Gastroenterology and Hepatology
Core framework
Split the domain into luminal disease, pancreaticobiliary disease, and liver disease with its complications. For liver cases, always establish whether injury is hepatocellular or cholestatic (R-factor pattern), then screen for viral, autoimmune, metabolic and drug causes. Grade severity of acute upper GI bleeding, acute pancreatitis and decompensated cirrhosis early, because management decisions hinge on severity scores.
Concepts examiners test
Upper GI bleeding: resuscitation before endoscopy, risk scoring (Glasgow-Blatchford, Rockall), timing of endoscopy, and the role of proton pump infusion in high-risk stigmata. Acute pancreatitis: diagnosis needs two of three criteria, with early fluid resuscitation, analgesia, and enteral feeding; ERCP only for cholangitis or persistent obstruction. Cirrhosis: ascites sodium restriction plus spironolactone/furosemide, spontaneous bacterial peritonitis diagnosis (ascitic neutrophil count ≥250/mm³) and prophylaxis, variceal bleeding management with vasoactive drugs and antibiotics, hepatic encephalopathy with lactulose and rifaximin. Inflammatory bowel disease: recognise acute severe colitis and its medical and surgical thresholds.
Traps
- Do not delay resuscitation for endoscopy in exsanguinating GI bleeding.
- Serum amylase/lipase magnitude does not grade severity; use clinical and organ-failure criteria.
- Antibiotics are not routine in mild pancreatitis but are indicated for infected necrosis or cholangitis.
- Spontaneous bacterial peritonitis can present without fever or pain; always tap ascites on admission.
- Coagulopathy in cirrhosis does not equal bleeding risk - avoid reflex fresh frozen plasma.
Worked rule of thumb
A cirrhotic patient with fever and ascites: perform diagnostic paracentesis before antibiotics; a neutrophil count ≥250/mm³ confirms SBP, treat with a third-generation cephalosporin plus albumin for high-risk features, and start secondary prophylaxis.