Biliary cysts are associated with an increased risk of cancer, particularly cholangiocarcinoma , but also pancreatic and gallbladder cancers. Cancer is more common in patients who are older and in those with type I and IV cysts.

Because of the increased risk of malignancy, it is recommended that patients with type I or IV cysts have the cysts completely removed with Roux-en-Y hepaticojejunostomy.

The risk of cancer appears to be lower in patients with type II or III cysts.

Patients with type II cysts can often be treated with simple cyst excision, while those with type III cysts can be treated with sphincterotomy or endoscopic resection

Patients with type V cysts have a moderate risk of cancer, but because of the intrahepatic nature of the cysts, treatment can be difficult and some patients require liver transplantation


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Courvoisier 's low

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Stages of Ulcer

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Abdominal x-ray anatomy

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Cough medications | Pediatric | ٲدوية السعال في الٲطفال,  الٲصناف المتوفرة والجرع الآمنة PDF

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Paracetamol , Albendazole, Mebendazole  | ٲدوية عيادات الٲطفال بالجرع الصحيحة PDF



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KCL postassoum chloride ,Rapid correction of hypokalemia   |  ٲدوية طوارئ الٲطفال بالجرع الصحيحة PDF

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Croup Management | pediatric | كيفية التعامل مع حالات الخناق الفيروسي في الطوارئ PDF


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🔵NF :

-Pain disproportionate to physical finding

-Rapidly spread  " serious disease"

- Cardinal features during examination:-  signs of Inflammation  + crepitus " gass forming bacteria " , Echymosia or necrosis ,  bullae " hemorrhagic ".

- Do the finger test .

- Dishwater fluid ( discharge) is when the fluid inside the tissues turns a grey, murky colour , offensive odour


- Patient may present in Shock state.

- Ludwig's angina and NF are extensive manifestations of soft tissue infection to occur in the cervico-facial region. 

-Fournier gangrene is a type of necrotizing fasciitis or gangrene affecting the external genitalia or perineum. 

🔹Investigations :-

CBC :
⬆️ WBCs

Electrolytes :
⬇️ Na

RFT , KFT :
⬆️Urea
⬆️ Creatinine


🔷 May be appear in x-ray:

Early findings are non-specific, similar to those of cellulitis, such as increased soft-tissue thickness and opacity. Soft tissue gas is seen in only a minority of cases.


🔷Treatment:

- Resuscitation
- Wide Aggressive surgical debridement
- Wide spectrum antibiotics
Should cover Gram +ve and -ve , aerobic and anaerobic bacteria
Such as :
- Vancomycin for MERSA
-  Metronidazole ir clindamycin for anaerobic bacteria
- Amikacin ( * normal creatinine) or levofloxacin for gram -ve
- may be Carbapenems : such as imipenem-cilastatin, meropenem

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Types of NF .

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Finger test in NF

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Management depends on stage ( Classification)

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The puncture, aspiration, injection, and reaspiration (PAIR) technique, which involves puncture of the cyst wall, aspiration of cyst contents, instillation, and reaspiration of the scolicidal agent, has gained international recognition

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A Klatskin tumor is a ( perihailar ) cholangiocarcinoma occurring at the confluence of the right and left hepatic bile ducts. The disease was named after Gerald Klatskin, who in 1965 described 15 cases and found some characteristics for this type of cholangiocarcinoma 

And was classified by bismuth classifications.

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Strasburg classifications of biliary injury.

applies to biliary injuries encountered during laparoscopic cholecystectomy 

وبعدين يرجع من E حسب ال Bismuth السابقة👆🏻👆🏻

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