Bailey and Love’s SHORT PRACTICE of SURGERY 2023 pdf

     Download Bailey and Love’s SHORT PRACTICE of SURGERY 2023 pdf Easily In Format For Free

There is no more intense environment than an operating theatre, so how a surgical team interacts is crucial to the outcome for a patient undergoing a surgical procedure. In recent years regulation of medical practice has become tighter. Whereas in certain jurisdictions some may feel that this has become stifing, there is no doubt that regulation is here to stay. Needless to say, we should all be aware of our responsibilities to patients, both morally and ethically, and, although most need no reminding, the law is continually changing as test cases are brought before the courts. Hence, we draw the attention of the reader to the chapters on consent, ethics and the law, patient safety, human factors and quality improvement. We are very conscious that Bailey & Love is popular throughout the world with a substantial readership in India, Nepal, Pakistan, Bangladesh, and Sri Lanka. We have consequently ensured that the 28th edition has an authorship refective of the readership. Our new authors bring a refreshing enthusiasm and perspective while retaining much of the accumulated wisdom of authors from the 27th and earlier editions. We have worked to create a consistent layout and style of tables, graphics and diagrams. Where appropriate we have included algorithms to assist the reader in understanding patient care pathways. Additional material is included in the Digital Learning Resource, including more detailed descriptions of operative techniques, explanatory videos and hyperlinks to other information sources.

As surgeons we are inextricably linked with tissue injury and its efects, both from the damage which operating inevitably causes and from the treatment of accidental traumatic injury. The body responds to signifcant local tissue injury, whether surgical or accidental, with a series of systemic changes which afect the functions of vital organs. This surgical stress response is brought about by several pathways involving hormones, infammation-related cytokines and neural circuits. It leads to alterations in body metabolism, wound healing and immunity and in the function of specifc organs. These changes are known collectively as the metabolic response to injury. While these responses are designed to limit damage and begin repair processes, not all the efects are benefcial by any means. They can lead to complications, especially sepsis, which can then amplify and prolong the abnormal processes and lead to or prolong multiple organ dysfunction syndrome (MODS). Given that these metabolic efects of injury can have a signifcant impact on recovery and survival from many types of surgery and surgical illness, surgeons require an understanding of them in order to care optimally for their patients. Successful management of the metabolic response improves outcomes and forms the basis of modern perioperative care after major surgery as well as the treatment of severely injured and septic patients. This chapter will look primarily at the metabolic responses to injury while shock, fuid balance, sepsis and nutrition are covered in greater depth in

Homeostasis

Homeostasis is the concept of maintaining a constant internal environment that allows cellular processes to function optimally. Many aspects of surgery, trauma and injury afect homeostasis and can lead to organ dysfunction. Traditionally the metabolic response to injury is divided into an initial period of catabolism (which may include a period of shock) followed by an anabolic phase of repair and tissue healing. The catabolic phase begins at the time of injury and is characterised by hypovolaemia, decreased basal metabolic rate, reduced cardiac output, hypothermia and lactic acidosis. The main physiological role of this phase is to conserve both circulating volume and energy stores and thus maximise survival chances for future recovery. A series of neurohormonal responses accompany these efects and trigger a systemic infammatory response syndrome (SIRS), where body stores are mobilised for recovery and repair. The catabolic efects include muscle breakdown, weight loss and hyperglycaemia, which themselves increase the risk of complications, especially sepsis. As the catabolic phase subsides, an anabolic (rebuilding) phase develops, which may last for weeks if extensive recovery and repair are required following serious injury.

Modern surgical care  

The role of surgical critical care, including resuscitation and/ or organ support, must be to work alongside the metabolic efects of injury while the patient is restored to a situation from which homeostatic mechanisms can achieve a return to normality. The systemic efects of injury still impact heavily on survival and complications through loss of muscle mass, sepsis and MODS. In fact, modern treatment of major trauma can now be so successful that the great majority of hospital deaths in developed countries occur after some days as a result of complex physiological processes, rather than as a direct and rapid consequence of organ damage or blood loss, although it is the initial injury and blood loss that sets the scene for the later systemic efects. Parallel with the catabolic efects introduced above, infammatory-type processes cause immune suppression. While this infammation is often initially sterile, the nature of surgery and injury predisposes to infection and sepsis. Impaired immunity as part of the metabolic response 

compounds this risk and explains why sepsis and MODS/ failure is a key part of perioperative care and a leading mode of death among our patients. Even in modern trauma systems, MODS carries a mortality of around 25%. As a consequence of modern understanding of the metabolic response to injury, elective surgical practice now seeks to actively reduce the need for a homeostatic response by minimising the primary insult via minimal access surgery and by ‘stress-free’ perioperative care or enhanced recovery after surgery (ERAS). This chapter will review the mediators of the stress response, the physiological and biochemical pathway changes associated with surgical injury and the changes in body composition that occur following surgical injury. Emphasis is placed on why knowledge of these events is important to understand the rationale for modern ‘stress-free’ perioperative and critical care