• 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.

• Antibiotic prophylaxis for all open extremity fractures is recommended.
• Washout and debridement of all open fractures within 24 hours of admission is recommended.
• Multidetector computed tomographic angiogram (MDCTA) has high sensitivity and specificity for identifying arterial injury in patients with soft signs of vascular injury due to blunt or penetrating extremity trauma
• Early tourniquet use can be life-saving when used to control active hemorrhage from severe extremity trauma and is associated with a low rate of complications
• If not immediately life threatening, the mangled extremity is best managed with a multi-disciplinary team approach.

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.

• 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.

• 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

• 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

• Percutaneous tracheostomy can be performed with perioperative morbidity and mortality rates equal to open tracheostomy. The risk of surgical site infection is considerably less with percutaneous tracheostomy.
• Intraosseous access is recommended for patients in extremis for whom a peripheral venous catheter is not readily established; blood, fluids, and medications can be effectively administered via this route until reliable venous access is obtained.
• The success rate of central venous catheterization is significantly enhanced with the use of ultrasonography, especially when accessing the internal jugular vein.
• The fourth to fifth intercostal space, anterior axillary line, is the preferred site for needle chest decompression of tension pneumothorax. Decompression is more likely to be successful due to less chest wall thickness at this site when compared with the traditional second intercostal space, midclavicular line.