Gastroenterology and Hepatology
Gastroenterology questions test a location-based approach to abdominal pain, plus recognition of bleeding, obstruction, and liver dysfunction. Candidates must know the alarm features in dyspepsia (weight loss, dysphagia, anemia, age) that mandate endoscopy, and the difference between upper and lower gastrointestinal bleeding presentations. Understand liver biochemistry patterns: hepatocellular (high transaminases) versus cholestatic (high alkaline phosphatase and bilirubin), and the work-up of jaundice. Master the complications of cirrhosis: ascites, varices, hepatic encephalopathy, and spontaneous bacterial peritonitis. Know when abdominal pain requires urgent surgical evaluation.
Traps: attributing epigastric pain to gastritis without excluding cardiac ischemia; missing spontaneous bacterial peritonitis because ascites was assumed benign; confusing hemolytic jaundice (unconjugated) with obstructive jaundice (conjugated); forgetting that normal liver enzymes do not exclude cirrhosis.
Worked example: a cirrhotic patient with fever and abdominal discomfort. Ascitic fluid analysis is mandatory. A polymorphonuclear cell count above the diagnostic threshold indicates spontaneous bacterial peritonitis, and treatment begins before culture results. Do not wait for cultures in a symptomatic patient.
Key concepts: alarm features, bleeding localization, liver enzyme patterns, cirrhosis complications, and ascitic fluid interpretation.