Introduction In paediatric surgery, the most important conditions presenting as emergencies are caused by congenital problems presenting in the neonatal period. In contrast to this, nonacute conditions present across the whole age range of childhood. This chapter deals with abdominal and urological problems in children, although it should be remembered that other systems can be affected by disease in childhood. The most common reasons for nonacute…

Introduction A neonate is a newborn less than 28 days old, an infant is less than a year, a child is 1 to 17 years old and an adult is 18 years or older. In the United Kingdom, paediatric clinical practice generally covers children only up to the age of 16 years. Increasingly, those between 13 and 18 years are being managed in adolescent units, where…

Introduction Patients with thyroid disorders most often present to the surgeon with a neck lump , which may be asymptomatic or it may cause symptoms or cosmetic deformity. A thyroid enlargement is generically known as a goitre , from the Latin for throat guttur , and increasingly, patients are being referred with nodule(s) detected by ultrasound, whilst investigating unrelated neck symptoms. Enlargement may be a discrete…

Disorders of the Oral Cavity (Excluding Salivary Calculi) The mouth should be examined in a systematic way after removal of dentures, taking note of the condition of the teeth and oral soft tissues. Teeth are straightforward to identify: they are either upper or lower and then left or right; they are then numbered from the midline backwards from 1 to 8. In this way, they can…

Introduction Neck lumps are common and may be related to disorders of the mouth, throat or skin. Infection in the cervical region can cause difficulty swallowing (dysphagia) and put the airway at risk. Referrals are often made to exclude malignancy, whilst some are for surgical treatment of a metabolic disorder, such as thyrotoxicosis or hyperparathyroidism. There is a large overlap with specialties in this area, notably…

Introduction Only a few skin disorders are surgically important, including unsightly lesions, lumps and potentially malignant lesions. These are often referred to surgeons for excision or for definitive management following biopsy. Lower limb ulcers in the West are usually venous, arterial or diabetic neural and/or ischaemic in origin (see Chapter 41, Chapter 43 ). Leg ulcers in the tropics often have a bacterial origin. Ulceration is…

Introduction to Breast Disease Virtually every woman with a breast lump, breast pain or discharge from the nipple fears she has cancer. The anxiety results from the unknown course of the disease, the threat of mutilation and the fear of dying. This has often prevented women from seeking medical advice, but publicity about self-examination and screening (see Ch. 6 ) and the potential benefits of early…

Introduction and Cardiopulmonary Bypass Surgery of the heart has long fascinated surgeons, but only a very limited range of cardiac procedures was possible until cardiopulmonary bypass was first successfully used in 1953. For the first time, the systemic circulation could be sustained artificially with the heart and lungs bypassed. The emptied heart could be manipulated and lung ventilation discontinued, giving optimal conditions for operating on the…

Venous Thrombosis and the Post-thrombotic Limb Anatomy of the Lower Limb Venous System Blood is drained from the lower limb via two separate systems. The deep venous system drains the deep tissues of the foot and muscles of the lower leg and thigh. These deep veins lie within the mass of lower limb muscles and include the large soleal venous sinuses . Muscle contraction during walking…

Aneurysms ( Table 42.1 ) Pathology of Aneurysms An aneurysm is defined as a localised area of pathological arterial dilatation. For the abdominal aorta, an anteroposterior diameter of ≥3 cm is generally accepted as defining an aneurysm. In some patients with aneurysmal disease, all major arteries are wider (arteriomegaly) and one or more becomes truly aneurysmal. Aneurysms of the abdominal aorta and the iliac, femoral and…

Introduction The specialty of vascular surgery has evolved over the last 60 or so years, with a move towards more noninvasive imaging and greater use of endovascular revascularisation. Peripheral atherosclerosis is well recognised as a marker for coronary and cerebrovascular atherosclerosis (approximately 30% 5-year mortality in intermittent claudication and 50% in patients with critical limb ischaemia), and best medical therapy (antiplatelet agent, statins, optimal blood pressure…

Introduction The term ‘peripheral arterial disease’ (PAD) is often used to mean obstructive (‘obliterative’) disease of major lower limb arteries, causing ischaemia. However, a range of vascular disorders can cause symptoms in upper and lower limbs, including any disease of arteries, veins or lymphatics outside the heart. This chapter concentrates on lower limb vascular-related problems as they are much more common. Upper limb symptoms are outlined…