• As patients with cystic fibrosis (CF) are living longer, gastrointestinal issues are becoming more evident.
• The CFTR genotype determines the CFTR phenotype.
• One episode of distal intestinal obstruction syndrome (DIOS) increases the risk of a future episode.
• In differentiating DIOS from constipation in CF, it is important to use an abdominal x-ray.
• CFTR potentiator and corrector medications may be helpful for nutritional outcomes in CF patients.

• Updated illustrations reflect perianal anatomy in greater detail
• Detailed illustrations accompany descriptions of mucosal advancement flap, ligation of fistula tract, and episioproctotomy techniques
• Additional discussion focuses on management of anovaginal fistulas

• In the United States, norovirus is by far the most common cause of acute gastroenteritis.  Susceptibility of individuals is determined in part by genetic makeup.
• Norovirus is a cause of prolonged and disabling diarrhea among immunocompromised individuals.
• Worldwide, Shigella species are the most common cause of diarrhea.
• Shiga toxin may be produced by isolates of S. sonnei, as well as by isolates of E coli and S dysenteriae.
• The rates of antibiotic resistance to several bacterial gastrointestinal pathogens continue to increase.

• Diagnostic technology is evolving for yeast infections, advancing to include nucleic acid testing and nanotechnology, although this may not be available at all centers.
• There are three general classes of antifungal agents, and the specific class used for an individual infection differs depending on the need to treat is superficial or invasive infection.
• The epidemiology of species responsible for an individual infection may depend on previous exposure and treatment to various antifungal agents.

• CT diagnosis of cholecystitis is not first line.
• Percutaneous cholecystostomy may be definitive treatment for acalculous cholecystitis.
• Point of care US is not suitable in ICU 
• Low-pressure pneumoperitoneum is safe for high-risk patients

Acute appendicitis remains a therapeutic challenge during active pregnancy. Both laparascopic and open approaches can be considered; the techniques remain largely the same, with a few caveats. Fetal monitoring may be performed using a transvaginal or left lateral abdominal wall approach. For open appendectomy, ultrasonography and magnetic resonance imaging may provide direction for the incision. Laparascopic appendectomies should be approached with a open trocar placement in the midline, with direct visualization. Late-term pregnancies may require alternative approaches in the subcostal region, and the patient may be rolled with their left side down to facilitate exposure of the appendix and relieve pressure on the inferior vena cava.

• Prevention of tube thoracostomy complications during insertion relies on three maneuvers: avoiding the neurovascular bundle by entering the pleura above the rib; performing a 360° finger sweep before placing the tube into the pleural space to ensure that there are no adhesions to the lung and to confirm the position of the thoracostomy above the diaphragm; and using a controlled pleural entry.
• Pigtail catheter thoracostomy is equivalent to larger chest tube thoracostomy for treating uncomplicated pneumothorax. Insertion-site pain is much reduced with pigtail catheters when compared with larger chest tubes.
• Pericardiocentesis for trauma has a very limited role in nontrauma centers where definitive surgical management of cardiac tamponade is not immediately available and transport time to a facility with a higher level of care would support use of temporary pericardial decompression in this manner.
• Temporal artery biopsy remains important to confirm the diagnosis of giant cell arteritis because the sensitivity and specificity of diagnosis based on clinical criteria alone are only 68.5% and 58%, respectively.
• Skeletal muscle biopsy specimens should be immediately submitted to Pathology fresh and wrapped in dry gauze, and the precise muscle biopsied must be recorded as there is variability in the type of collagen present in different muscle groups that may affect interpretation.

• Enhanced understanding of lung-protective ventilation strategies
• Elevated PaCO2 vs. reduced PaO2 in respiratory acidosis
• Enhanced understanding of the ventilatory load
• Understanding of the renal response to hypercapnia