Gastroenterology and Hepatology Clinical Summary

Posted on May 26, 2026 in Medicine

1. Liver Disease: Patterns, Causes, and Associations

Chronic Liver Diseases

Liver Injury Patterns

Acute Liver Conditions

• Ischaemic hepatitis: Hypotension, cardiac arrest, or hypoperfusion
• Liver failure: Encephalopathy + jaundice + coagulopathy
• Fetor hepaticus: Sweet, musty breath
• Prothrombin time: Best acute liver function marker
• Albumin: Poor acute marker

Liver Complications

• Hepatocellular carcinoma risk: Increased in haemochromatosis and PBC (x20 risk)
• Portal hypertension: Not a cause of hepatomegaly; thrombocytopenia is the earliest marker of cirrhosis

2. Portal Hypertension and Ascites

Emergency Complications

• TIPS: Worsens encephalopathy
• Constipation: Triggers decompensation
• Spontaneous bacterial peritonitis: Fever and abdominal pain

3. Upper GI Bleed

Core Principles

• Endoscopy within 24 hours
• High urea indicates UGIB
• Ligament of Treitz defines UGIB
• Surgery required if bleeding is uncontrolled

Variceal Bleed Management

Clinical Scores

• Blatchford: Pre-endoscopy (discharge risk)
• Rockall: Post-endoscopy prognosis

Peptic Ulcer Complications

• Posterior duodenal ulcer: Gastroduodenal artery bleed
• Gastric ulcer: Pain worse after eating
• Duodenal ulcer: Pain relieved by eating

4. Inflammatory Bowel Disease

Ulcerative Colitis (UC)

Key UC Features

• Starts at rectum; continuous inflammation
• Crypt abscesses and pseudopolyps
• Tenesmus; PSC association
• Smoking cessation can trigger flares

Crohn’s Disease

• Ileum is the most common site
• Smoking increases relapse risk
• Gallstones associated with ileal disease
• Goblet cell increase
• Treatment: Steroids (induction), Azathioprine (maintenance)
• Complications: Perianal abscess (I&D), fistula (MRI + seton), post-resection diarrhoea (cholestyramine)

5. Malabsorption and Deficiencies

Coeliac Disease Key Points

• tTG is first-line (check IgA)
• Villous atrophy and crypt hyperplasia
• Must be on gluten before testing
• Hyposplenism: Give pneumococcal vaccine
• Enteropathy-associated T-cell lymphoma risk
• Screen T1DM and autoimmune thyroid patients

6. Oesophageal Disorders

Achalasia Management

• Manometry is the gold standard
• Pneumatic dilation (young patients)
• Heller cardiomyotomy

Red Flags

• New dysphagia: Urgent endoscopy regardless of age
• Odynophagia: Oesophageal cancer concern
• Hoarseness: Recurrent laryngeal nerve invasion
• Progressive dysphagia

7. Pancreas and Biliary

Pancreatic Cancer Triad

• Hepatomegaly (metastases)
• Gallbladder enlargement
• Epigastric mass

Carcinoid Syndrome

• Flushing, diarrhoea, bronchospasm
• Right heart lesions: Tricuspid regurgitation, pulmonary stenosis
• Liver metastasis causes systemic symptoms; may secrete ACTH

8. Infections and Antibiotic GI Effects

C. Difficile

• Clindamycin and cephalosporins are high risk
• Antigen positive = exposure only
• Isolation required for 48 hours
• WBC is a severity marker

Liver Infections

• Pyogenic abscess: E. coli; treat with drainage and antibiotics
• Appendicitis: Liver abscess association

9. IBS and Functional Disorders

• IBS: Pain, bloating, bowel habit change
• Loperamide: First-line diarrhoea treatment
• SIBO: Hydrogen breath test; treat with rifaximin
• Scleroderma: SIBO risk

10. GI Bleeding and Emergencies

• Mallory-Weiss: Vomiting, self-limiting
• Boerhaave: Rupture and shock
• Peptic ulcer (posterior): Gastroduodenal artery
• Surgery: If refractory bleeding
• High urea: UGIB clue

11. Malignancy Associations

• HNPCC: Colorectal and endometrial cancer
• Peutz-Jeghers: Intussusception, SBO
• Gastric cancer: H. pylori, pernicious anaemia
• Barrett’s: Adenocarcinoma
• Oesophageal SCC: Smoking and alcohol
• Cholangiocarcinoma: PSC

12. Important Systemic and Metabolic

• Refeeding syndrome: Low phosphate, K, Mg
• Hepatic encephalopathy: Lactulose + rifaximin
• Metoclopramide: Dystonia; contraindicated in Parkinsonism/obstruction
• PPIs: Hyponatraemia, osteoporosis, fractures, C. diff risk
• OCP/Co-amoxiclav: Cholestasis

13. Key Emergency and Surgical

• Gallstone ileus: SBO + air in biliary tree
• SBO: Peutz-Jeghers, intussusception
• Mesenteric ischaemia: Pain, AF, lactate
• Budd-Chiari: Pain, ascites, hepatomegaly (Doppler US first-line)
• Pharyngeal pouch: Surgery
• Barrett’s dysplasia: Endoscopic intervention
• Early oesophageal cancer: Surgical resection

14. Final Ultra High-Yield Rules

• Courvoisier: Malignancy, not gallstones
• UC: Rectum, continuous
• Crohn’s: Skip lesions, ileum
• PSC: MRCP beading, UC
• PBC: AMA, IgM
• Coeliac: tTG, IgA
• SBP: Neutrophils >250
• UGIB: Endoscopy <24h
• Varices: Terlipressin, antibiotics
• C. diff: Vancomycin
• High SAAG: Portal HTN
• AST:ALT 2:1: Alcoholic hepatitis

Fatty Liver and Metabolic

• MASLD/NAFLD: Obesity, T2DM (bacterial overgrowth), abnormal LFTs
• Weight loss: First-line treatment
• ELF test: Used for fibrosis assessment
• Sudden weight loss: Can be associated