Gastrointestinal, Hepatic, and Hematologic Disorders
Core concepts
Understand GI bleeding management: resuscitation, risk stratification, PPI therapy, and urgent endoscopy. Recognize acute liver failure, hepatic encephalopathy, and the complications of cirrhosis (varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome). Know pancreatitis severity and its early management (fluids, analgesia, enteral nutrition). In hematology, master thrombocytopenia, disseminated intravascular coagulation, heparin-induced thrombocytopenia, and transfusion thresholds. Understand the indications and complications of massive transfusion, including the lethal triad (hypothermia, acidosis, coagulopathy).
Traps
In upper GI bleeding, do not delay resuscitation for endoscopy; stabilize first. In cirrhosis with ascites, diagnostic paracentesis is essential to exclude spontaneous bacterial peritonitis - do not skip it because of coagulopathy; it is generally safe. Hepatic encephalopathy triggers include infection, bleeding, and electrolyte disturbance - treat the trigger. In DIC, treat the underlying cause; platelet and factor replacement is reserved for bleeding or procedures.
Worked example
A patient with cirrhosis and ascites presents with fever and abdominal pain. Diagnostic paracentesis shows a polymorphonuclear count of 400 cells/mm³. This is spontaneous bacterial peritonitis; start empiric third-generation cephalosporin and albumin, and consider secondary prophylaxis. Rule of thumb: PMN ≥250 cells/mm³ in ascitic fluid defines SBP.