Gastroenterology and Hepatology
Core concepts
Understand the approach to GI bleeding (upper vs lower, resuscitate before endoscopy, risk scores like Glasgow-Blatchford), and the causes of deranged liver enzymes: hepatocellular (ALT-predominant) versus cholestatic (ALP/GGT-predominant). Know the complications of cirrhosis - ascites, varices, encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis - and their management. Be confident with inflammatory bowel disease phenotypes and when to use steroids, biologics, or surgery. Recognise pancreatitis (diagnosis needs two of three: typical pain, lipase >3× upper limit, imaging) and its severity markers.
Traps
Questions test ascitic fluid analysis: a neutrophil count ≥250/mm³ diagnoses SBP even with a negative culture. Do not attribute all jaundice to obstruction - check for haemolysis and hepatocellular injury. In coeliac disease, serology (anti-tTG IgA with total IgA) precedes biopsy. Distinguish upper from lower bleeding by presentation, not assumption. A normal lipase early in pancreatitis can mislead; repeat if suspicion is high.
Rule of thumb
In any patient with cirrhosis and ascites, perform diagnostic paracentesis on admission - SBP is often asymptomatic and requires prompt antibiotics (third-generation cephalosporin) plus albumin if creatinine is raised.
Worked example
A cirrhotic patient with fever and ascites: send cell count, culture, and treat empirically for SBP if PMN ≥250/mm³, while giving albumin to reduce hepatorenal risk.