Congenital Urinary Tract Disorders Introduction Serious congenital disorders of the kidneys and urinary tract nearly all present at birth or in early childhood (see Ch. 51 ). The exception is polycystic kidney , which presents more commonly in adulthood. Less common abnormalities of the upper tract may interfere with normal flow dynamics and predispose to infection, for example, duplex systems or medullary sponge kidney. Asymptomatic abnormalities,…

Introduction Urinary tract infections (UTIs) are a common problem in surgery. They may be responsible for urinary tract symptoms presenting to a clinician for diagnosis or for abdominal pain that is not obviously urological. More often, UTIs are a secondary problem. They can occur after operation, particularly if a urinary catheter has been used, or may complicate surgical disorders of the urinary tract, such as tumours…

Introduction Stones may occur in all parts of the urinary tract, including the pelvicalyceal system of the kidney, the ureter, the bladder and sometimes even the urethra. Stones most commonly provoke symptoms caused by obstruction or by predisposing to urinary tract infections. Upper tract calculi are much more common than bladder calculi and the incidence is rising. Stones range from the uncommon staghorn calculus , which…

Introduction Two types of cancer arise from the renal parenchyma: renal cell carcinomas and nephroblastomas. Renal cell carcinomas (also known as renal adenocarcinomas and previously as hypernephromas ) are confined to adults. Nephroblastomas (Wilms tumours) are developmental in origin and present in infancy or early childhood (see Ch. 51 ). Occasional benign renal tumours occur, for example, oncocytoma, adenoma and angiomyolipoma ( Box 36.1 ). BOX…

Introduction Benign hyperplasia and carcinoma are the most common prostatic disorders and have an increasing importance in an ageing population. Inflammation and infection of the prostate ( prostatitis ) is a less common condition that occurs in a younger age group and is rather poorly defined clinically. Anatomy The normal prostate gland is about 3 cm long and 3 cm in diameter and weighs 20 to…

Introduction Urinary tract disorders are common and comprise a significant part of the workload of General Practitioners, general physicians, paediatricians and surgeons. Prostate disorders account for at least half of the work in urological surgery. The main conditions are benign prostatic enlargement (BPE) caused by prostatic hyperplasia, affecting about 10% of ageing males in Western countries, and prostatic carcinoma, which is now the second most common…

Disorders of the Scrotal Contents Introduction Abnormalities of the scrotal contents include disorders of the testis and its coverings, the spermatic cord and inguinoscrotal hernias (see Ch. 32 ). Distinguishing between them usually requires only clinical examination. Diagnoses that must not be missed are testicular tumours and testicular torsion. Other problems include inflammation, infection, hydrocoeles and cysts, maldescent and testicular trauma, as well as varicocoele. Male…

Introduction This chapter describes the clinical presentation and diagnosis of lumps and swellings in the groin along with specific conditions causing these problems. Other hernias of the anterior abdominal wall (ventral hernias) are considered at the end of the chapter. Groin lumps and swellings account for about 10% of general surgical outpatient referrals. In both sexes, the most common lumps in the groin are hernias ,…

Introduction Thoracic surgery traditionally covers the diagnosis and management of all noncardiac disease within the chest. However, the practice varies between countries. For example, in the United Kingdom, unlike North America, most oesophageal disease is now managed by gastroenterologists and upper gastrointestinal (GI) surgeons rather than thoracic surgeons. This chapter will review the management of benign and malignant conditions of the chest and mediastinal disorders that…

Introduction Anal and perianal disorders make up about 20% of general surgical outpatient referrals. These conditions can be distressing or embarrassing and patients often tolerate symptoms for a long time before seeking medical advice. The common anal symptoms are summarised in Box 30.1 and interpretation is discussed in Chapter 18 . BOX 30.1 Common Anal Symptoms Anal bleeding Anal itching and discomfort Pain on defaecation Perianal…

Introduction Irritable bowel syndrome (IBS), chronic constipation and diverticular disease all arise from disordered peristaltic function and are at least partly attributable to the highly refined Western diet. These disorders could be regarded as endemic in developed societies. IBS causes distressing abdominal discomfort in younger patients, whilst chronic constipation affects people of all age groups. Diverticular disease is probably caused by long-term dietary factors. These disorders…

Introduction Substantial inflammation in any part of the small or large bowel usually presents with diarrhoea (i.e., frequent passage of loose stools). When inflammation affects the large bowel, the diarrhoea often contains blood. Chronic diarrhoea is defined as lasting for longer than 6 weeks, different from the acute diarrhoea of gastroenteritis, which is usually of viral origin or related to food poisoning and is usually self-limiting,…

Introduction Carcinoma of the colon and rectum is the third most common malignancy in both men and women in Western countries. In the United Kingdom, the lifetime risk of colorectal cancer is 5%, although the condition is less common in the developing world. It is rare below the age of 50 years but the diagnosis must be considered in symptomatic patients as this remains an important…

Introduction Acute appendicitis is the most common cause of intraabdominal infection in developed countries and appendicectomy, the most common emergency operation. In the United Kingdom, 1.9 females per 1000 have the operation each year compared with 1.5 males, and about one in seven people eventually undergo the operation. Surprisingly, the incidence of appendicitis fell by about 30% between the 1960s and the 1980s, for reasons unknown.…

Introduction Pancreatitis is a common inflammatory disorder of the pancreas characterised by abdominal pain. Most cases present in an acute form known as acute pancreatitis and attacks range between mild to severe. Severe attacks can be life threatening, with a mortality of around 20%. A small proportion of patients suffer a persistent form known as chronic pancreatitis ; this is much more common in men and…

Introduction More than 90% of pancreatic cancers are adenocarcinomas derived from exocrine ductal cells. These have the worst survival of all gastrointestinal (GI) malignancies, with only about 12% surviving 1 year and 2% surviving 5 years. Much less commonly, neoplasia arises from exocrine acinar (secretory) cells (2%) or from endocrine islet cells (8%). Most endocrine tumours present with excess hormone secretion, for example, insulin, glucagon or…

Introduction Most gastric tumours are malignant: nearly all are adenocarcinomas; the rest are lymphomas or rarely, carcinoid tumours or sarcoma. True adenomatous gastric polyps are rare; most gastric polypoid lesions are small benign hyperplastic nodules. Tumours of small bowel are rare. Of the malignant tumours, lymphomas and gastrointestinal stromal tumours (GIST) are much more common than adenocarcinomas. Peutz–Jeghers syndrome is a rare inherited disorder characterised by…

Introduction Benign oesophageal diseases form a small but significant part of upper gastrointestinal (GI) surgeons’ workload. Most are managed by medical gastroenterologists except those likely to require surgery; in which case close collaboration is needed between medical and surgical specialists. Oesophageal cancer surgery is largely performed in specialised units. Difficulty in swallowing, dysphagia , is the most common presenting symptom. Reflux oesophagitis and other peptic disorders…

Introduction Peptic ulcer disease affects the oesophagus, stomach and duodenum. The conditions share the symptom of epigastric pain and the common aetiology of mucosal inflammation associated with gastric acid–pepsin secretions. The most important aetiological factor in gastric and duodenal ulcer disease is chronic mucosal infection with the bacterium Helicobacter pylori . Peptic disorders, together with gallstone disease, are the most common causes of organic upper abdominal…

Introduction Gallstones and related disorders account for all but a small proportion of biliary tract disease in most countries. Gallstone disease is also known as cholelithiasis and choledocholithiasis is when stones are present in the bile ducts. Most gallstone-related disease presents with pain, typically located in the epigastrium or right hypochondrium (right upper quadrant or RUQ). The character of the pain varies, but in most cases,…