Gastroenterology and Hepatology

Gastroenterology rapid review

• Acute diarrhoea care starts with volume status and ORS, not automatic antibiotics.
• Bloody diarrhoea with severe cramps and little fever can be Shiga-toxin illness: avoid loperamide and usually avoid antibiotics while testing.
• Chronic diarrhoea: classify watery, fatty or inflammatory before ordering broad tests.
• Coeliac disease: test with tTG-IgA plus total IgA while eating gluten; adults usually need duodenal biopsy.
• UC is continuous mucosal colitis; Crohn disease is skip, transmural and prone to fistula or stricture.
• Exclude C. difficile and intestinal infection before escalating IBD immunosuppression.
• Acute severe UC needs admission, IV steroid, VTE prophylaxis, day-3 review and early surgical partnership.
• IBS is diagnosed positively only after alarm-feature review.
• Confirm active H. pylori with breath, stool antigen or biopsy testing; serology cannot prove cure.
• Test H. pylori cure at least 4 weeks after antibiotics and off PPI about 2 weeks when safe.
• Empiric clarithromycin triple therapy is obsolete where susceptibility is unknown.
• Gastric ulcer or abnormal gastric lesion requires appropriate biopsy and follow-up.

Hepatology rapid review

• ALT/AST are injury markers; ALP/GGT suggest cholestasis; INR/albumin reflect synthesis.
• R-ratio more than 5 is hepatocellular, less than 2 cholestatic, and 2–5 mixed.
• Falling ALT with rising INR can mean worsening liver failure.
• HEV in pregnancy can be severe; encephalopathy plus INR rise is an emergency.
• HBV serology depends on HBsAg, anti-HBc and anti-HBs; HBV DNA shows replication.
• HBV first-line oral drugs are high-barrier tenofovir-based therapy or entecavir, chosen by patient factors.
• Anti-HCV positivity proves exposure; HCV RNA proves current infection.
• DAAs replace interferon for almost all HCV; protease inhibitors are avoided in decompensated cirrhosis.
• PBC: antimitochondrial antibody clue and UDCA 13–15 mg/kg/day first-line.
• PSC: MRCP diagnoses; ERCP treats or samples relevant strictures.
• MASLD: fibrosis risk matters most; use FIB-4 then elastography/ELF if needed.
• Wilson disease is a composite diagnosis; ceruloplasmin alone is inadequate.
• Clinically significant portal hypertension begins at HVPG 10 mmHg; bleeding usually needs about 12 mmHg.
• Variceal bleed: vasoactive drug plus antibiotic now, restrictive transfusion and banding within 12 hours after stabilization.
• Ascites: diagnostic tap first; SAAG at least 1.1 g/dL supports portal hypertension.
• SBP: PMN at least 250/mm³; treat before culture result.
• More than 5 L paracentesis needs albumin replacement, commonly about 6–8 g per litre removed.
• HE: treat trigger plus lactulose to 2–3 soft stools daily; rifaximin prevents recurrence.
• Ammonia neither diagnoses nor grades HE by itself.
• HRS-AKI is diagnosed after correcting/excluding alternatives; use albumin plus vasoconstrictor and assess transplant.
• Terlipressin requires oxygenation and ischaemia monitoring.
• Pentoxifylline is not routine therapy for alcohol-associated hepatitis.
• ALF means INR at least 1.5 plus encephalopathy without prior cirrhosis; call a transplant centre early.
• NAC should not wait when acetaminophen toxicity is plausible.
• Budd-Chiari: anticoagulation, then recanalization/TIPS, then transplant if needed.