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SCHWARTZ’S PRINCIPLES OF SURGERY ABSITE a n d Bo a rd Re vie w NOTICE Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. T e authors and the publisher o this work have checked with sources believed to be reliable in their e orts to provide in ormation that is complete and generally in accord with the standards accepted at the time o publication. However, in view o the possibility o human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication o this work warrants that the in ormation contained herein is in every respect accurate or complete, and they disclaim all responsibility or any errors or omissions or or the results obtained rom use o the in ormation contained in this work. Readers are encouraged to con rm the in ormation contained herein with other sources. For example and in particular, readers are advised to check the product in ormation sheet included in the package o each drug they plan to administer to be certain that the in ormation contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications or administration. T is recommendation is o particular importance in connection with new or in requently used drugs. SCHWARTZ’S PRINCIPLES OF SURGERY ABSITE a n d Bo a rd Re vie w 10th Edition Edited by F. Charles Brunicardi, MD, FACS Moss Foundation Chair in Gastrointestinal and Personalized Surgery Pro essor and Vice Chair Surgical Services Chie o General Surgery, UCLA Santa Monica Medical Center Department o Surgery David Gef en School o Medicine at UCLA Los Angeles, Cali ornia Associate Editors Dana K. Andersen, MD, FACS John G. Hunter, MD, FACS Program Director Mackenzie Pro essor and Chair Division o Digestive Diseases and Nutrition Department o Surgery National Institute o Diabetes and Digestive and Oregon Health & Science University Kidney Diseases Portland, Oregon National Institutes o Health Jef rey B. Matthews, MD, FACS Bethesda, Maryland Surgeon-in-Chie and Chairman Timothy R. Billiar, MD, FACS Department o Surgery George Vance Foster Pro essor and Chairman Dallas B. Phemister Pro essor o Surgery Department o Surgery Chicago, Illinois University o Pittsburgh School o Medicine Raphael E. Pollock, MD, PhD, FACS Pittsburgh, Pennsylvania Pro essor and Director David L. Dunn, MD, PhD, FACS Division o Surgical Oncology Chie o Surgical Services Executive Vice President or Health Af airs The James Comprehensive Cancer Center Pro essor o Surgery, Microbiology and Immunology The Ohio State University Wexner Medical Center University o Louisville Columbus, Ohio Louisville, Kentucky James X. Wu, MD General Surgery Resident Department o Surgery UCLA David Gef en School o Medicine Los Angeles, Cali ornia New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney oronto Schwartz’s Principles of Surgery: ABSITE and Board Review, 10th Edition Copyright © 2016 by McGraw-Hill Education. All rights reserved. Printed in the United States o America. Except as permitted under the United States Copyright Act o 1976, no part o this publication may be reproduced or distributed in any orm or by any means, or stored in a data base or retrieval system, without the prior written permission o the publisher. Previous editions copyright 2011, 2007 by T e McGraw-Hill Companies, Inc. 1 2 3 4 5 6 7 8 9 0 ROV/ROV 20 19 18 17 16 ISBN 978-0-07-183891-7 MHID 0-07-183891-0 T is book was set in Minion Pro by Cenveo® Publisher Services. T e editors were Brian Belval and Christie Naglieri T e production supervisor was Catherine Saggese Project management was provided by anya Punj, Cenveo Publisher Services. RR Donnelley was the printer and binder. T is book is printed on acid- ree paper. Library of Congress Cataloging-in-Publication Data Schwartz’s principles o surgery. ABSI E and board review / edited by F. Charles Brunicardi ; associate editors, Dana K. Andersen, imothy R. Billiar, David L. Dunn, John G. Hunter, Raphael E. Pollock, Je rey B. Matthews.— enth edition. p. ; cm. Principles o surgery. ABSI E and board review Should be used in conjunction with the tenth edition o Schwartz’s principles o surgery. Includes index. ISBN 978-0-07-183891-7 (pbk., alk. paper)—ISBN 0-07-183891-0 I. Brunicardi, F. Charles, editor. II. Schwartz’s principles o surgery. enth edition. Complemented by (expression): III. itle: Principles o surgery. ABSI E and board review. [DNLM: 1. Surgical Procedures, Operative—Examination Questions. WO 18.2] RD31 617.0076—dc23 2015020914 International Edition. ISBN 978-1-259-25124-5; MHID 1-259-25124-1. Copyright 2016 by McGraw-Hill Education. Exclusive rights by McGraw-Hill Education or manu acture and export. T is book cannot be re-exported rom the country to which it is consigned by McGraw-Hill Education. T e International Edition is not available in North America. McGraw-Hill Education books are available at special quantity discounts to use as premiums and sales promotions or or use in corporate training programs. o contact a representative, please visit the Contact Us pages at www.mhpro essional.com CONTENTS Contributors PART II vii Introduction ix Specif c Considerations 105 Acknowledgments xi 16 The Skin and Subcutaneous Tissue 107 17 Breast 115 PART I 18 Disorders o the Head and Neck 121 Basic Considerations 1 19 Chest Wall, Pleura, and Mediastinum 125 1 Leadership 3 20 Congenital Heart Disease 135 2 Systemic Response to Injury and 21 Acquired Heart Disease 143 Metabolic Support 5 22 Thoracic Aneurysms and Aortic Dissection 151 3 Fluid and Electrolyte Management o the Surgical Patient 9 23 Arterial Disease 159 4 Hemostasis, Surgical Bleeding, and 24 Venous and Lymphatic Disease 179 Trans usion 17 25 Esophagus and Diaphragmatic Hernia 189 5 Shock 25 26 Stomach 203 6 Surgical In ections 33 27 The Surgical Management o Obesity 215 7 Trauma 41 28 Small Intestine 219 8 Burns 55 29 Colon, Rectum, and Anus 225 9 Wound Healing 61 30 The Appendix 237 10 Oncology 69 31 Liver 241 11 Transplantation 73 32 The Gallbladder and Extrahepatic 12 Patient Sa ety 81 Biliary System 253 13 Physiologic Monitoring o the 33 Pancreas 261 Surgical Patient 87 34 Spleen 275 14 Minimally Invasive Surgery 93 35 Abdominal Wall, Omentum, Mesentery, 15 Molecular and Genomic Surgery 97 and Retroperitoneum 283 v vi 36 So t Tissue Sarcomas 287 44 Surgery o the Hand and Wrist 335 37 Inguinal Hernias 289 45 Plastic and Reconstructive Surgery 341 38 Thyroid, Parathyroid, and Adrenal 299 46 Anesthesia or the Surgical Patient 343 39 Pediatric Surgery 305 47 Surgical Considerations in the Elderly 347 40 Urology 315 48 Ethics, Palliative Care, and Care at the End o Li e 351 41 Gynecology 319 49 Global Surgery 353 42 Neurosurgery 323 43 Orthopedic Surgery 331 Index 357 CONTRIBUTORS Dana K. Andersen, MD, FACS John G. Hunter, MD, FACS Program Director Mackenzie Pro essor and Chair Division o Digestive Diseases and Nutrition Department o Surgery National Institute o Diabetes and Digestive and Oregon Health & Science University Kidney Diseases Portland, Oregon National Institutes o Health Bethesda, Maryland Scott Louis, MD Surgery Resident Timothy R. Billiar, MD, FACS Oregon Health & Science University George Vance Foster Pro essor and Chairman Portland, Oregon Department o Surgery University o Pittsburgh School o Medicine Jef rey B. Matthews, MD, FACS Pittsburgh, Pennsylvania Surgeon-in-Chie and Chairman Department o Surgery F. Charles Brunicardi, MD, FACS Dallas B. Phemister Pro essor o Surgery Moss Foundation Chair in Gastrointestinal Chicago, Illinois and Personalized Surgery Pro essor and Vice Chair Surgical Services Fernando Mier, MD Chie o General Surgery, UCLA Santa Monica Advanced GI and Bariatric Surgery Fellow Medical Center Department o General and Gastrointestinal Surgery Department o Surgery Oregon Health and Science University David Ge en School o Medicine at UCLA Portland, Oregon Los Angeles, Cali ornia Alexis Moren, MD Mary Condron, MD General Surgery Resident Resident Oregon Health & Science University Department o Surgery Portland, Oregon Oregon Health & Science University Portland, Oregon Raphael E. Pollock, MD, PhD, FACS Pro essor and Director Christopher Connelly, MD Division o Surgical Oncology Chie o Surgical Services Resident T e James Comprehensive Cancer Center Department o Surgery T e Ohio State University Wexner Medical Center Oregon Health & Science University Columbus, Ohio Portland, Oregon Tana Lynn Repella, MD, PhD Mackenzie Cook, MD General Surgery Resident General Surgery Resident Department o Surgery Department o Surgery Oregon Health & Science University Oregon Health & Science University Portland, Oregon Portland, Oregon Julia C. Swanson, MD David L. Dunn, MD, PhD, FACS Congenital Cardiac Surgery Fellow Executive Vice President or Health A airs Department o Surgery Pro essor o Surgery, Microbiology and Immunology exas Children’s Hospital University o Louisville Houston, exas Louisville, Kentucky vii viii Erica Swenson, DO James X. Wu, MD General Surgery Resident General Surgery Resident Department o Surgery Department o Surgery Oregon Health & Science University UCLA David Ge en School o Medicine Portland, Oregon Los Angeles, Cali ornia Patrick R. Varley, MD Estin Yang, MD, MPH Resident Resident Physician Department o General Surgery Department o Surgery University o Pittsburgh Medical Center Oregon Health & Science University Pittsburgh, Pennsylvania Portland, Oregon INTRODUCTION T is 10th edition o Schwartz’s Principles of Surgery: ABSITE and a high level o review on the most up-to-date in ormation and Board Review marks a milestone o excellence in surgical education techniques currently taught and employed in the operating theater. or the betterment o cra , quality o care, and the edi cation o We have maintained the proven ormat o providing the answer- surgical students and colleagues alike. With 842 questions spanning bearing portion o the text immediately ollowing the question and the 49 updated chapters o this edition, including two new chapters, answer as an ef cient method or rein orcement and recall. T e user Fundamental Principles o Leadership raining in Surgery and may read the question ollowed by the answer as a orm o review, or Global Surgery, this is the comprehensive companion text or by covering the right-hand column o the page, the user can reviewing and assessing the in ormation compiled in the main book complete the questions in a more authentic test ormat and uncover and or preparation or the American Board o Surgery In- raining the answers or review/scoring. Examination (ABSI E). Contributors o the primary book have updated the questions or each chapter since the last edition in an e ort to continue to provide ix

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The only review based on the field's cornerstone text:Schwartz's Principles of Surgery,Tenth Edition"It will be particularly helpful to those in general surgery training programs, to general surgeons facing their board exams or recertification exams, and to all those subspecialty trained surgeons wh