infertility, 1242–1243

ischemic orchitis, 1243

postherniorrhaphy groin pain, 1241–1242

prosthetic complications, 1243

recurrence, 1241

seromas, 1243

testicular descent, 1243

urinary retention, 1241

vascular injury, 1243

wound infection, 1243

direct, 1873

embryology, 1873–1874

indirect, 1873

operative considerations, 1874

outcome, 1874

pathophysiology, 1873–1874

risk factors for development of, 1230t

steps for repair of, 1234t

Inguinal interstitial hernias, 1256

Inguinal ligament, 1214, 1216f

Inguinal region, anatomy of, 1218–1223

femoral sheath, canal, and ring, 1220–1221, 1221f

inguinal triangle, 1221, 1221f

lumbar plexus, branches of, 1222–1223, 1222f

spermatic cord, 1221–1222, 1222f

transversalis fascia, 1219, 1220f

transversalis fascia derivatives, 1219–1220, 1219f, 1220f

umbilical peritoneal folds, 1218–1219, 1219f

vasculature, 1223

Inguinal (Hesselbach) triangle, 1221, 1221f

Inhalation agents, 242, 242t

Inhalation injury, 221

Inhaled nitric oxide (iNO) and prostaglandins, 178

Inherited metabolic disorders, 558

Injured patients

advances and controversies

aggressive fluids vs. permissive hypotension, 355–356

ETCO2 monitoring, 356

prehospital blood protocols, 356

REBOA, 356–358

RSI vs. non-RSI, 355

tourniquet use, 356

prehospital assessments and interventions, 353t

prehospital care

personnel, 352

scoop and run vs. stay and play, 352–353

scene assessment and management priorities

airway, 353, 353t

breathing, 353–354

circulation, 354

triage, 354–355

Injury

biomechanics of, 340–342, 341t, 342t

with changing population demographics, 335

patterns of, 341t

Injury severity score (ISS), 410, 508

Innate immunity, 101–107

3340

Innominate artery compression syndrome, 1497

Inotropes and vasopressors

amrinone and milrinone, 163

dobutamine, 163

dopamine, 162–163

epinephrine, 163

isoproterenol, 163

norepinephrine, 163

pharmacodynamics of, 162t

phenylephrine, 163

vasopressin, 163

Insect bites and stings, 502

In situ grafting, 1698, 1699f

Instant blood-mediated inflammatory reaction (IBMIR), 624

Institute of Medicine (IOM), 323, 347

Insulin, 9, 840, 845, 848

half-life of, 849

resistance, 849

secretion and action, 849

synthesis, 848–849, 849f

type I diabetes, 849

type II diabetes, 849

Insulinoma, 850, 900t, 905–906, 905t, 906f, 1379

blind pancreaticoduodenectomy, 906

chemotherapy, 906

distribution, 905

72-hour monitored fast, 850

hypoglycemia-induced symptoms, 905

metastatic, 906

monitored fast, 905

surgical exploration, 906, 906f

Whipple triad, 905

Insulin resistance, 51–52

Insulin therapy, 252, 299t

Integra, 227

Integrated relaxation pressure (IRP), 656

Intensity-modulated radiation therapy (IMRT), 279, 2022

Intensive care unit (ICU), 161

infectious disease issues in

catheter associated urinary tract infections (CAUTI), 188

central line associated blood stream infections (CLABSI), 188

procalcitonin for antibiotic therapy, 187–188

sepsis guidelines, 187

nutrition

enteral nutrition, delivery of early, 182–183

immunitrition, delivery of, 183

supplemental parenteral nutrition, 183

scoring systems, comparison, 170t

venous thromboembolism (VTE) prophylaxis in, 178–179, 179t

Intensive care unit (ICU) Outcomes Model (ICOM), 170

Intensive insulin therapy (IIT), 186

Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), 1547–1548, 1549t,

1550t

Intercostal space, 1446, 1447f

Interferon-g (IFN-g), 107–108, 520

Interferons (type I), 106

Intergroup pediatric oncology group study, 1970

3341

Intergroup rhabdomyosarcoma study group (IRSG), 1963

Interleukin-1 (IL-1), 102–103

Interleukin-2 (IL-2), 107

Interleukin-4 (IL-4), 107

Interleukin-5 (IL-5), 107

Interleukin-6 (IL-6), 106, 799

Interleukin-10 (IL-10), 106–107

Interleukin-12 (IL-12), 104

Interleukin-13 (IL-13), 107

Interleukin-15 (IL-15), 106

Interleukin-18 (IL-18), 106

Intermittent claudication (IC), 1592

Intermittent hemodialysis (IHD), 186

Intermittent mandatory ventilation (IMV), 175, 1812

Intermittent pneumatic compression (IPC), 1790

Internal anal sphincter (IAS), 1172, 1173

Internal carotid artery (ICA) stenosis

bilateral high-grade, 1591–1592

current criteria for, 1591, 1591t

diagnosis of, 1587

Internal carotid artery (ICA) waveform, 1588–1589, 1589f

Internal jugular vein (IJV), 172

Internal supravesical hernia, 1255, 1256f

International Agency for Research on Cancer (IARC), 270

International Association for Study of the Liver (IASL), 950

International Association of Pancreatology (IAP), 1003

International classification of rhabdomyosarcoma (ICR), 1963

International Diabetes Federation, 745

International Mesothelioma Interest Group (IMIG) staging system, 1470, 1471t

International normalized ratio (INR), 553

International Pancreas Transplant Registry (IPTR), 618

International Registry of Acute Aortic Dissections (IRAD), 1572–1573

International Society for Heart and Lung Transplantation (ISHLT), 582, 591

International system of units, 1979

Interparietal hernia, 1255–1256

Interstitial edematous pancreatitis, 859, 860t

Interval appendectomy, 132, 1204–1205

Intestinal angina, 1654

Intestinal atresia

anatomy, 1876–1877

classification, 1877f

clinical presentation, 1877

diagnosis, 1877–1878

embryology, 1876–1877

outcome, 1878

results, 1878

treatment, 1878, 1878f

Intestinal blood flow, 785

Intestinal duplication, 1911, 1912f

Intestinal flora, 784–785

Intestinal fluid, 785

Intestinal gas, 784

Intestinal ischemia, 1649

Intestinal motility, 785

Intestinal obstruction, 1908

neonatal, 1875–1876, 1876t

Intestinal spillage, control of, 408

3342

Intestinal stenosis, 1876–1878

Intestines

mechanical obstruction of

pathophysiology of, 784–786

radiographs and imaging, 786–790, 787f

terminology and classification, 782–784, 783f

Intra-abdominal disease, 1761

Intra-abdominal infections

appendicitis, 130–132

biliary infections, 132–133

clostridium difficile infection (CDI), 135

diverticulitis, 133–134

pancreatitis, 135–137

Intra-abdominal sarcomas, 2021

Intra-abdominal sepsis, 571

Intra-aortic balloon pump (IABP), 1540, 1549, 1551f

Intracapsular fractures, 453

Intracavitary therapy, 279

Intracavity hemorrhage control, 349

Intracellular fluid (ICF), 19, 20f

Intracellular fluid compartments, 193t

Intracerebral hemorrhage, 365

Intracranial hemorrhage, 360

and pupillary signs, 363

Intracranial hypertension, 361

control of, 369

craniectomy for, 373

signs of, 367

Intracranial pressure (ICP), 360

monitoring, 368

Intraductal papillary-mucinous neoplasms (IPMNs), 883–884

branch-duct, 883

high-risk stigmata, 884

main-duct, 883

management of, 884, 884f

and mucinous cystic neoplasms, 883, 884t

surgical therapy for, 884

worrisome features, 884

Intrahepatic cholangiocarcinoma (ICC), 984. See Bile duct carcinomas

Intraocular pressure (IOP), 377

Intraoperative cholangiography (IOC), CBD stones, 1009

Intraoperative fluid therapy, 201

Intraoperative radiation therapy (IORT), 279, 2018

Intraperitoneal metastases, 759

Intraperitoneal onlay mesh (IPOM) repair, 1237, 1240

Intrathoracic kidney, 1934

Intravascular contrast extravasation (ICE), 423

Intravenous analgesics, 244, 245t

Intravenous glucose tolerance test, 850

Intravenous immunoglobulin (IVIG), 97

Intravenous sedatives, 242–243

Intussusception, 795–796

anatomy, 1905–1906

anatomy of, 795f

clinical presentation, 1906

complications, 1907

diagnosis, 1906–1907, 1906f

3343

ileocolic, 1905f

outcome, 1907

pediatric patients, 1905–1907

physiology, 1905–1906

predisposing factors to, 1906t

treatment, 1907

types of, 796f

Intussusceptum, 1906

Intussuscipiens, 1906

Invasive mucinous cystadenocarcinomas, 883

INvestigation of STEnt grafts in Aortic Dissection (INSTEAD) trial, 1573

Iodine, 23

daily requirements of, 24t

deficiency of, 23

Iodine-131 iodohippurate, 547

123Iodine Scintigraphy, 1345

Ionized calcium, 205

Ionizing radiation, 277–279, 1979–1980

fetal effects of, 1979

growth retardation, 1979–1980

lethal effects of, 1979

oncogenic potential of, 1980

physiologic changes of, 1980–1981

teratogenic effects of, 1979

ION-1 trial, 947

Ipilimumab, 1404, 2001

Irisin (protein), 50

Iron, 23

deficiency of, 23

storage of, 18

wound healing, role in, 63

Ischemia, 164

Ischemia-reperfusion injury, 157, 594

Ischemic colitis, 1077

Ischemic heart disease, 1519–1538

atherosclerosis, 1521–1522, 1521f

clinical manifestations, 1522–1523

coronary anatomy and physiology, 1519–1521, 1520f

diagnosis, 1524–1525

medical treatment, 1525–1527

myocardial infarctions, complications of, 1523t

cardiogenic shock, 1523

papillary muscle rupture, 1523–1524

postinfarction ventricular septal defect, 1523

ventricular free wall rupture, 1524

Ischemic injury to liver, 156

Ischemic stroke, 1622

Islets of Langerhans, 840, 845, 848. See also Insulin; Pancreas

Islet transplantation, 622

complications, 624

donor selection, 623

future of, 625

graft failure, 624–625

history of, 622

immunosuppression, 624

metabolic control, 624

patient selection, 622–623

3344

perioperative care, 623–624

transplant techniques, 623, 623f

Isolated iliac artery aneurysms, 1755–1756

Isolated limb perfusion (ILP), 2000

Isoproterenol, 163

Isotonic fluid, 158

Israeli Defense Force, 353

Italian Randomized Controlled Trial (SCORE), 1101

J

Jackson–Pratt drain, 691

JAk2 inhibitors (ruxolitinib), 1279

Janus protein tyrosine kinase (JAK3), 549

Japanese Gastric Cancer Association, 760

Japanese Pancreas Society, 853

Jaundice, 1968

acute liver failure and, 939, 940

gallbladder cancer and, 1034

pancreatic cancer and, 885, 896

surgical palliation of, 896

Jejunal artery aneurysm, 1661

Jejunoileal bypass, 741, 742f

Jejunostomy tube placement, 706, 706f

Jeune asphyxiating thoracic dystrophy, 1847

Jod-Basedow phenomenon, 1347

Joint Theater Trauma Registry (JTTR), 348, 432

Jugular venous oxygen saturation monitor (JVO2

), 361

Juvenile polyps, 1107, 1115

Juxtarenal abdominal aortic aneurysms, 1757–1758

Juxtarenal aortic occlusion, 1674f

K

Kaplan–Meier plot, 285, 2022f

Kaposi sarcoma, 1194

Kaposi sarcoma-associated herpes virus, 271

Karydakis flap, 1187

Kasabach–Merritt syndrome, 980, 1916

Kawasaki disease, and thoracic aneurysms, 1566

Kehr sign, 413

Kerckring folds, 770

Kerlix gauze, 223

Ketamine, 245, 355

Ketoacidosis, 209

Ketoconazole, in Cushing disease, 1414t

Keyhole technique, 1253

“Keyhole” urethra, 1940

Kidney, 423–426, 532

anomalies, 1934–1935

cystic conditions, 1934–1935, 1934t

rhabdoid tumor of, 1961–1962

solitary, 1935

Kidney Disease Improving Global Outcomes (KDIGO), 184

Kidney donor profile index (KDPI) score, 543

Kidney procurement, 535–536, 535f

Kidneys, cadaver, 541

Ki-67 index, 899–900, 1316

Killed in action (KIA), 433

Killer bees, 503–504

3345

Killian triangle, 644

King Airway, 353

Kinin

bradykinin production, 112

cellular kininogenase activity, 113

production in tissue, 112–113

Kinks, 1632

Kleihauer–Betke (KB) analysis, 483

Knight and North Classification system, 379

Kocher maneuver, 417, 418, 771, 1022

Konno aortoventriculoplasty, 1494

KRAS mutations, 881

Krebs cycle. See Citric acid cycle

Kugel procedure, 1237

Kupffer cells, 157, 944

Kussmaul sign, 1579

L

Labial adhesions, 1944, 1944f

Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, 139, 140t

Lactate

conversion of, 9

serum level, 10

Lactated Ringer solution, 159

Lactic acid, 209

Lactic acidosis, 209

Lactobacillus acidophilus, 790

Lactobacillus sp., 1886

Lactotroph adenomas. See Prolactinomas

Lactulose, in hepatic encephalopathy, 954

Lacunar ligament, 1214, 1216f

Ladd bands, 1893

Laennec cirrhosis, 946

Lamivudine, 936

Lanreotide depot, in acromegaly, 1413t

Laparoscopically assisted endorectal pull-through, 1902, 1903f

Laparoscopic antireflux surgery (LARS), 681

Laparoscopic cholecystectomy, and bile duct injury, 1017, 1020

Laparoscopic choledochotomy, 1011

Laparoscopic colectomy, for colorectal cancer, 1134

Laparoscopic common bile duct exploration (LCBDE), 1010–1011

Laparoscopic gastrectomy, 763

Laparoscopic surgery, for chronic pancreatitis, 876

Laparoscopic transcystic CBDE, 1011

Laparoscopic ventral hernia repair, 1251–1252

Laparoscopic vs. open appendectomy, 131

Laparotomy. See also Abdominal trauma

damage control, 407–408, 407f, 408f

trauma, 406–407

Large cell neuroendocrine carcinoma, 1434, 1434f

Laryngeal cancer, 640

advanced stage, 641

Laryngeal mask, 353

Laryngopharyngeal reflux (LPR), 658, 666–667

Laryngotracheoesophageal clefts, 1859

Larynx, 640–641

Larynx staging, 638t

L-asparaginase, 1926

3346

Lateral aberrant thyroid tissue, concept of, 1341

Lateral canthotomy, 378f

Lateral pancreaticojejunostomy (LPJ), 874

Latissimus dorsi muscle rotation flap, for chest wall reconstruction, 1451, 1453f

Laugier hernia, 1257

Laxatives, 1058, 1058t

Leadership and policy, 324

Leaky gut hypothesis, 947

Leapfrog Group, 314

LEA29Y, 520

Ledipasvir/sofosbuvir, 947

Left anterior descending (LAD) coronary artery, 1519

Left pulmonary artery (LPA), 1497

Left ventricular assist device (LVAD), 1540. See also Mechanical circulatory support (MCS)

Left ventricular end-diastolic pressure (LVEDP), 172

Left ventricular end-diastolic volume (LVEDV), 172

Left ventricular stroke area (LVSA), 162

Leiomyoma, 695–697

esophagogram of, 696f

Leiomyosarcomas, 1852t, 1854, 2017

Lembert sutures, 418

Lentigo maligna melanoma (LMM), 1992

Leptin, 44–45, 44f

Leriche syndrome, 1674

Lethality of war wounds (among US soldiers), 346t

Lethal triad, 488

Letrozole, 1325

Leuconostoc mesenteroides bacteria, 199

Leucovorin, 764

Leukocyte depletion, 521

Leukocytes

recruitment, 88t

subsets, 87t

and thrombosis, 74–75

Leukocyte scintigraphy, for vascular infection, 1613

Leukopenia, 522

Leuprolide, 1325

Levator ani muscle, 1172, 1174f

LeVeen peritoneovenous shunt, 968, 968f

Level of consciousness monitors, 258

Lexipafant, 865

Lichtenstein hernioplasty, 1236–1237, 1237f

Lidocaine, 355

Lifelong learning, 3. See also Self-regulated learning

ACGME on, 3

self-regulated learning and, relationship between, 4, 4t

in surgery education, 7

Lifestyle interventions and obesity, 739–740

Li–Fraumeni syndrome, 1310

Ligament of Berry, 1341

Ligament of Treitz, 741, 770

Ligandins, 18

Ligation of intersphincteric fistula tract (LIFT), 1184

Light-emitting diode (LED), 676

Limb abnormalities, 1883

Limb-threatening disease, 1773

Linea alba, 1246

3347

Lipase, 846, 848, 862

deficiency, 847

Lipid-lowering therapy, 1677–1678

Lipid mediators

cyclooxygenase pathway (prostaglandins), 110

eicosanoids, 110

lipoxygenase pathway (leukotrienes and lipoxins), 110–112

Lipids

as fuel for energy, 22–23

storage of, in adipose tissue, 42

transport of, 11

wound healing, effect on, 63

Lipolysis, 218

Lipolytic enzymes, 775, 846

Lipoma, 1107, 1108f

cardiac, 1516

spermatic cord, 1232

Lipopolysaccharide (LPS), 152

Lipopolysaccharide-binding protein (LBP), 864

Lipoproteins, 11, 80

Liposuction, 2059

Lipoteichoic acid (LTA), 116

Lipoxins, 111

Lipoxygenase pathway (leukotrienes and lipoxins), 110–112

Liraglutide (Victoza), 741

Lithium, 299t

Littre hernia, 1256

Liver, 532

abscesses

amebic, 930–931, 931f

pyogenic, 930, 931f

amebic abscess of, 1918

bile production by, 996

biopsy, 1921

biotransformation in, 18

dysfunction, and hyperlactatemia, 9

infections, 1918

macronodular, 945–946

micronodular, 945

pyogenic abscess, 1918

resection, in children, 1917, 1917f

teratomas of, 1916

transplantation, in children, 1923

tumors of childhood, 1914–1918, 1915t

Liver and biliary tract. See also Liver

anatomy, 410

diagnostics, 410

epidemiology, 410, 411f

extrahepatic biliary tract injury, 412–413

OIS-AAST grading scale, 410t

treatment, 410–412, 411f, 412f

Liver disease complications, 554t

Liver failure

clinical features, 940

definition, 939

diagnosis, 939–940

etiology, 940

3348