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Coagulopathies and Sickle Cell Disease

Hemostasis is a complex physiologic phenomenon that keeps the blood in a fluid state and prevents thrombus formation in normal vessels. In case of vascular injury, this phenomenon is responsible for inducing hemostatic plug formation to prevent hemorrhage from the injured site. This is a complex process carefully regulated by the body to prevent the excess growth of thrombus by using normally occurring anticoagulant and fibrinolytic…

Renal Impairment and Renovascular Hypertension

Body Fluids and Electrolyte Regulation Effective kidney function maintains the normal volume and composition of body fluids. Although there is wide variation in dietary intake and nonrenal expenditures of water and solute, water and electrolyte balance is maintained by the excretion of urine, with the volume and composition defined by physiologic needs. Fluid balance is accomplished by glomerular ultrafiltration of plasma coupled with modification of the…

Anesthetic Considerations for Pediatric Surgical Conditions

Anesthetizing children is an increasingly safe undertaking. When discussing the risks and benefits of a child’s operation with his or her family, surgeons should feel confident that their anesthesiology colleagues can provide an anesthetic that facilitates the procedure while ensuring the child’s safety. Providing optimal perioperative care for children requires close collaboration between the surgeon and anesthesiologist on issues both large and small. The intent of…

Nutritional Support for the Pediatric Patient

Despite advances in the field of nutritional support, malnutrition among hospitalized pediatric patients, especially those with a protracted clinical course, remains prevalent worldwide and is associated with worse outcomes. Moreover, it has been well established that preoperative malnutrition is associated with higher postoperative mortality. Optimal nutritional therapy requires a careful assessment of the child’s energy needs and the provision of macronutrients and micronutrients via the most…

Physiology of the Newborn

Of all pediatric patients, the neonate possesses the most distinctive and rapidly changing physiologic characteristics. These changes are necessary because the newborn must adapt from placental support to the extrauterine environment. There is also early organ adaptation and the physiologic demands of rapid growth and development. This chapter will emphasize the dynamic physiologic alterations of the neonate. Newborns are classified based on gestational age, weight, head…

Hepato-pancreato-biliary trauma

Introduction Trauma care in general has been revolutionized by the increased availability and accuracy of cross-sectional imaging and interventional radiology. The ‘trauma CT scan’ is an integral part of most units’ major trauma protocols and specialized trauma centres depend on 24-hour availability of endovascular embolisation. As a result, injuries are diagnosed quickly, often allowing detailed assessment of severity and direction of treatment strategy with traumatic haemorrhage…

Cystic and neuroendocrine neoplasms of the pancreas

Acknowledgement We would like to acknowledge Saxon Connor who authored the previous version of this chapter. Introduction Although pancreatic ductal adenocarcinoma accounts for the majority of pancreatic neoplasms, over the last three decades there has been increasing recognition of cystic and neuroendocrine pancreatic neoplasms. The aim of this chapter is to examine these tumours in more detail, with particular emphasis on intraductal papillary mucinous neoplasms (IPMN)…

Pancreatic adenocarcinoma

Introduction Pancreatic adenocarcinoma accounts for over 90% of tumours arising from exocrine pancreas. Due to its late presentation at an advanced stage, it has a poor prognosis in the majority of patients. In the United States in 2020 there was estimated to be in excess of 47 000 deaths due to pancreatic cancer. The disease represents 3% of all new cancer cases and accounts for 8%…

Chronic pancreatitis

Summary Chronic pancreatitis (CP) is an inflammatory disease of the pancreas characterised by inflammation and scarring resulting in irreversible damage to the gland, leading to variable loss of pancreatic exocrine and endocrine function. The most common aetiological factor is long-term excessive consumption of alcohol. There is also an association with cigarette smoking. , Chronic pancreatitis is associated with mutations in trypsin activation genes and mutations in…

Complicated acute pancreatitis

Introduction Acute pancreatitis is a common disease, characterised by painful inflammation of the pancreas. It is diagnosed if two of the following three criteria are present: abdominal pain, level of serum lipase (or amylase) three times the upper limit of normal serum levels, and characteristic finding on imaging (i.e., contrast-enhanced computed tomography [CECT]) ( Fig. 15.1 ). The clinical course and severity of acute pancreatitis varies…

Malignant lesions of the biliary tract

Introduction Malignant lesions of the biliary tract, including the gallbladder, are uncommon and account for approximately 15% of hepatobiliary neoplasms and 3% of gastrointestinal (GI) malignancies overall. Biliary tract cancers are prevalent in certain regions, such as Thailand, Chile and India, while rare in most Western countries. It was estimated that there would be 11 980 new cases, and 4310 deaths from a gallbladder or biliary…

Benign biliary tract diseases

Introduction Apart from those disorders related to choledocholithiasis, benign diseases of the biliary tree are relatively uncommon ( Box 13.1 ). The most challenging patients are those who present with symptoms associated with biliary strictures, which arise more commonly following iatrogenic injury during cholecystectomy. Congenital abnormalities such as biliary atresia and choledochal cysts are usually in the domain of the paediatric surgeon, although later presentation of…

Gallstones

Introduction The gallbladder serves as a reservoir to hold bile and release it in a bolus when fat is ingested ( Fig. 12.1 ). Fat in the stomach results in the release of cholecystokinin (CCK) which causes contraction and emptying of the gallbladder as food enters the duodenum. Bile helps to emulsify fat within the small bowel and aid its absorption. Whilst in the gallbladder, bile…

The spleen and adrenal glands

Introduction The spleen is a little understood organ largely mystifying early physicians since antiquity. It was not until the latter half of the 20th century that the spleen’s four main functions are better understood: antibody presentation and production, foetal haematopoiesis, sequestration of formed blood elements, and phagocytosis for recycling of blood cells, iron and particulate matter. Though splenic primary and secondary malignancies are rare, the differential…

Pancreas and islet cell transplantation: beta-cell replacement therapy

Introduction The discovery of insulin by Banting and Best in the early part of the 20th century saw type I diabetes become a treatable chronic illness rather than a rapidly fatal diagnosis. Since then, patients with diabetes have been able to lead relatively normal lives, thanks to ongoing refinements in insulin therapy. Despite this, many patients suffer from the secondary complications of diabetes, including retinopathy, neuropathy,…

Portal hypertension and liver transplantation

Acknowledgement The authors are grateful to Mr Stephen O’Neill, consultant transplant surgeon, Belfast City Hospital, for his comprehensive contribution to a previous edition of this chapter. Introduction Surgical management of portal hypertension with portosystemic vascular shunts has essentially been rendered obsolete by the success of less invasive endoscopic and radiological treatments. However, for patients who are suitable candidates, liver transplantation has become the treatment of choice…

Non-colorectal hepatic metastases

Introduction Colorectal cancer (CRC) is the second most common cancer diagnosed in women and the third most common cancer diagnosed in men worldwide. The majority of CRC-related mortality is due to metastatic disease with the liver being the most common site (80%). Fifty percent of patients with CRC have liver metastases at presentation; however, the majority of these liver metastases are unresectable. Although CRC is the…

Colorectal liver metastases

Introduction Despite recent advances in screening, diagnosis and management, colorectal cancer (CRC) remains the second leading cause of cancer death in Western countries. In 2018, 1.8 million new CRC cases were estimated to have occurred worldwide. Almost two-thirds of patients with CRC develop distant metastases and the liver is the most frequent site of metastatic disease. Although as many as 25% of patients will present with…

Primary malignant tumours of the liver

Introduction Primary liver malignancies comprise a group of tumours, some very rare, that have traditionally been divided into three main categories based on the cell type of origin—hepatocellular (hepatocellular carcinoma [HCC]), biliary (intrahepatic cholangiocarcinoma [ICC]), and mesenchymal (angiosarcoma, epithelioid haemangioendothelioma). Yet, as our understanding of the molecular genetics and tumorigenesis of primary liver malignancy evolves, the once clear distinction between and uniformity within categories continue to…

Benign liver lesions

Introduction Benign liver tumours are common and frequently found coincidentally. Most benign liver lesions are asymptomatic, although larger lesions can cause non-specific complaints such as vague abdominal pain. Although rare, some of the benign lesions, e.g. large hepatic adenomas, can cause complications such as rupture or bleeding. Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT of the liver are the routine…