Spiral CT (CECT–contrast enhanced CT) is better—gold standard in acute pancreatitis, it is done after 72 hours.

Instrumentation is by far the most common cause of perforation.

Saint's triad:
1-Cholecystolithiasis
2-Hiatus hernia
3-Diverticulosis of left colon.

Triad of choledochal cyst "in 10٪ of patients":

1-Right upper quadrant pain
2-Jaundice
3-Palpable abdominal mass.

Charcot's triad of ascending cholangitis:
1-Intermittent pain(may be colicky)
2-Intermittent fever
3-Intermittent jaundice

Reynold's pentad:خماسي
Charcot's triad +shock"toxicity"+ altered mental status.

Mirizzi syndrome:
gallstones impacted in the GB wall and compresses it causing pressure necrosis which further gets adherent to CBD. It leads to fistula.
Four types.

The Chvostek signis a clinical sign of existing nerve hyperexcitability (tetany) seen in hypocalcemia.It refers to an abnormal reaction to the stimulation of the facial nerve.

Trausseu's sign:
placing the tourniquet around the hand and inflating up to 200mmHg for seconds induces spasm of the hand in hypoparathyroidism.

Whipple's triad:
1-Hypoglycemic episodes by fasting
2-Relief of illness by oral or intravenous glucose
3-Hypoglycemia lower than 3.3mmol/L.

Wermer's syndrome: "MEN" type1
1-Parathyroid adenoma 90٪
2-Pancreatic islets tumor in 80٪
3-Pituitary gland adenoma in 65٪.

Sipple's syndrome: MEN II
1-Parathyroid hyperplasia in 60٪
2-Medullary carcinoma of thyroid gland
3-Pheochromocytoma in 40٪.

Mucosal neuroma syndrome:
1-Medullary carcinoma of thyroid
2-Pheochromocytoma.

Thoracic outlet syndrome(TOS):
-It is a condition in which there is compression of the nerves, arteries, or veins in the passageway from the lower neck to the armpit.There are three main types: neurogenic, venous, and arterial.

1-The neurogenic type: is the most common and presents with pain, weakness, and occasionally loss of muscle at the base of the thumb.

2- The venous type results in swelling, pain, and possibly a bluish coloration of the arm. 

3-The arterial type results in pain, coldness, and paleness of the arm.

Mediastinal syndrome:
SOB, congested neck veins and brassy cough.

Normal blood calcium level is between 8.5 to 10.5 mg/dL (2.12 to 2.62 mmol/L) and that of ionized calcium is 4.65 to 5.25 mg/dL (1.16 to 1.31 mmol/L).

Raise in amylase level is common in:

Acute pancreatitis, pseudocyst of pancreas, pancreatic trauma, after ERCP.

Amylase is also often increased in other conditions like:
1™ Salivary gland diseases like parotitis
2™ Mesenteric ischaemia
3™ Ruptured aortic aneurysm
4™ Intestinal obstruction
5™ Ectopic gestation, salpingitis
6™ Duodenal ulcer perforation
7™ Ectopic amylase production in cancers of breast, lungs, ovary,
multiple myeloma
8™ Renal failure

Causes of raised serum amylase level other than acute pancreatitis:

● Upper gastrointestinal tract perforation
● Mesenteric infarction
● Torsion of an intra-abdominal viscus
● Retroperitoneal haematoma
● Ectopic pregnancy
● Macroamylasaemia
● Renal failure
● Salivary gland inflammation.

#Surgery

Pruritus ani:

● Common
● Numerous causes including skin diseases, parasites
(threadworm), anal discharge, allergies, diabetes
● Treat the cause if possible
● Symptomatic treatment is the mainstay.

#Surgery

Imperforate anus:

● A rare congenital disorder
● Classified as being high or low depending on the site of the
rectal termination in relation to the pelvic floor
● Low defects: relatively easy to correct but prone to
constipation
● High defects: more difficult to correct and prone to faecal incontinence.

#Surgery
#Pediatrics

The hallmark of Barrett's esophagus is the presence of goblet cells "intestinal metaplasia".

In urinary tract trauma, CT scan with IV contrast is the most important and accurate modality.

Urethral injury is the most common.

Blunt injury is the most common in renal injuries. 80-85٪.

In ureteric injury, iatrogenic injuries are the most common.

Most common presentation in renal tumors are asymptomatic.

Prostate cancer is the most common in men in USA.