Courvoisier's sign:
A painless palpably enlarged gallbladder accompanied with mild jaundice is unlikely to be caused by gallstones. It's more likely to be caused by a malignancy at the head of the pancreas.

The condition is painless because it's chronic and the gallbladder is distended and obstructed in a gradual manner due to the malignant growth. This is in contrast with the sudden onset of painful gallstones.

+ لازم أتذكر أسولف عن:
SIADH & meningitis
+ Cerebral Salt-Wasting (CSW) syndrome

بس ورة النسائية...

Helpful tips:

🐈‍⬛ AST/ALT > 2 = alcoholic liver

🐈‍⬛ AST/ALT > 5 = rhabdomyolysis or MI

🐈‍⬛ ALP levels are also raised in conditions associated with increased bone turnover or bone loss (e.g.: Paget’s disease, bone metastases)

🐈‍⬛ Low ALP is characteristically observed in Wilson disease

Everyone, say hi to Murtadha 🍻

A 67-year-old man
- history of vague abdominal discomfort on the right side, intermittent diarrhea

- episodes of facial flushing every 2 to 3 days

- no history of ingestion of alcohol or other precipitants of flushing

- recent echocardiogram showed trace tricuspid regurgitation.

Suspected Carcinoid tumor

To confirm the dx: CT abdomen was done and there was a mass in the midgut in addition to liver lesion which guided to a biopsy that revealed a well-differentiated neuroendocrine tumor.

Normally, the placenta is seperated from the uterine wall by the decidua basalis.
Placenta accreta spectrum is when the placenta penetrates through the decidua and invades too deeply into the uterine wall.

Accreta is when the placenta reaches the myometrium but does not invade it.
Increta is when it invades the myometrium.
Percreta is when it invades the entire uterine wall and reaches the uterine serosa.

It's not considered a gestational trophoblastic disease. Because, although it involves abnormal invasion of the uterine wall, the placenta remains normal, and the trophoblasts that form the placenta proliferate in a normal manner. While the hallmark of gestational trophoblastic disease is abnormal proliferation of trophoblasts.

طبعًا أكو معلومة ممتأكد من صحّتها:
Paternally imprinted genes contribute to placenta accreta spectrum

أتذكر سامعها بكورس روبرت سابولسكي، بس ممتأكد إذا جانت عن الـ placenta accreta بالذات لو عن الـ gestational trophoblastic disease

هسة تأكدت
They do contribute to placenta accreta. Especially a group of genes called: C19MC miRNA cluster

A barium swallow of esophagus showing Pseudoachalasia which is an achalasia-like disorder that is usually produced by adenocarcinoma of the cardia.
We should be suspicious about it because as we know achalasia is uncommon.
The difference is there’s irregular tapering unlike achalasia which described as a bird’s beak.

All types of simple goitre are more common in the female than in the male owing to the presence of oestrogen receptors in thyroid tissue.

Both simple goitre and autoimmune thyroiditis frequently coexist, so we need to asses circulating thyroid antibodies to exclude autoimmune thyroiditis..