BASIC SCIENCE FOR THE MRCS

INDEX 491

fibroadenoma, breast, 332, 415 forebrain, 154b
fibroblasts, 295 foregut, 22
fibroids, uterine, 427
fibroma development, 22, 23f
mesentery, 6, 6f
bone, 409 foreign body
ovarian, 426 embolism, 327
fibrosarcoma, 410 giant cells, 324
fibrosis, 323 granulomatous reactions, 323, 324
fibrous dysplasia, 409 infections, 376
fibula, 92, 93f reactions, 323
Fick method, cardiac output measurement, 220 surgically implanted, 392, 393t
fight or flight response, 269 formaldehyde, 387, 389
filtration, 388 fossa ovalis, 4, 15
filum terminale, 157, 157f Fournier’s gangrene, 382, 383
fingers fovea centralis, 124, 124f
joints, 71, 72 Fowler’s method, 202, 202f
muscle innervation, 176t fractures, 406–407
muscles, 72–73, 73f complications, 406–407
pulp spaces, 78, 78f fat embolism, 327
fistulae, intestinal, 438–439 healing, 300–301
flaps, 298–300 pathological, 339, 407–408
classification, 298, 300f, 301f, 302f, 303f vascular occlusion, 328
free, 299–300, 302f, 304f free fatty acids (FFAs), 233, 238
local, 298–299, 302f, 464 free radicals, 304
flexor (withdrawal) reflex, 286–287, 288f fresh frozen plasma (FFP), 370
flexor retinaculum, 68 Frey’s syndrome, 453
flexor tendon injuries, wrist, 83, 451–452 frontal cortex, 155, 156
flexors frontal lobe, 154–155, 155f
hand, 72, 73, 73f damage, 156
thumb, 73 frontal nerve, 168
flow–volume curves, 203, 205f frontal sinus, 131
flucloxacillin, 389, 393t fructose absorption, 234f
fluid balance, 183–185, 190–192 functional residual capacity (FRC), 201,
after surgery and trauma, 190–191
disturbances, 184–185 201b, 201f
gastrointestinal tract, 233–234, 233t fungi
see also water
fluid intake, 184, 233 cancer causation, 334
fluid loss, 184, 190 chest infections, 414
excessive insensible, 192 fusidic acid, 391
gastrointestinal tract, 192t
intraperitoneal, 191 G
surgical patients, 191, 191b
third space, 270 gag reflex, 275
fluid replacement therapy, 190–192 galactocoele, 83
colloid and crystalloid solutions, 192–193 galactose, 233, 234f
septicaemia, 191 gall bladder
surgical patients, 191
uncomplicated patient, 190–191 anatomy, 54, 54f, 55f
fms oncogene, 337t cholesterolosis, 437
folic acid, 243b clinical physiology, 240–241
follicle-stimulating hormone (FSH), 254 disorders, 54–55, 435
fomites, 373 empyema, 437
food intake, regulation, 243–244 function, 226, 240
food poisoning, 378, 379 mucocoele, 437
foot gallstones, 435–437
arches, 109–111, 111f complications, 436–437, 459
bones, 93–95, 94f ileus, 436
joints, 109 OSCE scenarios, 244, 458–459
foot drop, 104 types, 435–436, 459
foramen of Winslow, 31, 31f g motor neurons, 286, 287f
foramen ovale, 3 gamma reflex loop, 286, 287f
closure at birth, 3, 4, 5 gangrene, 294, 329–330
fetal circulation, 4, 5f bacterial, 382
Gardner’s syndrome, 440
gas diffusion, 207
gas embolism, 326–327

492 INDEX glomerular filtration, 246
glomerular filtration rate (GFR), 250
gas exchange, 207–210, 207t, 208f glomerulonephritis, membranous, 339
gas gangrene, 294, 383 glomerulus, 245, 246–248
gas transport, 207–210
gastrectomy blood supply, 245
microscopic structure, 246, 246f
Bilroth I and II partial, 231, 232f glossopharyngeal nerve (IX), 112, 134, 171, 172f
complications, 231 lesions, 171
gastric acid, 228–229, 228f parasympathetic fibres, 178
gastric arteries, 43, 43f glucagon, 267, 270b
gastric carcinoma, 434–435 glucagonoma, 269
post-gastrectomy, 231 glucocorticoids, 261, 262
referred pain, 45 deficiency, 263
spread, 44, 339, 435 excess, 263–264
gastric inhibitory polypeptide (GIP), 229, 230 glucose regulation, 268
gastric mucosa, 44–45, 45f, 228 response to trauma, 270b
gastric ulcers, 45, 434 glucose
gastrin, 227, 229, 230, 236 absorption, 233, 234f
gastrinoma, 269, 332 control of insulin secretion, 266
gastrocnemius reflex, 103, 176t hormonal regulation, 266, 267, 268
gastrocolic reflex, 241 metabolism, 237
gastroduodenal artery, 43, 43f, 45 renal absorption, 250
gastroepiploic arteries, 43, 43f solutions, 193, 193t
gastroileal reflex, 235 glucose 6-phosphate dehydrogenase (G6PD)
gastrointestinal (GI) tract
anastomoses, 302 deficiency, 315
anatomy, 41–65 glutamate, 280
burn injury response, 307 glutaraldehyde, 387, 388–389
development, 22–26, 23f gluteal region, 88–90, 88f
fluid absorption and secretion, 233–234, 233t gluteus maximus, 88, 88f
fluid and electrolyte losses, 191, 192t gluteus medius, 88f, 89, 105f
functions, 226 gluteus minimus, 89, 105f
healing of injuries, 302–303 glycine, 280
hormones and neurotransmitters, 226 glycogen, 266
mucosal erosions, 302 glycosuria, 250
mucosal ulcers, 302 goitre, 422, 422b, 445, 478
multi-organ dysfunction, 381 Golgi tendon organ reflex, 286
nervous regulation, 226 gonadotrophin-releasing hormone (GnRH), 254
pathology, 433–445 gonads see ovary; testis
physiology, 226–244 gonococcal urethritis, 431
gastrosplenic ligament, 57 gonorrhoea, 377, 378
gelatin solutions, 192 gout, 408–409
Gelofusin, 192, 193 graft rejection, 323, 351–352
gemelli (superior and inferior), 89
gender differences, cancer, 335, 335b accelerated acute, 352
genioglossus, 133f, 134 acute, 352, 472
geniohyoid, 133, 133f chronic, 352
genital herpes, 432 hyperacute, 352
genital warts, 432 immunological pathology, 351–352, 351f
genitofemoral nerve, 100f, 101, 103f prevention, 352–354
genitourinary (GU) tract graft-vs-host disease, 354
anatomy, 38–40, 58, 59–64 grafts
development, 23, 24–25, 24f closure of tissue defects, 297–298
pathology, 425–433 types, 349, 351
surgery/instrumentation, 393t Gram-negative bacilli, 378, 379–380
see also urinary tract Gram-negative cocci, 377–378
gentamicin, 390, 393t Gram-positive cocci, 376–377
germ cell tumours, ovarian, 426 Gram-positive rods, 377
GH see growth hormone granulation tissue, 295, 322
giant cell tumour, 410 granulocyte-colony stimulating factor (G-CSF), 370
giant cells, 324 granulocytes, 370
gigantism, 266, 404 granulomatous disease, 323–324
Gilbert’s syndrome, 240 Graves’ disease, 256
glabella, 119 Grawitz tumour, 430
glial cells, 272 great cardiac vein, 15f, 17
glioblastoma multiforme, 380–382 great saphenous vein, 99

INDEX 493

great vessels haemostasis, 359–361
anatomy, 15f disorders of, 362–363
development, 4 see also coagulation

greater auricular nerve, 116, 117f, 144f haemothorax, 412
greater occipital nerve, 117f Haldane effect, 209, 210
greater omentum, 30, 30f hamartomas, 332–333
greater petrosal nerve, 170 hamate, 68, 69f, 72f
greater sciatic foramen, 90 hand
greater vestibular glands see Bartholin’s glands
grey matter, 272 arteries, 74f, 75
gridiron incision, 28, 451 bones, 68, 69f
growth, 311–314 bursae and synovial sheaths, 78–79, 79f
joints, 71–72
acquired disorders, 316–317 muscles, 72–73, 73f
decreased, 314 palmar spaces, 79
factors affecting, 312–313 spaces, 78–79
increased, 313 tingling sensations, 318, 465–466
tumour, 333 veins, 74
growth factors, 311, 313 Hartmann’s pouch, 54
tumour dependency, 340–341 Hartmann’s solution, 193, 193t
growth hormone (GH), 265–266, 313 Hashimoto’s thyroiditis, 256, 423
actions, 265, 266, 268, 270b, 313 Hasselbach’s triangle, 29
control of secretion, 254, 265 head
deficiency/deficient action, 254, 313 anatomy, 115–125, 126–130, 132–133, 134–135
excess, 254, 266, 313, 377 dermatomes, 116–117, 117f
growth hormone-inhibiting hormone (GHIH), 254, 265 development, 112–115
growth hormone-releasing hormone (GHRH), 254, 265 lymph nodes, 146–147
gubernaculum testis, 25 sensory innervation, 116, 117f
gustatory sweating, 453 sympathetic innervation, 175, 282
gut see gastrointestinal tract head injury, 400–401
gynaecological causes, acute abdominal pain, 425 anosmia, 166
gynaecomastia, 417, 418b, 444, 476–477 cerebral blood flow, 273
OSCE scenarios, 178, 290, 454–455, 462
H pulmonary oedema, 207
headache, 402
Hþ/Kþ ATPase, 228, 230 healing, 295–303
H2-receptor antagonists, 230 factors affecting, 303
haem, 355 by first intention, 296
Haemaccel, 192 by second intention, 296
haematocrit, 357 see also wound(s)
haematological changes, after trauma/surgery, 271 heart
haemofiltration, 460 anatomy, 15–17, 15f
haemoglobin blood supply, 15f, 16–17
chambers, 15–16
carbon monoxide affinity, 307, 308t conducting system, 16, 216
concentration, 355 congenital anomalies, 5–6
fetal (HbF), 208, 209f development, 3–4, 3f
oxygen dissociation curve, 208, 209f excitation/contraction coupling, 216
oxygen transport, 208 fibrous skeleton, 16
sickle cell (HbS), 356 intracardiac pressures, 218, 218f
haemolysis nerve supply, 17
anaemia, 355–356 physiology, 215–216, 217, 218
jaundice, 239–240 referred pain, 17
transfusion reactions, 370–371 response to trauma/surgery, 271
haemolytic disease of newborn, 369 surface anatomy, 18
haemophilia A, 362, 371 heart rate, 216, 219
Haemophilus influenzae, 379 heart sounds, 218
type b (Hib) vaccine, 367, 379 heart valves, congenital anomalies, 6
haemopoiesis, 239, 355 heat
haemopoietic system, 355–372 loss, 181, 182
haemorrhage, 191 production, 181
anaemia, 355 heat sterilisation, 388
blood transfusion, 369, 370 heatstroke, 182
complicating fractures, 406 Helicobacter pylori, 334, 379–380
haemorrhagic shock, 252, 460–461 helium dilution method, 201
haemorrhoids, 48

494 INDEX posterior pituitary, 254
response to trauma/surgery, 269–271, 270b
helper T-cells (CD4þ), 346 tumour dependency, 340–341
functions, 348 Horner’s syndrome, 146
graft rejection, 351, 352 hospital-acquired infections (HAI), 373–376, 399, 474
subtypes, 348 methicillin-resistant Staphylococcus aureus, 375–376
methods of spread, 374
Henderson–Hasselbach equation, 187–188 prevention and control, 374, 474
heparin, 363, 468 sources, 373–374
hepatic artery, 33f, 43, 51f human immunodeficiency virus see HIV
hepatic ducts, 51f, 53–54, 54f human papillomaviruses (HPV), 333, 431, 432
human T-cell lymphotrophic virus-1 (HTLV-1), 334
accessory, 55f humerus, 66–67, 67f
hepatic failure, 381 fractures, 66, 78
hepatic veins, 52–53, 53f humoral immunity, 344–346
hepatitis B virus (HBV), 394–395 Hunter’s canal, 95–96
hydatid of Morgagni, 40
cancer risk, 334 hydralazine, 224
post-exposure prophylaxis, 398 hydrocele, 26, 26f
precautions against infection, 396–397 hydrocephalus, 115, 274, 276, 401, 402
sharps injuries, 397 hydrogen ions (Hþ)
vaccination, 397, 398 gastric secretion, 228, 228f, 229
hepatitis C virus (HCV), 395, 396–397, 398 renal secretion, 249–250, 249f
hepatobiliary disorders, 435–439 hydrothorax, 412
hepatoblastoma, 332 hydroxocobalamin, 459
hepatocellular carcinoma, 334 25-hydroxycholecalciferol, 252, 259
hepatocellular tumours, 334 hydroxyethyl starch, 192–193
hepatoma, 333 21-hydroxylase deficiency, 264
hepatomegaly, 339 1a-hydroxylase, 252
hereditary non-polyposis colorectal cancer (HNPCC), 440 5-hydroxytryptamine (5-HT; serotonin), 231, 279
Hering–Breuer reflex, 211 carcinoid syndrome, 441
hernias, surgical anatomy, 29 response to trauma, 270b
herpes, genital, 432 hyoglossus, 133, 133f, 134
hetastarch (Hespan), 192, 193 hyoid bone, 139f
heterotopia (ectopia), 316 muscles attached to, 136
high altitude, 207, 313 hyperaldosteronism, 263, 424
hindbrain, 154b hyperbilirubinaemia
hindgut, 22, 23f congenital, 240
development, 23 conjugated, 240
hip unconjugated, 239, 240
developmental dysplasia, 316 hypercalcaemia, 259, 260
pain, 103 of malignancy, 260, 339
hip (innominate) bone, 84, 85f hyperglycaemia, 271, 437
hip joint, 104–106, 105f hyperglycaemic hyperosmolar non-ketotic
dislocation, 106
muscle innervation, 176t coma (HONK), 268
surgical exposure, 106 hyperkalaemia, 187, 187b, 195, 455–456
Hirschsprung’s disease, 315 hypernatraemia, 184, 186, 186b
histamine, 229, 270b, 279, 320 hypernephroma, 430
histamine H2-receptor antagonists, 230 hyperparathyroidism, 259, 340
histiocytes, epithelioid, 324 hyperphosphataemia, 260
HIV, 395–396 hyperplasia, 313
cancer risk, 334 hyperprolactinaemia, 254, 377
post-exposure prophylaxis, 398 hypersensitivity reactions, 349–350
precautions against infection, 396–397 hypersplenism, 365–366
testing, 396, 397 hyperthyroidism, 422
HLA (human leucocyte antigens), 346
class I, 351 benign toxic goitre, 445, 478
class II, 351 causes, 256, 340
disease associations, 346, 346b, 350 clinical features, 257f, 422
organ transplantation, 351 drug treatment, 255
homeostasis, 181–183 thermoregulation, 183
hordoleum, 382 hypertrophic pulmonary osteoarthropathy, 340
hormones, 181, 253 hypertrophied scar, 296
anterior pituitary, 254 hypertrophy, 313
cancer causation, 334 hyperventilation, 188, 189b, 462
gastrointestinal tract, 226
growth effects, 313
kidney, 251–252

INDEX 495

hypocalcaemia, 259, 260, 437 immune response, 348
hypochlorite, 387 immune system
hypogastric plexus, 34, 177
burn injuries, 307
control of bladder function, 251, 251f essential features, 343
surgical damage, 34, 178 response to trauma/surgery, 271
hypoglossal nerve (XII), 134, 144f, 172, 172f structure, 346–348
damage, 134, 172 immunity, 343
floor of mouth, 133 immunocompromised patients, chest infections, 413–414
hypoglycaemia immunoglobulins, 344–346, 344f, 345t
diabetes mellitus, 268 immunology, 343–354
glucocorticoid release, 268 immunosuppression, 352–354, 472
growth hormone secretion, 265, 268 side-effects, 354
hypokalaemia, 187, 187b immunosuppressive drugs, 352–354
hypomagnesaemia, 259 incisions, surgical
hyponatraemia, 186, 186b, 195, 455 abdomen, 27–28
hypoparathyroidism, 259 healing, 296
hypopharynx, 140f, 142 lines of relaxed skin tension, 296–297, 297f
hypophosphataemia, 260 incus, 127
hypopituitarism, 254, 404 infarction, 328–329
hypoplasia, 314, 315, 316 infections, 373–376
hypospadias, 25, 431 endogenous, 373
hypotension exogenous, 373–374
atrial fibrillation, 457 immunodeficiencies, 349f
postoperative sepsis, 458 immunosuppressed patients, 354
pulmonary embolism, 457 methods of spread, 374
hypothalamo-pituitary-adrenal axis, 190 prevention and control, 374, 386–387
hypothalamus, 253–254 sources of surgical, 373–374
antidiuretic hormone, 248 special precautions, 397
eating/food intake control, 243 surgical site (SSI), 384–386
osmoregulation, 184 transfusion-related, 371
respiratory control, 210 universal precautions, 396–397
thermoregulation, 181–182 see also micro-organisms; sepsis
hypothenar eminence, 73 inferior alveolar nerve, 116, 169
hypothermia, 183 inferior gluteal nerve, 88, 88f, 101f, 102
hypothyroidism, 183, 256–257, 258f, 422 inferior mesenteric artery, 48, 48f
hypoventilation, 188b, 211 inferior mesenteric vein, 55
hypovolaemia, 270 inferior oblique, 125
hypoxaemia, 211–212 inferior rectal artery, 48
hypoxia, 211–212 inferior rectus, 125
acute, 212 inferior sagittal sinus, 164, 165f
chronic, 212 inferior thyroid artery, 138, 139
pulmonary embolism, 457 inferior vena cava (IVC), 34
hypoxic drive, 211, 212 inflammation, 319–324
hypoxic pulmonary vasoconstriction (HPV), 204 acute, 319, 321–323
hysteresis, 197 catarrhal, 321
chronic, 319, 322, 323
I fibrinous, 321
haemorrhagic, 321
ibuprofen, 462 membranous, 322
I:E ratio, reversal, 213 necrotising, 322
ileocolic artery, 47, 48f pseudomembranous, 322
ileogastric reflex, 235 resolution, 322
ileum serous, 321
suppurative, 321, 323
anatomy, 46 systemic effects, 322–323
resection of terminal, 235–236 inflammatory bowel disease, 441–445
iliacus, 32, 105f inflammatory mediators, 269
iliofemoral ligament, 105 influenza vaccination, 367
iliohypogastric nerve, 103f infra-orbital nerve, 116, 117f
ilioinguinal nerve, 100f, 101, 103f infrahyoids, 136, 144
iliolumbar ligaments, 88 infrapatellar fat pad, 106f, 108, 108f
ilium, 84, 85f inguinal canal, 28–29
imipenem, 391 inguinal hernias, 29
immune complexes, 349 inguinal lymph nodes, 95
immune deficiency, 348–349, 349f

496 INDEX iron, 243b
absorption, 235
inhalation injury, 307, 465 deficiency, 231, 472
injuries transport, 355

burns, 306–310 ischaemia, 328
healing, 295–303 ischaemic cardiomyopathy, 420
ionising radiation, 303–305 ischaemic colitis, 329
reconstructive ladder, 297, 297f ischaemic heart disease (IHD), 419–420
reconstructive methods, 297–300 ischio-rectal abscess, 385t
see also healing; specific injuries ischiofemoral ligament, 87f, 105
innate immunity, 343 ischiorectal fossa, 37
inner ear, 127–128, 128f, 129f ischium, 84, 85f
innominate bone, 84, 85f islets of Langerhans, 57, 266
inotropes, 224, 458 isograft, 351
inspiration, 15, 196 isoprenaline, 224
inspiratory neurons, 210
inspiratory reserve volume (IRV), 201, 201f J
insulin, 266–267
actions, 266, 267 J receptors, 211
infusion, 456 Jackson’s burn wound model, 306–307,
response to trauma, 270b
insulin-like growth factor-1 (IGF-1), 313 307f
insulin-like growth factor-2 (IGF-2), 313 jaundice, 239–240, 435
insulinoma, 269, 332, 340
intercostal drains see chest drains causes, 239–240, 339, 436b, 478
intercostal nerves, 13, 173 cholestatic, 240, 244, 459
irritation, 9, 13 congenital acholuric, 356
intercostal spaces, 8–9, 9f, 449 hepatocellular, 240, 445, 478–479
intercostobrachial nerve, 82f prehepatic, 239–240
interdigitating dendritic cells (IDC), 347 jejunum, 46
intermittent positive pressure ventilation (IPPV), 213 joint replacement surgery, 385, 393t
internal anal sphincter, 49, 50f, 241 jugulo-omohyoid nodes, 146
internal carotid artery, 137, 137f, 163 jugulodigastric nodes, 146
internal iliac artery, 33f, 34 juxtaglomerular apparatus, 248
internal jugular vein, 137–138, 137f
cannulation, 138 K
internal mammary (thoracic) artery, 81
internal oblique, 26 kaolin-cephalin clotting time (KCCT), 361
internal pudendal artery, 88f Kartagener’s syndrome, 315
internal pudendal nerve, 88f Kehr’s sign, 280
international normalised ratio (INR), 363 keloid, 296
interossei, 73 kidney
interphalangeal joints, 72
interventricular septum, development, 3 agenesis, 24, 316
intervertebral discs anatomy, 58, 58f, 59f
aging changes, 151 blood supply, 245–248
anatomy, 149, 150f, 151, 158f, 159f, 455 burn injury response, 307
prolapsed (slipped), 151–153, 152f, 178, 455 calculi, 427, 428
intervertebral joints, 149–151, 150f development, 24–25, 24f
intestinal failure, 381 developmental anomalies, 24
intestinal fistulae, 438–439 healing, 301
intestinal metaplasia, gastric, 336t hormone production, 251–252
intracellular fluid, 183 horseshoe, 24
intracerebral haemorrhage, 401–402 hypermobile (floating), 59
intracranial haemorrhage, 401–402 ion and nutrient reabsorption, 249–250
intracranial pressure (ICP) pelvic, 24
normal, 276, 402 physiology, 245–250
raised, 276–277, 290, 402, 462 polycystic, 24
intrafusal muscle fibres, 286 radiation damage, 305
intramuscular injections, buttock, 90, 104f sodium regulation, 185–186, 248–250
intravenous drug users (IVDUs), 394, 395 structure, 245
intrinsic factor, 229, 235 tumours, 40, 429–430
inulin clearance, 250 kinin system, 321
iodide, 255 Klebsiella, 378
iodine, 243b Klinefelter’s syndrome, 315, 417
iris, 123–124 Klumpke’s paralysis, 77
knee

INDEX 497

joint, 106–108, 106f, 107f, 108f leukotrienes, 320
muscle innervation, 176t levator ani, 35, 35f
pain, 443, 443f, 475, 475f levator scapulae, 70
Kocher’s incision, 28 Li–Fraumeni syndrome, 334t, 337t, 338
Krukenberg tumours, 339 lienorenal ligament, 31f, 58
Kupffer cells, 239 ligamentum arteriosum, 4
kwashiorkor, 313 ligamentum flavum, 149, 151f, 158, 158f
ligamentum patellae, 106f, 107, 108f
L ligamentum teres, 51, 51f, 105, 105f
ligamentum venosum, 51f
labia majora, 39 limbic system, 210
labia minora, 39 linea alba, 27, 27f
labyrinth, 127–128, 128f linea aspera, 90, 91f
lacrimal apparatus, 125 lines of Zahn, 326
lacrimal nerve, 168 lingual artery, 133f, 134
lactic acidosis, 269 lingual nerve, 112, 133, 133f, 134, 169
lambda, 119 lingula, 11
lambdoid suture, 119, 119f lipase, 236, 437
Lancefield groups, 377 lipids
Langer’s lines, 297
Langhans giant cells, 324 absorption, 233, 234f
Laplace’s law, 197, 220 after trauma/surgery, 271
large intestine, 46–47 atherosclerosis, 419
metabolism, 238–239, 267
blood supply, 47–48, 48f lipocortin, 262
cancer see colorectal cancer lipolytic enzymes, 236
clinical physiology, 241–242 Little’s area, 130
function, 226, 241–242 liver
lymphatic drainage, 48–49 abscess, 385t
motility, 241 anatomy, 50–53, 51f
polyps see colorectal polyps bare area, 51
radiation damage, 305 cirrhosis, 336b
Laron dwarfism, 313 clinical physiology, 239–240
laryngopharynx (hypopharynx), 140f, 142 disease, 362, 435–439
laryngoscopy, 141, 141f function, 226, 237–239
larynx, 139–141, 139f, 140f, 141f functional anatomy, 52, 52f, 53f
lateral collateral ligament of knee, 107, 108, 108f neoplasms, 333
lateral cutaneous nerve of arm, 82f regeneration, 301
lateral cutaneous nerve of calf of leg, 103f resection, 52, 53
lateral cutaneous nerve of forearm, 82f liver fluke, 334
lateral cutaneous nerve of thigh, 100f, 101, 103f lobular carcinoma in situ, breast, 416
lateral geniculate body, 166f, 167 local anaesthetics, 282, 463
lateral plantar nerve, 102, 103f locomotion, 286–289
lateral pterygoid, 132 locomotor system, 284–289
lateral rectus, 125 long plantar ligament, 110
left atrium, 15f, 16 long (great) saphenous vein, 99
enlargement, 43 long thoracic nerve of Bell, 70
left colic artery, 48, 48f loop of Henle, 247, 247f
left coronary artery, 17 lower leg compartments, 99–100
left-to-right shunts, 5–6 lower limb, 84–111
left ventricle, 15f, 16 arteries, 96–99, 97f
left ventricular failure, 206 bones, 84–86, 90–95
leg cutaneous nerves, 103f
bones, 90–95 dermatomes, 104f
compartments, 99–100 joints, 104–109
see also lower limb motor nerves/nerve roots, 176t
Legionnaire’s disease, 413 nerve injuries, 104
lens, 124–125 nerves, 100–104
lesser occipital nerve, 117f, 144f pulses, 111, 453
lesser omentum, 30, 52 sympathetic innervation, 176–177
lesser sciatic foramen, 90 tendon reflexes, 103
leucocytes, 357–358 veins, 99
leucocytosis, 358, 358b see also foot; leg
leucopenia, 358 lower motor neurons, 173–174
leukaemia, 333 lesions, 174b

498 INDEX disease associations, 346, 346b, 350
graft rejection, 351, 352
Lugol’s solution, 255, 461 organ transplantation, 351
lumbar plexus, 100–101, 100f, 173 restriction, 346
lumbar puncture, 115, 157–158 malabsorption, 235, 237, 260
lumbar sympathectomy, 34, 177 male
lumbar sympathetic chain, 34 breast, 81
lumbar vertebrae, 149, 150f perineum, 36–37, 36f
lumbosacral ligament, 87f ureter, 59
lumbosacral trunk, 100f male reproductive tract
lumbricals, 73 anatomy, 38, 39–40, 61
lunate, 68, 69f, 72f development, 25, 25f
lung male urethra
anatomy, 38–39
abscess, 385t, 414–415 development, 25, 25f
anatomy, 10–11 malleus, 127
blood flow, 204–207 malnutrition, 231, 237, 313, 349
blood supply, 11 malrotation, intestinal, 23
bronchopulmonary segments, 11, 12f mammary duct ectasia, 417
compliance, 198–199, 198f mandible, 115–116
function, assessment, 201–203 dislocation, 133
gas diffusion and exchange, 207–210 mandibular nerve, 116, 117f, 135, 168–169
infections, 412–414 mannitol, 184, 462
pressures, 197, 197f manubriosternal junction, 19–21
radiation damage, 305 manubrium, 8
roots, 11 marasmus, 313
surface anatomy, 13 march fractures, 94
surface tension, 197–198, 198f Marfan’s syndrome, 315
tumours, 411 marginal artery (of Drummond), 48, 48f
ventilation, 196–197 mass movements, 241
lung carcinoma (bronchial carcinoma), 411 masseter, 117, 132
aetiology, 333, 411 mastication, 227
clinical effects, 338b, 339, 411 muscles of, 117, 131–132
lung volumes, 201–203, 201b, 201f mastitis, acute pyogenic, 417
luteinizing hormone (LH), 254 maxillary nerve, 116, 117f, 131, 168
lymph, 364 maxillary sinus, 131
lymph nodes, 347f, 363–364 carcinoma, 131
enlarged see lymphadenopathy McBurney’s point, 28, 451
immune function, 346–347 MCC gene, 335f
lymphadenitis, 383 mean arterial pressure, 221
lymphadenopathy, 339, 365, 365b mean corpuscular haemoglobin (MCH), 357, 357t
lymphangitis, 383 mean corpuscular haemoglobin concentration (MCHC), 357
lymphangitis carcinomatosa, 206 mean corpuscular volume (MCV), 357, 357t
lymphatics, 364–365 mechanical ventilation, 213–214
acute inflammation, 321 Meckel’s diverticulum, 23, 316
carcinoma spread, 339 medial collateral ligament of knee, 107, 108
obstruction, 194–195, 364 medial cutaneous nerve of arm, 82f
lymphocytes, 344, 358, 358b medial cutaneous nerve of forearm, 82f
see also B-lymphocytes; T-lymphocytes medial cutaneous nerve of thigh, 103f
lymphoedema, 194–195, 364 medial plantar nerve, 102, 103f
lymphoid system, 363–364 medial pterygoid, 132
lymphoma, 333, 454 medial rectus, 125
gastric, 334 median cubital vein, 74
lymphoreticular system, 355–372 median nerve, 75f, 76, 77, 80
Lynch syndrome, 440 lesions, 78, 452
lysosomal products, 320, 321, 322 mediastinum, 18–21, 19f, 20f, 21f
medulla oblongata, 156
M respiratory control, 210
vomiting centre, 230
macrocytes, 357 medulloblastoma, 380
macrolide antibiotics, 390 Meibomian glands, 125
macrophages, 321 Meigs’ syndrome, 426
macula lutea, 124, 124f Meissner’s (submucosal) plexus, 226, 283
magnesium, 243b melanoma, 333, 339, 341
magnetic resonance cholangiopancreatogram

(MRCP), 54f
major histocompatibility complex (MHC), 346

INDEX 499

Meleney’s gangrene, 383 middle rectal artery, 48
memory, immunological, 343 midgut, 22
meningeal nerve, 171
meninges, 162–166 development, 22–23, 23f
meningiomas, 380 midline abdominal incision, 27–28
meningocele, 114 midpalmar space, 79
meningococcal vaccine, 367 migrating motility complex (MMC), 235
meningomyelocele, 114, 115 mineralocorticoids, 261
menisci (semilunar cartilages), 107, 107f,
deficiency, 263
108, 108f minerals, 243, 243b
mental nerve, 116, 117f
meralgia paraesthetica, 101 hepatic storage, 239
meropenem, 391 misoprostol, 231
mesenchymal tumours see connective tissue tumours missile injury, to brain, 400
mesentery mitosis, 311
mitral valve, 16
appendix, 47
development, 23, 23f development, 3
foregut, 6, 6f mixed neoplasms, 332
large bowel, 47 moderator band, 16
small bowel, 30, 30f, 46 monoclonal antibodies, 353
mesonephric duct, 24, 25 monocytes, 358, 358b
mesonephros, 24, 24f Monroe–Kellie doctrine, 276, 402, 462
metabolic acidosis, 188–189, 189b, 190t mons pubis, 39
metabolic alkalosis, 188, 189, 189b, 190t Montgomery’s tubercles, 83
metabolic bone disease, 410–411 Morganella, 378
metabolism morphine, 463
effect of burns, 307 morphogenesis, 314–317
effects of trauma/surgery, 271
liver, 237–239 congenital disorders, 315
metacarpals, 68, 69f, 72f motor cortex, 154, 155f, 156
metacarpophalangeal joints, 72 motor neurons
metanephric duct, 24
metanephros, 24, 24f a, 285, 286, 287f, 288f
metaplasia, 316, 317 g, 286, 287f
metaplasia–dysplasia sequence, 335, 336t mouth see oral cavity
metastases, 338, 339 mucocoele, gall bladder, 437
bone, 339, 342, 342f, 407, 410, 470, mucosa-associated lymphoid tissue (MALT), 347
mucus, gastric secretion, 229
470f, 471 multi-organ dysfunction syndrome (MODS), 381
central nervous system (CNS), 380 multi-organ failure, 381
ovary, 426 multiple endocrine neoplasia (MEN) syndromes, 334t, 441
metastasis, tumour, 338–339 muscarinic antagonists, 230
metatarsals, 94–95, 94f muscle
methicillin-resistant Staphylococcus aureus (MRSA), cardiac, 215–216
contraction, 284, 285f
375–376, 474 excitation contraction coupling, 284–285
metronidazole, 391, 393t skeletal, 284–286
MHC see major histocompatibility complex stretch reflex, 286, 287f
micelles, 233 muscle spindle, 286
micro-organisms musculocutaneous nerve, 75f, 76–77
musculoskeletal system
commensal, 373 burn injuries, 307
normal body flora, 373 pathology, 406–411
surgically important, 376–380, 376b myc (c-myc) gene, 335f, 337t
see also infections mycophenolate mofetil (MMF), 353
microbiology, 373–399 mycophenolate sodium (MMS), 353
microcytes, 357 Mycoplasma pneumoniae, 413
microglia, 272 mycotic aneurysms, 420
micturition, 250–251 myelinated nerve fibres, 279, 280f
midbrain, 154b, 156 myeloma, 410
middle cardiac vein, 15f, 17 myenteric plexus, 226, 283
middle cerebral artery, 163, 164f mylohyoid, 133, 133f
middle cervical ganglion, 175 myocardial infarction (MI), 280, 329
middle colic artery, 48, 48f acute, 419–420
middle cranial fossa, 120, 120f, 121t ischaemia of extremities, 328
middle ear, 126 myocutaneous flap, 300f
middle meningeal artery, 119, 454 myofibrils, 284
myofibroblasts, 295

500 INDEX neuropathic arthritis, 409
neuropraxia, 405
myoglobin, 208, 209f neurotensin, 231
myosin filaments, 215, 284 neurotmesis, 405
myositis ossificans, 407 neurotransmitters, 279–280
myxoedema, 422–423
gastrointestinal tract, 226
see also hypothyroidism synaptic transmission, 279
neutropenia, 358, 359b
N neutrophilia, 358, 358b
neutrophils, 320, 321, 358, 358b
nasal polyps, 317 nickel, 334
nasal septum, 129 nipples
nasociliary nerve, 168 adenomas, 415
nasopharynx, 140f, 142 inversion, 83
natural killer (NK) cells, 343 Paget’s disease, 416
nausea and vomiting, 402 supernumerary, 83
navicular, 94, 94f nitrates, 224
neck nitric oxide (NO), 270, 320
nitrogen (N2), 207t
anatomy, 135–141, 142–143, 144–147 nitroprusside, 224
anterior triangle, 136–138, 454 nitrosamines, 333, 434
block dissection, 147 nociceptive pain, 280
blood vessels, 137–138, 137f non-steroidal anti-inflammatory drugs (NSAIDs), 282, 462
dermatomes, 116–117, 117f norepinephrine (noradrenaline)
development, 112–115 adrenal medulla, 262, 265
fascial compartments, 135–136 excess secretion, 264–265
lumps, 153, 454 neurotransmitter function, 282
lymph nodes, 146–147 pharmacological use, 224, 458
posterior triangle, 143, 153, 454 physiological effects, 263b
root, 145–146, 145f response to trauma/surgery, 269
sensory innervation, 117f normocytes, 357
sympathetic innervation, 175, 282 normovolaemic haemodilution, 371
triangles, 136–138, 136f, 153 nose, 128–130, 129f, 130f
necrosis, 293–294, 294t nosocomial infections see hospital-acquired infections
necrotising fasciitis, 382, 399, 473 nutrition, 242–244
needlestick injuries, 397–399 growth and, 313
Neisseria gonorrhoeae, 377, 378 regulation, 243–244
Neisseria meningitidis, 377 requirements, 242–244
neonates, thermoregulation, 183
neoplasia, 318, 331–342 O
immunosuppressed patients, 354
see also tumour(s) oblique ligament (knee), 107
nephroblastoma, 332 obturator hernia, 103
nephron, 245 obturator internus, 34, 89
nerve fibres obturator nerve, 100–101, 100f, 103f
classification, 280t occipital lobe, 154, 155f, 156
propagation of action potentials, 279, 280f
nerve injuries, peripheral, 405–406 damage, 156
lower limb, 104 occipital nodes, 147
OSCE scenario, 443, 474–475 occipital sinus, 165
upper limb, 77–78 occipitofrontalis, 118
nerves, peripheral occupational health (OH), 397–398
conduction/transmission, 278–280, 280f oculomotor nerve (III), 167, 172f, 178
important muscle groups, 176t oedema, 194–195
regeneration, 302, 406 oesophageal atresia, 22, 22f, 316
nervous system oesophageal sphincter, 227
anatomy, 154–178 oesophageal varices, 42, 56
components, 272 oesophagus
functions, 181, 272
pathology, 400–406 anatomy, 41–42
physiology, 272–290 carcinoma, 433–434
tumours, 379–380, 386b foreign bodies, 42
nervus intermedius, 170, 172f function, 226, 227
neural tissue, healing, 302 oesotrogens, 334
neuroblastoma, 332 oestrogen receptors, 340
neuroglia, 272 OKT3, 352, 353
neuromuscular transmission, 285–286

INDEX 501

olfactory nerve (I), 130, 166 blood supply, 63f, 64
oligodendroglia, 272 cysts, 425
oligodendrogliomas, 380 disease, 425–427
oliguria, 252, 459–460 radiation damage, 305
Ollier’s disease, 409 teratoma, 256, 426
omental bursa (lesser sac), 30f, 31 tumours, 426
oncogenes, 337, 337t oxygen (O2)
oncogenesis, 333 diffusion, 207
operating theatre see theatre, operating dissociation curve, 208, 209f
ophthalmic nerve, 116, 117f, 168 exchange, 207–210, 207t, 208f
ophthalmoscopy, 124f partial pressure see PaO2; PO2
opioids, 282, 463 therapy, 212–214
opponens pollicis, 73 transport, 208
opportunistic infections, 354, 413 see also hypoxia
opportunistic pathogens, 376 oxytocin, 254
opsonisation, 344, 365
optic chiasma, 166f, 167 P
optic disc, 124, 124f
optic nerve (II), 166–167, 166f, 172f p53 gene, 294, 337t, 338
packed cell volume (PCV), 357
lesions, 167 PaCO2
optic tract, 166f, 167
oral cancer, 334 cerebral blood flow regulation, 273
oral cavity hypoxaemia, 211, 212
respiratory failure, 212
floor of mouth anatomy, 133, 133f Paget’s disease of bone, 336b, 410–411
function, 226, 227 Paget’s disease of nipple, 416
oramorph, 463 pain, 280–281
orbicularis oculi, 117, 118 drug modulation, 281–282, 290, 462–463
orbicularis oris, 118 gate control theory, 281, 281f
orbit, 121–123 transmission, 281
bony, 121–123, 122f palliative radiotherapy, 305
contents, 123–125 palmar aponeurosis, 79
muscles, 125 palmar digital arteries, 74f
organ of Corti, 128 palmar surface method, burn assessment, 308
organ transplantation see transplantation, organ pancreas, 226, 236–237
organisation, tissue, 295, 322, 467 anatomy, 56–57, 57f
organogenesis, anomalies of, 315–316 carcinoma, 438
oropharynx, 140f, 142 clinical physiology, 237
orthopaedic implant surgery, 385 endocrine disorders, 268–269
os innominatum, 84, 85f endocrine function, 266–271
osmoregulation, 184 endocrine tumours, 269
osmotic diuresis, 184 exocrine secretions, 236
osseous metaplasia, 316 pancreatectomy, 237
ossicles, 127 pancreatic duct
osteoarthritis, 407, 408 accessory (of Santorini), 45, 53, 57, 57f
osteoblasts, 289, 300 main (of Wirsung), 53, 54f, 57, 57f
osteochondroma, 409 pancreaticoduodenal arteries, 45, 57
osteoclastoma, 410 pancreatitis, 437–438
osteoclasts, 289 acute, 191, 437–438
osteocytes, 289 chronic, 438, 479
osteofasciocutaneous flap, 300f pancytopenia, 359b
osteogenic sarcoma see osteosarcoma panhypopituitarism, 254
osteoid osteoma, 409 pantothenic acid, 243b
osteoma, 409 PaO2
osteomalacia, 260, 410 cerebral blood flow regulation, 273
osteomyelitis, 406 low see hypoxaemia
osteoporosis, 289, 410 respiratory failure, 212
osteosarcoma, 409–410 papilla, duodenal, 45
OSCE scenario, 443, 443f, 475, 475f papilloedema, 402
otic ganglion, 169, 178, 283, 283f papilloma, 332
ovarian arteries, 63f, 64 para-aminohippuric acid (PAH), 250
ovarian cancer, 339, 426 paracetamol, 282, 462
familial, 337t paramedian incision, 28
ovarian ligament, 63f, 64 paranasal air sinuses, 130–131
ovary, 64

502 INDEX peptic ulceration, 230–231, 434
surgical treatment, 231, 232f
paraneoplastic disorders, 339
paraphimosis, 432 perforating cutaneous nerve, 101f
pararectus incision, 28 periampullary sphincter, 53
parasites, cancer causation, 334 pericarditis, constrictive, 295
parasympathetic nervous system, 178, 283–284, 283f pericardium, 17–18, 18f
perineal body, 37
bladder control, 60, 251, 251f perinephric abscess, 59, 385t
functions, 284 perineum, 36–38, 36f, 37f
gastrointestinal control, 226, 227, 229, 235, 241 peripheral arterial occlusion, 329–330, 330f, 468–469,
heart rate control, 216
parathormone (PTH), 249, 259 469f
ectopic production, 259 peripheral nervous system (PNS)
parathyroid glands
anatomy, 139 anatomy, 173–174, 272
development, 114 physiology, 278–282
parathyroid hormone (PTH)-related peptide, 259, 339 see also nerves, peripheral
parietal lobe, 154, 155, 155f peripheral resistance, 221
damage, 156 peristalsis, 235, 241
parotid duct, 134 peritoneal cavity, 30–31, 30f
parotid gland, 134, 227 peritoneum, 30–31, 31f
pleomorphic adenoma, 332, 333, 453–454 adhesions, 295, 302, 322, 467
parotid nodes, 147 greater sac, 30, 30f
parotidectomy, 153, 453–454 healing of injuries, 302
Pasteurella multocida, 379 lesser sac, 30f, 31
pasteurisation, 388 peritonitis, 191
patella, 92, 106f peroneal artery, 97f, 98
patellar ligament see ligamentum patellae Peutz–Jeghers syndrome, 317, 318,
patellar retinacula, 107, 108f
patent ductus arteriosus (PDA), 6 465
pathogens Peyer’s patches, 347
conditional, 373, 376 pH
conventional, 376
opportunistic, 376 blood, 189–190
PCO2, 189–190, 207 regulation see acid–base balance
acid–base balance, 188 phaeochromocytoma, 264–265, 271, 332, 423,
regulation, 210–214
see also PaCO2 461–462
peak expiratory flow rate (PEFR), 203 phagocytic cells, 343, 357
pectoral girdle, 66 phagocytosis, 239, 321
pectoralis major, 70 phalanges, 68, 69f, 94f
pectoralis minor, 70 pharyngeal nerve, 171
pelvic abscess, 385t pharyngeal pouches, 112, 112b
pelvic fascia, 35–36 pharynx
pelvic floor, 34–36
pelvic ganglion, 283, 283f anatomy, 140f, 142–143
pelvic girdle, 84–86 function, 226, 227
pelvic inflammatory disease (PID), 425 muscles, 143
pelvic splanchnic nerve, 101f, 251f phenoxymethyl penicillin, 389
pelvic wall, 34–36 phenylketonuria, 315
pelvis phimosis, 432
bones, 84–86 phosphate
cleft, 25 disorders, 259–260
joints and ligaments, 86–88, 87f regulation, 259
sympathetic innervation, 177–178 renal reabsorption, 249
penicillin V, 389 phosphodiesterase inhibitors, 224–225
penicillins, 389, 393t phospholipase A2, 236
hypersensitivity reactions, 389, 471 phosphorus, 243b
penis phrenic nerve, 14, 14f, 144–145
anatomy, 38 damage, 14
congenital lesions, 25, 431 mediastinum, 20f, 21f, 144
development, 25, 25f phrenicocolic ligament, 46
pathology, 431–433 phylloides tumour, breast, 416
tumours, 432 physiology, 179–195
pentastarch (Pentaspan), 192, 193 pia mater, 163
pepsinogen, 229 piperacillin, 389
pirenzepine, 230
piriform fossa, 141, 142
piriformis, 34, 88f, 89
pisiform, 68, 69f

INDEX 503

pituitary gland, 253–254 aneurysms, 98
anterior, 253, 254 injuries, 92, 98
control of function, 253–254 palpation, 98, 453
disorders, 254 popliteal fossa, 96, 96f
infarction, 329 porta hepatis, 50, 51f
posterior, 253–254 portal hypertension, 56, 438, 438b
portal venous system, 55–56, 56f
pituitary tumours, 254, 381 positive end expiratory pressure (PEEP), 213
plantar arch, 98 post-concussion syndrome, 400
plasma post-gastrectomy syndromes, 231
post-splenectomy sepsis, 366–367
fresh frozen (FFP), 370 posterior auricular nodes, 147
loss during surgery, 191 posterior cerebral artery, 163, 164f, 277, 290b
plasma cells, 344, 365 posterior (dorsal) columns, 160f, 161
plasma expanders, 192–193 posterior cord syndrome, 161f, 162, 405
plasma proteins, glomerular filtration, 246 posterior cranial fossa, 120–121, 120f, 121t
plasmids, transmissible, 393 posterior cutaneous nerve of arm, 82f
plasmin, 321, 360, 361 posterior cutaneous nerve of forearm, 82f
plasminogen-activator inhibitor I (PAI-I), 361 posterior cutaneous nerve of thigh, 88f,
platelet(s), 359
abnormal function, 362 101f, 103f
activation, haemostasis, 359–360 posterior longitudinal ligament, 149, 151f, 159f
concentrates, 370 posterior spinal artery, 161
count, 361 posterior tibial artery, 97f, 98, 453
disorders, 362 posthitis, 431
plug, 359–360 potassium (Kþ), 186–187, 243b
thrombus formation, 325, 326
transfusion, 370 intestinal absorption, 234
platelet-activating factor (PAF), 270 nerve action potential, 279
platelet-derived growth factor, 359 renal reabsorption, 249
pleura, 12–13 potassium chloride, 193
nerve supply, 13 povidone–iodine, 387
referred pain, 13 precentral gyrus, 288
surface anatomy, 12–13 preload, 220
pleural effusion, 205–206, 339, 412, 426 premalignant disease, 335–336, 336b
pleuroperitoneal membrane, 6f, 7 premature babies, thermoregulation, 183
plicae circulares, 231 pressure controlled ventilation (PCV), 213
Plummer’s disease, 256 pressure support ventilation (PSV), 213
Plummer–Vinson syndrome, 433 pretracheal fascia, 135
pneumococcal vaccine, polyvalent, 367 prevertebral fascia, 135
pneumococcus, 377 Pringle’s manoeuvre, 31, 54
Pneumocystis carinii, 414 processus vaginalis, 25, 26
pneumonia, 412–414 profunda femoris, 96–98, 97f
aspiration, 413 proinsulin, 266
atypical, 413–414 prolactin, 254
lobar, 413 prolactinoma, 254, 377
see also chest infections pronephros, 24, 24f
pneumotaxic centre, 210 propylthiouracil, 255, 461
pneumothorax, 200–201, 412 prostaglandin E, 229, 231
open, 200–201, 412 prostaglandins, 270, 282, 320
spontaneous, 21, 200, 412, 449 prostate
tension, 200, 412, 476 anatomy, 61
traumatic, 200, 412, 444, 444f, 475–476, benign hypertrophy, 61, 432–433
carcinoma, 340, 433
476f pathology, 432–433
PO2, 189–190, 207 prostatitis, 432–433
protein C, 363
arterial blood see PaO2 protein S, 363
regulation, 210–214 proteins, 242
polycyclic aromatic hydrocarbons, 333 after trauma/surgery, 271
polycythaemia, 357, 357b digestion and absorption, 233
polygeline (Haemaccel), 192 hepatic synthesis, 239
polyposis, 317 metabolism, 237–238, 267
polyposis coli, 317, 439 proteolytic enzymes, 236
familial see familial adenomatous polyposis Proteus, 378
polyps, 317 prothrombin time (PT), 361, 361b
pons, 156, 210
popliteal artery, 96f, 97f, 98

504 INDEX R

proto-oncogenes, 337 racial differences, cancer risk, 334
proton pump inhibitors, 230 radial artery, 74f, 75
Providencia, 378
proximal convoluted tubule, 247 assessment, 452
pseudohermaphroditism, 315 radial forearm flap, 299–300, 304f
pseudomembranous colitis, 322, 377, 392 radial nerve, 75f, 76, 82f
Pseudomonas aeruginosa, 379
psoas abscess, 32 lesions, 78
psoas major, 32 radiation, 303–306
psoas test, 33
pterion, 119, 454 cancer risk, 333
pterygopalatine ganglion, 168 effects on tissues, 304–305, 471
pubis, 84, 85f fractionation of dose, 305
pubofemoral ligament, 105 ionising, 303–305, 333
puborectalis, 35, 35f response modifiers, 306
pudendal nerve, 37, 49, 101f, 102 sterilisation, 388
therapeutic, 305–306
block, 38, 103 ultraviolet, 305
control of bladder function, 251, 251f whole body, 305
pulmonary artery radical radiotherapy, 305
anatomy, 11, 15f radicular arteries, 161
development, 4, 4f radiotherapy, 305–306, 471
pressure, 204 radius, 68, 68f
pulmonary artery occlusion pressure (PAOP), 223 rami communicantes, 174, 175, 282
pulmonary assessment, 201–203 rapamycin, 353
pulmonary blood flow, 204–207 ras oncogene, 337t
regional variations, 204 Rb1 (retinoblastoma gene), 311, 337t, 338
regulation, 204 receptors, 181, 253
pulmonary capillary wedge pressure, 223 reciprocal inhibition, 286, 287f
pulmonary embolism (PE), 326–327 reconstructive ladder, 297, 297f
pathophysiology, 205, 457 reconstructive surgery, 297–300
postoperative, 214, 457 rectal examination, 49–50
prevention, 363 rectouterine pouch (of Douglas), 30, 47, 62, 62f
treatment, 363, 457 rectum
pulmonary ligament, 12 anatomy, 47–49
pulmonary oedema, 206–207 bleeding per, 318, 324, 465, 466–467
pulmonary vascular resistance, 204 disorders, 439–441
pulmonary veins rectus abdominis, 26
anatomy, 11, 16, 18f rectus sheath, 27, 27f
development, 3f, 4 recurrent laryngeal nerves, 11, 20f, 141
pulp spaces, fingers, 78, 78f damage, 141
pulse oximetry, 223 developmental anatomy, 4, 4f
pulse pressure, 221 red blood cells, 355
pulses impaired formation/function, 356
peripheral arterial, 111, 452, 453 increased destruction, 356
venous, 218, 219f red cell concentrates, 370
pupillary light response, 275 referred pain, 280
Purkinje cells, 216 reflex, 286
pus, 321, 322 reflex sympathetic osteodystrophy, 407
need for drainage, 384, 391, 392, 467 regeneration, 295
pyelonephritis, 428 renal arteries, 33f, 58, 245
pyothorax, 412 aberrant, 24
pyramidal tracts, 159–160, 160f renal blood flow (RBF), 245–246
pyrexia see fever autoregulation, 245, 460
pyrexia of unknown origin (PUO), 340 renal cell carcinoma, 430
pyuria, sterile, 429 renal circulation, 245
renal dysgenesis, 316
Q renal failure, 381
renal pelvis, 59
quadratus femoris, 88f, 89, 108 calculi, 428
quadratus lumborum, 32 transitional cell carcinoma, 430
quadriceps reflex, 103, 176t, 286, 287f renal plasma flow, 250
quaternary ammonium salts, 387 renal replacement therapy, 252, 460
quinolone antibiotics, 390–391 renal transplantation, 354, 472
quinsy, 142 renal veins, 58

INDEX 505

renal well of Rutherford Morrison, 32 sacro-iliac ligaments, 87, 87f
renin, 248, 251–252 sacrococcygeal ligament, 87f
renin–angiotensin–aldosterone (RAS) system, 185, sacrospinous ligament, 87f, 88
sacrotuberous ligament, 87f, 88, 88f
248, 261 sacrum, 84–86, 86f
activation by surgery/trauma, 190 sagittal suture, 119, 119f
response to shock, 461 salbutamol, 456
renography, dynamic, 250 saline, normal (0.9%), 193, 193t
repair, 295 saliva, 227
residual volume (RV), 201, 201b, 201f salivary glands, 134–135, 227
respiration Salmonella, 378
accessory muscles, 15, 196 saltatory conduction, 279, 280f
anatomy, 14–15 saphenous nerve, 99, 103f
changes after trauma/surgery, 271 sarcoma, 332, 339
regulation, 210–214 sarcomere, 284
see also breathing; ventilation Saturday night palsy, 78
respiratory acidosis, 188, 188b, 190t scalds, 306
respiratory alkalosis, 188, 189b, 190t scalp, 118, 454
respiratory depression, 188 scaphoid, 68, 69f, 72f
respiratory failure, 212, 381, 456
respiratory system, 196–214 avascular necrosis, 407
burn injuries, 307 fractures, 80
clinical physiology, 200–201 scapula, 66, 67f
components, 196 movements, 70
function, 196 winging, 70
mechanics of ventilation, 196–203 scar
pathology, 411, 412–415 formation, 295
rete testis, 40 hypertrophied, 296
reticulocytes, 355 placement, 296–297
reticulospinal tract, 288 Scarpa’s fascia, 26
retina, 124 schistosomiasis, 316, 334
retinoblastoma, 332, 334t, 336, 337t, 338 sciatic nerve, 88f, 90, 102, 104f
see also Rb1 artery accompanying, 104
retroperitoneal varices, 56 injury, 104, 106
retropharyngeal nodes, 147 sciatica, 151
rhesus (Rh) blood group system, 369 sclera, 123
rhesus incompatibility, 369 sclerocorneal junction, 124f
rheumatoid arthritis, 408 screening, cancer, 341–342
rhomboids, 70 scrotal cancer, 333
ribs, 7 scrotum, 39
atypical, 7 secretin, 229, 230, 231, 236
cervical, 8 segmentation, 235
fractures, 7 selenium, 243b
notching, 7, 449 semicircular ducts (canals), 127, 128, 128f
respiratory movements, 14 semilunar cartilages (menisci), 107, 107f, 108, 108f
rickets, 260, 410 seminal vesicles, 61
vitamin D resistant, 260 sensation, 280–281
right atrium, 15, 15f sensory cortex, 155, 155f, 156
right colic artery, 47, 48f sepsis
right coronary artery, 15f, 16 pathophysiology, 380–382
right-to-left shunts, 6 post-splenectomy, 366–367
right ventricle, 15f, 16 postoperative, 225, 458
rima glottidis, 140 risk factors, 386, 386b
rotation flap, 299, 303f severe, 380
rotator cuff, 70 surgical, 382–384
Rotor’s syndrome, 240 see also infections
rubrospinal tract, 288 sepsis syndrome, 380–381, 382
rule of nines, 308, 308f septic arthritis, 406
septic shock, 380, 381, 473–474
S septicaemia, fluid replacement therapy, 191
septum primum, 3, 4, 5f
saccule, 128, 128f septum secundum, 3, 4, 5f
sacral nerves, 101, 178 septum transversum, 6, 6f
sacral plexus, 101–104, 101f, 173 serotonin see 5-hydroxytryptamine
sacro-iliac joints, 86f, 87–88 Serratia, 378

506 INDEX obstruction, 467–468
radiation damage, 305
serratus anterior, 70 ulceration, 235
sesamoids, foot, 94, 94f small saphenous vein, 99
sex chromosome abnormalities, 315 small vessel obstruction, 328
sex-cord stromal tumours, ovarian, 426 smoking, tobacco, 333, 411
sharps injuries, 397–399 sodium (Naþ), 185–186, 243b
shaving, preoperative, 374, 387 disturbances see hypernatraemia; hyponatraemia
Sheehan’s syndrome, 254 intestinal absorption, 234
Shigella, 378 nerve action potential, 279
shock regulation, 185–186, 248–250
renal reabsorption, 247, 247f, 248
anaphylactic, 349, 354, 471 sodium bicarbonate solutions, 193, 193t
body temperature, 183 somatic nervous system, 272
haemorrhagic, 252, 460–461 somatic pain, 280
hormonal response, 461 somatomedins, 313
septic, 380, 381, 473–474 somatostatin, 229, 231, 254, 265, 268
short plantar ligament, 110 somatostatinoma, 269
short saphenous vein, 99 sotrastaurin, 354
shoulder girdle, 70 space-occupying lesions (SOLs), intracranial,
shoulder joint, 68–70, 69f
muscle innervation, 176t 276–277, 277f
shoulder tip pain special precautions, 397
anatomy, 13, 14, 280, 281 spermatic cord, 29
OSCE scenario, 21, 450 sphenoidal sinus, 131
shunting, intrapulmonary, 208 sphenopalatine ganglion, 178, 283, 283f
Sibson’s fascia, 7, 145 spherocytosis, hereditary, 356
sick euthyroid syndrome, 257 sphincter of Oddi, 53
sickle cell disease, 315, 356, 406 Spigelian hernia, 27
sigmoid arteries, 48, 48f spina bifida, 114–115, 314
sigmoid colon, 47 spinal accessory nerve, 143, 172, 454
sigmoid mesocolon, 30, 31f spinal cord, 157–162, 157f, 158f, 159f
sigmoid sinus, 165
single gene defects, 315 blood supply, 161
sinoatrial (SA) node, 16, 17, 216 growth, 115, 157
failure, 216 internal anatomy, 158–159, 160f
sinus venosus, 3, 3f, 4 pain transmission, 281
sirolimus, 353 reflexes, 286–287
sis oncogene, 337t sympathetic outflow, 174, 177t
situs inversus, 5 tracts, 159–161, 160f
skeletal muscle, 284–286 spinal cord injuries, 161–162, 161f, 404–405
skin bladder function, 251
abnormal healing, 296 complete transection, 161, 405
abscess (boil), 382, 385t incomplete lesions, 161–162, 161f, 405
anatomy, 295, 296f thermoregulation, 183
cancer, 310, 310f, 463–464 spinal nerve roots, 160f, 173
healing, 295–300 important muscle groups, 176t
infections, 382 tendon and abdominal reflexes, 176t
preoperative preparation, 387 see also dermatomes
radiation damage, 305 spinal nerves, 157, 160f, 173
tension lines, relaxed, 296–297, 297f sympathetic fibres, 174, 175, 177f
skin grafts, 297, 464 spine
full-thickness, 298, 299f anatomy, 147–153, 158f, 159f
split-thickness, 298, 298f development, 114–115
skull, 115f, 116f, 118–121 growth, 115
base, 121, 122f spinocerebellar tracts, 160, 160f
foramina, 120, 121, 121t spinothalamic tracts, 160, 160f
sliding filament hypothesis, 284, 285f spirometry, 201
small cardiac vein, 15f, 17 spleen, 365–367
small intestine accessory, 58
absorption, 233–234, 235 anatomy, 57–58
anatomy, 46 disorders, 365–366
clinical physiology, 235–236 immune function, 347, 365
fistulae, 438–439 internal structure, 365, 366f
function, 226, 231–236 traumatic injury, 58
motility, 235 splenectomy, 356, 365, 366–367
mucosa, 231–235

INDEX 507

splenic artery, 33f, 43, 43f, 58 submandibular nodes, 146
splenic vein, 55, 58 submental nodes, 146
splenomegaly, 366, 367b submucosal plexus, 226, 283
spring ligament, 110 subphrenic abscess, 32, 385t
squamous cell carcinoma, cutaneous, 310, 463–464 subphrenic spaces, 31–32
squamous metaplasia, 316, 336t subsartorial canal, 95–96
stapedius, 127 substance P, 280
stapes, 127 succinylated gelatin (Gelofusin), 192, 193
staphylococci, 376 sucralfate, 230
sudden cardiac death, 420
coagulase-negative, 376 sulfamethoxazole þ trimethoprim, 390
control of outbreaks, 374, 375f sulphonamides, 390
Staphylococcus aureus, 376, 382 superficial inguinal ring, 29
methicillin resistant see methicillin-resistant superficial palmar arch, 75
superficial perineal pouch, 36–37
Staphylococcus aureus superficial peroneal nerve, 103, 103f
pneumonia, 412 superficial temporal artery, 118
Staphylococcus epidermidis, 376 superinfection, 392
Staphylococcus saprophyticus, 376 superior cervical ganglion, 175, 283f
Starling equilibrium, 194, 194f, 206 superior gluteal artery, 88f
Starling’s law of the heart, 219, 219f, 458 superior gluteal nerve, 88f, 89, 101f, 102
starvation, 313 superior laryngeal nerve, 141, 171
steal syndrome, 328
steam sterilisation, 388 damage, 141
stellate (cervicothoracic) ganglion, 145f, 146, 175, 283f superior mesenteric artery, 33f, 47, 48, 48f
stenosis, 295 superior mesenteric vein, 55
Stensen’s duct, 134 superior oblique, 125
stercobilin(ogen), 237, 238f, 239 superior rectal artery, 48, 48f
sterilisation, 388–389 superior rectus, 125
sternoclavicular joint, 66, 70 superior sagittal sinus, 164, 165f
sternum, 8 superior thyroid artery, 138, 139
stomach, 43–45 superior vena cava, 20f, 21f
blood supply, 43, 43f suppuration, 322, 467
cancer see gastric carcinoma supraclavicular nerve, 82f, 117f, 144f
clinical physiology, 230–231 suprahyoids, 136
function, 226, 228–231 supraorbital nerve, 116, 117f, 168
lymphatic drainage, 44, 44f suprapleural membrane, 7, 145
motility, 229–230 suprarenal glands see adrenal glands
nerve supply, 44 supraspinatus, 70
pathology, 434–435
secretion, 228–229, 228f tendinitis, 70
straight sinus, 164, 165f tendon rupture, 70
streptococci, 377 supratrochlear nerve, 117f, 168
Streptococcus milleri, 377 sural nerve, 96f, 99, 103f
Streptococcus pneumoniae, 377 surface tension, 197–198, 198f
Streptococcus pyogenes, 377, 382 surfactant, 197–198
stretch reflex, muscle, 286, 287f surgery
stricture, 295 antibiotics, 391–392
stroke volume, 219 blood-borne viruses and, 394
stye, 382 fluid and electrolyte problems, 191,
styloglossus, 134
subarachnoid cisterns, 163 191b
subarachnoid haemorrhage, 274, 401 hormonal response, 269–271, 270b
subarachnoid space, 157f, 158f, 159f, 163 physiological responses, 190–191
subclavian artery post-operative confusion, 277–278
anatomy, 137f, 145, 145f surgical incisions see incisions, surgical
development, 4, 4f surgical site infections (SSI), 384–386
subclavian vein, 145f, 146 prevention, 384–386
subcostal incision, 28 sources of contamination, 374, 384
subdural haemorrhage, 401 see also wound infections
subfalcial herniation, 276, 277, 277f suspensory ligament of ovary, 63f, 64
subhepatic spaces, 32 suspensory ligament of Treitz, 45
sublingual gland, 133, 133f, 135, 227 swallowing, 227
submandibular duct, 133f, 135 sympathetic chain (trunk), 34, 174, 283f
submandibular ganglion, 169, 178, 283f sympathetic nervous system, 282, 283f
submandibular gland, 133, 133f, 135, 227 adrenal medulla, 262
anatomy, 174–178, 177f, 177t

508 INDEX therapeutic embolism, 327
thermal burns, 306
sympathetic nervous system (Continued ) thermodilution, cardiac output measurement, 220
bladder control, 61, 251, 251f thermoreceptors
functions, 283
gastrointestinal control, 226, 227, 235, 241 on internal surfaces, 182
heart rate control, 216 peripheral, 182
response to trauma/surgery, 269 thermoregulation, 181–183
abnormal, 182–183
symphysis pubis, 86, 87f factors affecting, 183
synaptic transmission, 279 thigh compartments, 99
synchronised intermittent mandatory ventilation (SIMV), thirst, 184
thoracic breathing, 14
213 thoracic cage, 7–9
synovial tendon sheaths, 78–79, 79f thoracic duct, 146
syphilitic aneurysms, 421 thoracic vertebrae, 149, 149f
systemic inflammatory response syndrome (SIRS), thorax, 1–21
development, 3–7
380–382 thorotrast, 333
systemic vascular resistance (SVR), 221 thrombin time (TT), 361
systole, 217, 217f thrombocytopenia, 359,
systolic pressure, 221
359b, 361
T thromboembolism, 326
thrombolysis, 326
T-cell receptors (TCRs), 346 thrombophilia, 325
T-lymphocytes, 344, 346, 348 thrombophlebitis migrans, 340
thrombosis, 325–326
lymphoid tissues, 347, 364 thromboxane A2, 359
tacrolimus, 353 thumb
taenia coli, 47, 241
talocrural joint, 110f joints, 71, 72
talus, 93–94, 93f, 94f muscles, 73
tarsal bones, 93–95 thymoma, 368
tectospinal tract, 288 thymus, 346
teicoplanin, 391 agenesis, 316, 368
temperature, body, 182 disorders, 368
tumours, 368
abnormalities, 182–183 thyroglossal duct/cysts, 113
core, 182 thyrohyoid ligament, 139f
peripheral, 182 thyroid-binding globulin (TBG), 256
regulation see thermoregulation thyroid carcinoma, 423, 423t
temporal lobe, 154, 155–156, 155f hormone dependency, 341
damage, 156 hyperthyroidism, 256
temporalis, 117, 132 radiation-related risk, 333
temporomandibular joint, 132–133 thyroid cartilage, 139, 139f
tendon reflexes, 176t, 286 thyroid disease, 256–257, 422–423
lower limb, 103 thyroid gland, 255–257
tensor fasciae latae, 89 aberrant tissue, 114
tensor tympani, 127 anatomy, 138–139, 138f, 255
tentorial herniation see transtentorial herniation carcinoma, 138
tentorium cerebelli, 162 development, 113
teratogens, 315, 315b enlargement, 138
teratomas, 332, 426 physiology, 255–257
testicular artery, 40 thyroid hormone
testis effects, 256, 268
anatomy, 39–40 growth effects, 256, 313
development, 25 secretion and transport, 255–256
ectopic, 25, 26 synthesis, 255, 255f
radiation damage, 305 thyroid-stimulating hormone (TSH), 254,
undescended, 26, 40, 315
tetanus, 383–384, 393t 255, 341
tetracycline, 391 thyroid storm (crisis), 271, 461
theatre, operating thyroid veins, 138
air flow, 385–386 thyroidea ima, 138
infection control, 374, 385–386 thyroidectomy, 138, 139, 141
layout, 385 thyroiditis, 256
personnel, 374, 386 thyrotoxicosis see hyperthyroidism
special precautions, 397
thenar eminence, 73
thenar space, 79

INDEX 509

thyrotrophin-releasing hormone (TRH), trigeminal nerve (V), 116, 117f, 168–169,
254, 255 172f

thyroxine (T4), 255, 255f, 256 lesions, 169
tibia, 92, 93f mandibular division see mandibular nerve
tibial nerve, 101f, 102, 103f maxillary division see maxillary nerve
ophthalmic division see ophthalmic nerve
injuries, 104 triglycerides, 233
tibiofibular joint, 108 triiodothyronine (T3), 255, 255f, 256
tibioperoneal trunk, 97f trimethoprim, 390
tidal volume (TV), 201, 201b, 201f triquetral, 68, 69f
tissue loss trisomies, 336
trisomy 21 (Down’s syndrome), 315, 336
closure methods, 297–300, 464 trochlear nerve (IV), 167–168, 172f
healing after, 296 Troisier’s sign, 146
tissue plasminogen activator, 361 tropomyosin, 215, 284, 285
TNM classification, 341 troponin, 215, 284, 285
toes, innervation, 176t truncus arteriosus, 3, 3f, 4
tongue trypsin, 236
anatomy, 133, 133f, 134 trypsinogen, 236
carcinoma, 169 tuberculosis
development, 112 breast, 417
tonsillar herniation, 276, 277, 277f urinary tract, 429
tonsillectomy, 142 tubo-ovarian abscess, 385t
tonsils, palatine, 142 tumour(s), 331–342
torsion, 327 benign, 331, 331b, 332t
total body irradiation, 305 classification, 331
total lung capacity (TLC), 201, 201b, 201f clinical effects, 339–340
Touton giant cells, 324 dependency, 340–341
trace elements, 243 emboli, 327
trachea, 9, 10f, 140f growth patterns, 333
tracheo-oesophageal fistula, 22, 22f invasion, 338, 338b
tracheostomy, anatomy, 10 malignant, 331, 331b, 332, 332t
transcutaneous electrical nerve stimulation (TENS), 282, markers, 340, 340b
metastasis, 338–339
463 nomenclature, 331–333, 332t
transfer factor, 203 prognosis, 341
transferrin, 235, 355 promotion, 336
transfusion see blood transfusion secondary see metastases
transitional cell carcinoma, 430, 431 staging, 341
translocations, chromosomal, 336 see also cancer
transplant tolerance, 352 tumour suppressor genes, 311, 337–338,
transplantation, organ, 351–354
337t
immunosuppression, 352–354 tunica albuginea, 39, 40
OSCE scenario, 354, 472 tunica vaginalis testis, 40
see also graft rejection Turner’s syndrome, 315
transposition flap, 298–299, 303f tympanic cavity, 126
transposons, 393–394 tympanic membrane, 126–127, 127f
transtentorial herniation, 276, 277, 277f,
U
402b, 454
transverse cervical nerve, 144f ulceration, chronic, 323
transverse colon, 46 ulcerative colitis, 336b, 442
transverse mesocolon, 30, 31f, 46, 57 ulna, 68, 68f
transverse rectus abdominis myocutaneous (TRAM) flap, ulnar artery, 74f, 75

300, 304f assessment, 452
transverse sinus, 165, 165f ulnar nerve, 75, 75f, 76, 77, 82f
transversus abdominis, 27
trapezium, 68, 69f, 72f lesions, 78, 452
trapezius, 70 ultraviolet (UV) light, 305, 333
trapezoid, 68, 69f, 72f umbilical arteries, 5, 5f
trauma umbilical vein, 4, 5f
uncinate fit, 166
hormonal response, 269–271, 270b unconscious patients, 134
physiological responses, 190–191 uncus, 155f, 156, 166
triangular ligament, 31f, 51f, 52 universal precautions, 396–397
triceps reflex, 176t, 286
tricuspid valve, 16
development, 3
trigeminal ganglion, 168

510 INDEX V

upper limb, 66–83 v-wave, 218, 219f
arteries, 74–75, 74f vaccinations
bones, 66–68
cutaneous nerves, 82f blood-borne viruses, 397
dermatomes, 82f post-splenectomy, 367
joints, 68–73 vagina, 63–64
lymphatics, 80 blood supply, 63f, 64
motor nerves/nerve roots, 176t examination, 64–65
nerve lesions, 77–78 orifice, 39
nerves, 76–77 vaginal artery, 63f
specialised areas, 79–80 vagotomy
sympathetic innervation, 175–176 complications, 231
veins, 73–74 procedures, 231, 232f
see also hand vagus nerve (X), 171, 172f, 178
lesions, 171
upper motor neurons, 173–174 mediastinum, 20f, 21f
lesions, 174b oesophagus, 42
stomach, 44, 229
urachus, 24f, 25 vancomycin, 391
urea, 250 varicocele, 40
ureter varicose vein surgery, 99
vas deferens, 40
anatomy, 59–60 vasa recta, 245, 248
blood supply, 60, 451 vascular endothelium
calculi, 60, 65, 427, 428, 451 radiation-induced damage, 304
development, 24–25, 24f response to trauma, 270
double/ectopic, 24 vascular injury
function, 250 haemostasis, 359
ureteric colic, 65, 451 thrombosis, 325
urethra vascular insufficiency, non-thromboembolic, 327–328
anatomy, 38–39 vascular occlusion
calculi, 428 causing ischaemia, 328
development, 24, 25, 25f external pressure, 328
innervation, 251f spontaneous, 328
obstruction, 431 vascular permeability, increased, 320
pathology, 431 vascular spasm, 328
rupture, 26, 39 vascular surgery, 393t
tumours, 431 vascular wall abnormalities, 362
urethritis, 431 vasoactive intestinal polypeptide (VIP), 236, 269
urinary tract vasoconstriction, 182, 359
calculi, 427–428 vasodilatation, reflex, 182
components, 245 vasodilators, 224
functions, 245 vasomotor centre, 211
pathology, 427–429, 430–431 vasopressin see antidiuretic hormone
physiology, 245–252 vasopressors, 224
structure, 245 vena cava, development, 4
tumours, 429, 430–431 venae comitantes, 74
see also bladder; genitourinary (GU) tract; kidney; venae cordis minimae, 17
venous obstruction, 328
ureter; urethra venous pulse, 218, 219f
urinary tract infections (UTIs), 399, 428–429, venous thromboembolism, 326–327, 329, 468
prophylaxis, 363, 468
474 treatment, 363, 457, 468
urine venous thrombosis, 325
see also deep vein thrombosis
formation, 246, 247–248, 247f, 250 ventilation
output, 223 mechanical, 213–214
storage in bladder, 250 mechanics, 196–203
water losses, 184 pulmonary, 196–197
urobilin(ogen), 237, 238f, 239, 240 regional variations, 199–200, 200f
urogenital sinus, 24, 25 ventilation/perfusion mismatch, 212
urogenital triangle, 36 ventilation/perfusion ratio (V/Q), 205
urorectal septum, 23, 24f ventricular septal defect (VSD), 6
uterine artery, 62, 63f vertebra prominens, 149
uterine polyps, 317
uterine tubes, 62–63, 63f
uterovesical pouch, 62, 62f
uterus, 61–62, 62f
blood supply, 62, 63f
fibroids, 427
utricle, 128, 128f

INDEX 511

vertebrae, 147–153, 147f, 149f, 150f balance, 184
vertebral arteries, 137f, 163, 164f body, 183
vertebral column, 147–153 boiling, 387
control of renal reabsorption, 248–250
growth, 115, 157 depletion, 184, 185t
see also spine disturbances of body, 184–185, 185t
verumontanum, 38 diuresis, 183
vesicoureteric reflux, 428 intestinal absorption, 234, 236, 241
vestibular nerve, 170 intoxication, 185, 185t
vestibule, vaginal, 39 renal reabsorption, 247, 247f, 248
vestibulo-ocular reflex, 275 see also fluid balance
vestibulocochlear nerve (VIII), 127, 170–171, Waterhouse–Friderichsen syndrome, 424
weight loss, 324, 466–467
172f Wharton’s (submandibular) duct, 133f, 135
vestibulospinal tract, 288 Whipple’s triad, 269
villi, intestinal, 231 white blood cells, 357–358
vipomas, 269 transfusion reactions, 371
Virchow’s node, 146 white cell count, 358b
Virchow’s triad, 325 white matter, 272
viridans streptococci, 377 whole blood, 369
viruses whole-blood clotting time, 361
whole body irradiation, 305
blood-borne, 394, 396–399 Wilms’ tumour, 429–430
carcinogenic, 333–334 withdrawal reflex, 286–287, 288f
chest infections, 414 work of breathing, 199, 199f
viscera, abdominal, 41–65, 41f wound(s)
sympathetic innervation, 177–178 clean, 386
visceral pain, 280 clean contaminated, 386, 392, 393t
visual cortex, 155f, 156 contaminated, 386
visual field defects, 167 contamination, sources, 374, 384
visual pathways, 166–167, 166f contraction, 295
vital capacity (VC), 201, 201b, 201f dirty, 386, 392
vitamin A deficiency, 243b, 316 healing, 295–303
vitamin B1, 243b incised, 296
vitamin B2, 243b repair of defects, 296–297
vitamin B3, 243b tissue loss, 296
vitamin B6, 243b wound infections, 386
vitamin B12 factors influencing development, 386b
absorption, 235 preoperative skin preparation, 387
deficiency, 231, 236, 243b, 459 wound classification by risk, 386
vitamin C, 235, 243b see also surgical site infections
vitamin D, 259 wrist
activation, 239 carpal bones, 68, 69f, 72f
deficiency, 243b, 260 flexor aspect injuries, 83, 451–452
vitamin-D-resistant rickets, 260 joint, 71, 72f
vitamin E deficiency, 243b muscle innervation, 176t
vitamin K structures around, 81f
deficiency, 243b, 362
warfarin reversal, 363 X
vitamins, 243
absorption, 235 x-descent, 218, 219f
deficiencies, 243b xenograft, 297, 351
hepatic storage, 239 xeroderma pigmentosum, 336, 336b
vitreous body, 125 xiphoid, 8
vocal cord, 140, 141f
volume–time curves, 203, 206f Y
vomiting, 230
bilious, 231 y-descent, 218, 219f
von Hippel–Lindau syndrome, 334t Yersinia, 378
von Willebrand’s disease, 362
vulva, 39 Z

W Z-plasty, 299, 303f
zinc, 243b
Wallerian degeneration, 405–406 Zollinger–Ellison syndrome, 269, 332
warfarin, 363, 468 zymogen granules, 236
warts, genital, 432
water

Intentionally left as blank