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Rajeev j sinha Head department of surgery MLBMC jhansi india


This book is intended for `

the undergraduates ,

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post graduates grad ates of all disciplines and

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the practicing surgeon.


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Without the sound basis ,of physiological principles of surgery optimal day to day management of clinical diseases with their associated alterations in body physiology physiology, is not possible Understanding these principles makes for a often tedious and uninteresting g exercise . This book is an attempt to present just the core principles ,in a manner where they can be easily understood.


Key Features: `

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Only important basic principles have been included. l d d Presentation P t ti format f t includes i l d a point i t wise i presentation which is ,easy to remember.


1. Homeostasis.......................................................................................................1.1—1.15 2. Shock.................................................................................................................2.1—2.26

3. Systemic Inflammatory Response Syndrome........................................................3.1—3.16

4. Fluid and Electrolyte Management.......................................................................4.1—4.32

5. Haemostasis and Related Disorders.....................................................................5.1—5.29

6. Blood Transfusion...............................................................................................6.1—6.14

7. Thermal Burns.....................................................................................................7.1—7.26 8. Surgical Nutrition................................................................................................8.1—8.30

9. Carcinogenesis....................................................................................................9.1—9.33

10. Surgical Infections.............................................................................................10.1—10.41

11. Sterilization.......................................................................................................11.1—11.11

12. Investigations g in Surgery....................................................................................12.1—12.16 g y

13. Transplantation Immunology..............................................................................13.1—13.21 14. Wound Healing...................................................................................................14.1—14.36

15. Energy Sources in Surgery...................................................................................15.1—15.19

16. Needles,, Sutures,, Knots and Suturing..................................................................16.1—16.23 g


Overview O i ` • Types ` • Assessment

Routine methods (Conventional) Special and adjunctive investigations

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• Pathophysiology • Mediators of shock

Hormones Chemical mediators

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• Treatment • Specific types

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• Organ dysfunction syndrome

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Hypovolimic Traumatic Neurogenic Anaphylactic/Anaphylactoid H d l Hypoadrenal Septic


▀█ DEFINITION ` Clinical syndrome off tissue hypoperfusion f ▀█ TYPES ` Cardiogenic - Cardiocompressive or cardio myopathic ` Neurogenic - Neurosurgical, Spinal injuries. ` Hypovolimic - Haemorrhagic - Non-Hemorrhagic Non Hemorrhagic  Dessication-Dehydration syndrome: loss of water without salt from skin, lung, as in ARF, diarrheoa with tube feeding, di betic ketoacidosis, simple dehydration.  Desalting water loss: Loss of water and electrolytes in physiological proportions p opo t o s like e in vomiting, o t g, d diarrhoea. a oea ` Vasogenic  Infectious-SIRS (Systemic inflammatory response syndrome), Sepsis,Septic shock  Non-infectious ¾ Traumatic ¾ Adrenal ¾ Anaphylactic and Anaphylactoid ▀█ ASSESSMENT ` The Conventional Clinicoinvestigatory Profile These parameters, in common usage, can also be termed as global parameters because they investigate the general body physiological profile. Included are heart rate, blood pressure,central venous pressure measurement, haematocrit, blood gas analysis and urine output.But all these are, at best, relatively insensitive and inexact measures, subject to influence by a number of variables.Also they are indicative of the organ dysfunction resulting fromhypoperfusion and thus are late indicators as far as diagnosis of shock is concerned. concerned ` Heart rate (normal 60-90 beats/min)- In hypovolimia,tachycardia (>90/min) is usual,but patients may even have bradycardia, because of parasympathetic stimulation. Also there could be other causes like pain leading to tachycardia without hypovolimia. Thus an increment of more than 30 beats per minutes on postural change from supine to erect is more specific for hypovolimia induced tachycardia. It must be pointed out that athletes and heavy manual workers may have a normal heart rate of less than 60/min but above 50/min. significant than in a patient of 30 years of age.The reason is that the level of tachycardia has to be interpreted in the light of the maximal achievable HR for that individual.A individual A simple but unscientific formula is HR (max) = 220-age. 220 age


Mail to Prof Rajeev Sinha ,HOD HOD Department of Surgery ,MLB MLB Medical College,Jhansi ,India 284128 Or e mail at sinha_rga@yahoo.co.in Or `

PULSE PUBLICATIONS GHAZIABAD Mr Rahul 09560194703, 09312784703

Essential Principles of Surgery  

This book is an attempt to bring out and highlight the important and essential principles required for correct intervention involved in pati...