- Anterior abdominal wall anomalies
- Urological abnormalities
CHAPTER 22:Terminal care
- Pain management
- Rehabilitation
- Principles of organ donation
  - Basic issue
  - Strategies to minimise donor shortage

INDEX

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Index

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Chapter Notes