{"id":36928,"date":"2026-06-03T21:49:03","date_gmt":"2026-06-03T16:19:03","guid":{"rendered":"https:\/\/atsixty.com\/?p=36928"},"modified":"2026-06-03T21:50:45","modified_gmt":"2026-06-03T16:20:45","slug":"git-hepatology-summative-revision-notes","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/cms\/git-hepatology-summative-revision-notes\/","title":{"rendered":"GIT &amp; Hepatology: Summative Revision Notes"},"content":{"rendered":"\n\n\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&#038;family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&#038;display=swap\" rel=\"stylesheet\">\n<style>\n\/* ============================================================\n   Morning Rounds \u00b7 GIT Series \u00b7 Summative Revision Notes\n   Namespace: #grev01\n   Palette: deep teal-green (GIT series standard)\n   ============================================================ *\/\n#grev01 *,#grev01 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.rv-closing{margin:36px 0 0;padding:24px 24px 22px;background:var(--ter-pale);border:1px solid #B0D8D0;border-left:4px solid var(--ter);border-radius:10px;font-size:0.92rem;color:var(--ink-mid);line-height:1.78}\n#grev01 .rv-closing-head{font-family:'Playfair Display',serif;font-size:1.05rem;font-weight:700;color:var(--ter-dark);margin-bottom:10px}\n#grev01 .rv-closing p{margin-bottom:0.85em}\n#grev01 .rv-closing p:last-child{margin-bottom:0}\n\/* Print *\/\n@media print{\n  #grev01 .rv-header{background:#1A6B5A !important;-webkit-print-color-adjust:exact}\n  #grev01{padding-bottom:20px}\n  #grev01 .rv-section{break-inside:avoid;box-shadow:none}\n}\n@media(max-width:480px){\n  #grev01 .rv-title{font-size:1.45rem}\n  #grev01 .rv-sec-title{font-size:1rem}\n  #grev01 table{font-size:0.76rem}\n  #grev01 td,#grev01 th{padding:6px 8px}\n}\n<\/style>\n\n<div id=\"grev01\">\n\n  <div class=\"rv-header\">\n    <div class=\"rv-eyebrow\">Morning Rounds &middot; GIT Series<\/div>\n    <div class=\"rv-title\">GIT &amp; Hepatology<br><em>Summative Revision Notes<\/em><\/div>\n    <div class=\"rv-subtitle\">Seven rounds &middot; 40 cases &middot; NEET-PG and UPSC CMS &middot; Core facts, tables, and diagrams<\/div>\n    <div class=\"rv-chips\">\n      <span class=\"rv-chip\">Esophagus &amp; Stomach<\/span>\n      <span class=\"rv-chip\">Intestinal<\/span>\n      <span class=\"rv-chip\">Viral Hepatitis<\/span>\n      <span class=\"rv-chip\">Liver<\/span>\n      <span class=\"rv-chip\">Pancreas<\/span>\n      <span class=\"rv-chip\">Biliary<\/span>\n      <span class=\"rv-chip\">Oncology &amp; Surgery<\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"rv-body\">\n\n    <div class=\"rv-intro\">\n      <p>These notes summarise the seven Morning Rounds in the GIT series. They are written for rapid pre-exam revision &mdash; not first-time learning. Each section distils the core facts, differentials, and clinical traps from its round. For the full clinical reasoning behind every question, return to the debrief panels in the quizzes.<\/p>\n      <p>The sequence follows the series: proximal to distal, parenchymal to vascular, medical to surgical.<\/p>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 1 \u2014 ESOPHAGUS & STOMACH\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 01 &middot; GIT Series<\/div>\n        <div class=\"rv-sec-title\">Esophagus &amp; Stomach<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">GERD<\/div>\n        <p>Primary mechanism: <strong>transient LES relaxation (TLESR)<\/strong>. First-line treatment: <strong>PPI<\/strong>. Gold standard investigation: <strong>24-hr ambulatory pH monitoring<\/strong>. Red flags mandating urgent endoscopy: dysphagia, odynophagia, unintentional weight loss, haematemesis, anaemia.<\/p>\n\n        <div class=\"rv-sub\">Barrett's Oesophagus<\/div>\n        <p>Definition: replacement of squamous epithelium by <strong>specialised intestinal metaplasia with goblet cells<\/strong>. Risk: <strong>adenocarcinoma<\/strong> (30&ndash;40&times; &mdash; NOT squamous cell carcinoma). Sequence: GERD &rarr; Barrett's &rarr; low-grade dysplasia &rarr; high-grade dysplasia &rarr; adenocarcinoma. Surveillance: lifelong PPI + endoscopy.<\/p>\n\n        <div class=\"rv-sub\">Achalasia Cardia<\/div>\n        <p>Pathology: degeneration of <strong>inhibitory (VIP\/NO) neurons in Auerbach's plexus<\/strong>. Dysphagia for <strong>both solids and liquids from onset<\/strong>. Barium: <strong>bird-beak sign<\/strong>. Gold standard: oesophageal manometry (absent peristalsis + incomplete LES relaxation). Treatment: pneumatic dilation \/ Heller myotomy \/ POEM.<\/p>\n\n        <div class=\"rv-sub\">Peptic Ulcer Disease<\/div>\n        <p><em>H. pylori<\/em>: urease-positive Gram-negative spiral rod. Causes ~90% DU, ~70% GU. <strong>Urea breath test<\/strong>: non-invasive gold standard for eradication confirmation (serology is useless post-treatment). DU: pain <em>relieved<\/em> by food, no malignant potential. GU: pain <em>worsened<\/em> by food, must biopsy to exclude malignancy. Triple therapy: PPI + clarithromycin + amoxicillin &times; 14 days.<\/p>\n\n        <div class=\"rv-sub\">Gastric Carcinoma \u2014 Spread Patterns<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Eponym<\/th><th>Site<\/th><th>Route<\/th><\/tr>\n            <tr><td><strong>Virchow's node (Troisier's sign)<\/strong><\/td><td>Left supraclavicular<\/td><td>Thoracic duct<\/td><\/tr>\n            <tr><td><strong>Sister Mary Joseph's nodule<\/strong><\/td><td>Periumbilical<\/td><td>Falciform ligament lymphatics<\/td><\/tr>\n            <tr><td><strong>Krukenberg tumour<\/strong><\/td><td>Both ovaries<\/td><td>Transperitoneal<\/td><\/tr>\n            <tr><td><strong>Blumer's shelf<\/strong><\/td><td>Pouch of Douglas (rectal exam)<\/td><td>Transperitoneal<\/td><\/tr>\n          <\/table>\n        <\/div>\n        <p><strong>Lauren classification:<\/strong> Intestinal type (H. pylori, antrum, glandular, better prognosis) vs Diffuse type (<strong>signet ring cells, linitis plastica, CDH1 mutation, worse prognosis<\/strong>).<\/p>\n\n        <p><span class=\"rv-pill\">Barrett's &rarr; adenoCa, never SCC<\/span> <span class=\"rv-pill\">DU: food relieves; GU: food worsens<\/span> <span class=\"rv-pill-teal\">Serology useless post-eradication<\/span><\/p>\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 2 \u2014 INTESTINAL DISEASES\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 02 &middot; GIT Series<\/div>\n        <div class=\"rv-sec-title\">Intestinal Diseases<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">IBS \u2014 Rome IV<\/div>\n        <p>Recurrent abdominal pain &ge;1 day\/week for &ge;3 months, associated with &ge;2 of: related to defaecation, change in stool frequency, change in stool form. Red flags that exclude IBS: age &gt;50, rectal bleeding, nocturnal symptoms, weight loss, anaemia, elevated CRP, family history of CRC\/IBD\/coeliac.<\/p>\n\n        <div class=\"rv-sub\">Crohn's vs Ulcerative Colitis<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Feature<\/th><th>Crohn's Disease<\/th><th>Ulcerative Colitis<\/th><\/tr>\n            <tr><td>Distribution<\/td><td>Any part, mouth to anus<\/td><td>Colon only, starts at rectum<\/td><\/tr>\n            <tr><td>Pattern<\/td><td>Skip lesions<\/td><td>Continuous<\/td><\/tr>\n            <tr><td>Depth<\/td><td>Transmural<\/td><td>Mucosal only<\/td><\/tr>\n            <tr><td>Histology<\/td><td>Non-caseating granulomas<\/td><td>Crypt abscesses<\/td><\/tr>\n            <tr><td>Complications<\/td><td>Fistulae, strictures, abscesses, perianal disease<\/td><td>Toxic megacolon, CRC risk after 8&ndash;10 yr<\/td><\/tr>\n            <tr><td>Smoking<\/td><td>Worsens CD<\/td><td>Protective in UC<\/td><\/tr>\n            <tr><td>PSC association<\/td><td>Rare<\/td><td>Strong (70&ndash;80% of PSC = UC)<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Intestinal TB vs Crohn's \u2014 Key Differentiators<\/div>\n        <p><strong>ITB:<\/strong> ileocaecal site, <em>caseating<\/em> granulomas, patulous ileocaecal valve, Stierlin's sign on barium, AFB culture, IGRA positive. <strong>CD:<\/strong> non-caseating granulomas, narrowed ileocaecal valve. <strong>Must exclude ITB before anti-TNF therapy<\/strong> &mdash; anti-TNF reactivates latent TB.<\/p>\n\n        <div class=\"rv-sub\">Coeliac Disease<\/div>\n        <p>HLA-DQ2 (~95%) \/ HLA-DQ8. Screening: <strong>anti-tTG IgA<\/strong> (check total IgA simultaneously &mdash; IgA deficiency gives false negative). Gold standard: <strong>duodenal biopsy<\/strong> (villous atrophy + crypt hyperplasia + raised IEL). Most common adult presentation in India: <strong>iron-deficiency anaemia refractory to oral iron<\/strong>. Complication: EATL (enteropathy-associated T-cell lymphoma). Treatment: strict lifelong gluten-free diet.<\/p>\n\n        <div class=\"rv-sub\">Acute Diarrhoea \u2014 Secretory vs Invasive<\/div>\n        <p><strong>Secretory:<\/strong> watery, no blood, no fever, stool WBC absent, ORS cornerstone. Mechanism: enterotoxin &rarr; cAMP &rarr; Cl&sup3; secretion (cholera). <strong>Invasive:<\/strong> blood + mucus, fever, tenesmus, stool WBC positive. Organisms: Shigella, Campylobacter, Entamoeba, EIEC. <strong>E. coli O157:H7:<\/strong> antibiotics CONTRAINDICATED (increase Shiga toxin release &rarr; HUS). HUS triad: MAHA + thrombocytopaenia + AKI.<\/p>\n\n        <p><span class=\"rv-pill\">Anti-TNF + TB = disseminated TB risk<\/span> <span class=\"rv-pill\">O157: no antibiotics<\/span> <span class=\"rv-pill-teal\">CD: smoking worsens; UC: smoking protects<\/span><\/p>\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 3 \u2014 VIRAL HEPATITIS\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 03 &middot; GIT Series<\/div>\n        <div class=\"rv-sec-title\">Viral Hepatitis<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">HAV and HEV<\/div>\n        <p>Both: RNA viruses, feco-oral, self-limiting in immunocompetent, no chronicity. <strong>HEV in pregnancy (3rd trimester): mortality 20&ndash;25%<\/strong>. HEV = epidemic waterborne jaundice in India. Chronic HEV only in immunosuppressed (transplant patients). HAV vaccine available; no licensed HEV vaccine in India.<\/p>\n\n        <!-- SVG: HBV serology states -->\n        <div class=\"rv-figure\">\n          <svg viewBox=\"0 0 700 230\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" style=\"width:100%;max-width:700px;display:block;margin:0 auto;font-family:'Source Serif 4',Georgia,serif\">\n            <rect width=\"700\" height=\"230\" fill=\"#FDFFFE\" rx=\"6\"\/>\n            <text x=\"350\" y=\"20\" text-anchor=\"middle\" fill=\"#1C2E2A\" font-size=\"12\" font-weight=\"700\">HBV Serological States \u2014 Quick Reference<\/text>\n\n            <!-- Headers -->\n            <rect x=\"10\"  y=\"28\" width=\"115\" height=\"22\" rx=\"4\" fill=\"#1A6B5A\"\/>\n            <rect x=\"132\" y=\"28\" width=\"80\"  height=\"22\" rx=\"4\" fill=\"#1A6B5A\"\/>\n            <rect x=\"219\" y=\"28\" width=\"80\"  height=\"22\" rx=\"4\" fill=\"#1A6B5A\"\/>\n            <rect x=\"306\" y=\"28\" width=\"95\"  height=\"22\" rx=\"4\" fill=\"#1A6B5A\"\/>\n            <rect x=\"408\" y=\"28\" width=\"80\"  height=\"22\" rx=\"4\" fill=\"#1A6B5A\"\/>\n            <rect x=\"495\" y=\"28\" width=\"90\"  height=\"22\" rx=\"4\" fill=\"#1A6B5A\"\/>\n            <rect x=\"592\" y=\"28\" width=\"98\"  height=\"22\" rx=\"4\" fill=\"#1A6B5A\"\/>\n            <text x=\"67\"  y=\"43\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9\" font-weight=\"700\">State<\/text>\n            <text x=\"172\" y=\"43\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9\" font-weight=\"700\">HBsAg<\/text>\n            <text x=\"259\" y=\"43\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9\" font-weight=\"700\">Anti-HBs<\/text>\n            <text x=\"353\" y=\"43\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9\" font-weight=\"700\">Anti-HBc IgM<\/text>\n            <text x=\"448\" y=\"43\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9\" font-weight=\"700\">Anti-HBc IgG<\/text>\n            <text x=\"540\" y=\"43\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9\" font-weight=\"700\">HBeAg<\/text>\n            <text x=\"641\" y=\"43\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9\" font-weight=\"700\">Interpretation<\/text>\n\n            <!-- Row data -->\n            <!-- Acute HBV -->\n            <rect x=\"10\" y=\"52\" width=\"680\" height=\"26\" rx=\"2\" fill=\"#FDF0EB\"\/>\n            <text x=\"67\"  y=\"69\" text-anchor=\"middle\" fill=\"#1C2E2A\" font-size=\"9\" font-weight=\"600\">Acute HBV<\/text>\n            <text x=\"172\" y=\"69\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"259\" y=\"69\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"353\" y=\"69\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"448\" y=\"69\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"540\" y=\"69\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"641\" y=\"69\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"8.5\">High infectivity<\/text>\n\n            <!-- Window period -->\n            <rect x=\"10\" y=\"80\" width=\"680\" height=\"26\" rx=\"2\" fill=\"#EBF6F3\"\/>\n            <text x=\"67\"  y=\"97\" text-anchor=\"middle\" fill=\"#1C2E2A\" font-size=\"9\" font-weight=\"600\">Window Period<\/text>\n            <text x=\"172\" y=\"97\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"259\" y=\"97\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"353\" y=\"97\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">+ ONLY<\/text>\n            <text x=\"448\" y=\"97\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"540\" y=\"97\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"641\" y=\"97\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"8.5\">Sole +ve marker<\/text>\n\n            <!-- Recovered -->\n            <rect x=\"10\" y=\"108\" width=\"680\" height=\"26\" rx=\"2\" fill=\"#FDF0EB\"\/>\n            <text x=\"67\"  y=\"125\" text-anchor=\"middle\" fill=\"#1C2E2A\" font-size=\"9\" font-weight=\"600\">Recovered<\/text>\n            <text x=\"172\" y=\"125\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"259\" y=\"125\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"353\" y=\"125\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"448\" y=\"125\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"540\" y=\"125\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"641\" y=\"125\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"8.5\">Anti-HBs + anti-HBc<\/text>\n\n            <!-- Vaccinated -->\n            <rect x=\"10\" y=\"136\" width=\"680\" height=\"26\" rx=\"2\" fill=\"#EBF6F3\"\/>\n            <text x=\"67\"  y=\"153\" text-anchor=\"middle\" fill=\"#1C2E2A\" font-size=\"9\" font-weight=\"600\">Vaccinated<\/text>\n            <text x=\"172\" y=\"153\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"259\" y=\"153\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"353\" y=\"153\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"448\" y=\"153\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"540\" y=\"153\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"641\" y=\"153\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"8.5\">No anti-HBc (key)<\/text>\n\n            <!-- Chronic active -->\n            <rect x=\"10\" y=\"164\" width=\"680\" height=\"26\" rx=\"2\" fill=\"#FDF0EB\"\/>\n            <text x=\"67\"  y=\"181\" text-anchor=\"middle\" fill=\"#1C2E2A\" font-size=\"9\" font-weight=\"600\">Chronic Active<\/text>\n            <text x=\"172\" y=\"181\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"259\" y=\"181\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"353\" y=\"181\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"448\" y=\"181\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"540\" y=\"181\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"641\" y=\"181\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"8.5\">High DNA, high infectivity<\/text>\n\n            <!-- Precore mutant -->\n            <rect x=\"10\" y=\"192\" width=\"680\" height=\"26\" rx=\"2\" fill=\"#EBF6F3\"\/>\n            <text x=\"67\"  y=\"209\" text-anchor=\"middle\" fill=\"#1C2E2A\" font-size=\"9\" font-weight=\"600\">Precore Mutant<\/text>\n            <text x=\"172\" y=\"209\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"259\" y=\"209\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"353\" y=\"209\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"448\" y=\"209\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"10\" font-weight=\"700\">+<\/text>\n            <text x=\"540\" y=\"209\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">&mdash;<\/text>\n            <text x=\"641\" y=\"209\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"8.5\">Anti-HBe +, high DNA (trap)<\/text>\n          <\/svg>\n          <div class=\"rv-fig-cap\">HBV serology at a glance. The window period (anti-HBc IgM as the sole positive marker) and the vaccinated state (anti-HBs without anti-HBc) are the two most examined patterns. The precore mutant trap: anti-HBe positive does not mean low infectivity when HBV DNA is high.<\/div>\n        <\/div>\n\n        <div class=\"rv-sub\">Hepatitis C<\/div>\n        <p>Anti-HCV = exposure\/screening only. <strong>HCV RNA (PCR)<\/strong> = active infection (becomes positive 1&ndash;2 weeks post-exposure). Genotype 3 = commonest in India. <strong>SVR (sustained virological response)<\/strong> = HCV RNA undetectable 12 weeks post-treatment = cure. Sofosbuvir + velpatasvir &times; 12 weeks: SVR &gt;95% pan-genotypic. Post-SVR: anti-HCV remains positive for life; patients with cirrhosis still need HCC surveillance.<\/p>\n\n        <div class=\"rv-sub\">HDV and FHF<\/div>\n        <p>HDV is defective &mdash; requires HBsAg. <strong>Superinfection<\/strong> (HDV into chronic HBV carrier) &gt; co-infection for FHF risk. FHF in India: HEV #1 (pregnancy), HAV, HBV, HDV superinfection. In the West: paracetamol OD #1 &rarr; treat with <strong>N-acetylcysteine<\/strong>. King's College Criteria guide liver transplant listing.<\/p>\n\n        <p><span class=\"rv-pill\">HEV + pregnancy = 20&ndash;25% mortality<\/span> <span class=\"rv-pill\">Window: anti-HBc IgM only<\/span> <span class=\"rv-pill-green\">HCV now curable &gt;95%<\/span> <span class=\"rv-pill-teal\">Genotype 3: India's commonest<\/span><\/p>\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 4 \u2014 LIVER DISEASES\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 04 &middot; GIT Series<\/div>\n        <div class=\"rv-sec-title\">Liver Diseases<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Alcoholic Liver Disease<\/div>\n        <p><strong>AST:ALT &gt;2:1<\/strong> (neither usually exceeds 300 IU\/L &mdash; this ceiling excludes viral hepatitis). GGT: most sensitive marker of alcohol use. <strong>Maddrey's DF<\/strong> = 4.6 &times; (PT<sub>patient<\/sub> &minus; PT<sub>control<\/sub>) + bilirubin. <strong>MDF &ge;32 = severe<\/strong>; prednisolone 40 mg &times; 28 days if no infection \/ GI bleed \/ renal failure. Lille score at day 7 assesses response.<\/p>\n\n        <div class=\"rv-sub\">NAFLD \/ NASH<\/div>\n        <p>Steatosis + metabolic syndrome. <strong>Liver biopsy<\/strong> = only way to distinguish simple steatosis from NASH. FibroScan assesses fibrosis but cannot diagnose NASH. <strong>Weight loss 7&ndash;10%<\/strong> = only proven treatment. Statins are NOT contraindicated in NAFLD. Lean NAFLD common in Indians (visceral adiposity at normal BMI).<\/p>\n\n        <div class=\"rv-sub\">Portal Hypertension and Cirrhosis Complications<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Complication<\/th><th>Diagnosis<\/th><th>Treatment<\/th><\/tr>\n            <tr><td><strong>Variceal bleed<\/strong><\/td><td>Endoscopy<\/td><td>Terlipressin + EBL + prophylactic antibiotics + albumin<\/td><\/tr>\n            <tr><td><strong>Ascites<\/strong><\/td><td>SAAG &ge;1.1 = portal HTN<\/td><td>Salt restriction + spironolactone &plusmn; furosemide; LVP + albumin<\/td><\/tr>\n            <tr><td><strong>SBP<\/strong><\/td><td>Ascitic PMN &gt;250 cells\/mm&sup3;<\/td><td>Cefotaxime IV + albumin; prophylaxis: norfloxacin<\/td><\/tr>\n            <tr><td><strong>HRS<\/strong><\/td><td>Functional AKI in cirrhosis<\/td><td>Terlipressin + albumin<\/td><\/tr>\n            <tr><td><strong>HE<\/strong><\/td><td>Clinical (asterixis, confusion)<\/td><td>Treat precipitant; lactulose; rifaximin; NO protein restriction<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Wilson's Disease<\/div>\n        <p><strong>ATP7B<\/strong> gene (chromosome 13). Copper accumulates in liver, brain, cornea, kidney. <strong>Kayser-Fleischer rings<\/strong> on slit-lamp (&gt;95% with neurological disease; may be absent in hepatic-only). Best screening test: <strong>24-hr urinary copper &gt;100 &micro;g\/day<\/strong>. Serum ceruloplasmin low in ~85%. Gold standard: liver biopsy with copper quantification. Treatment: <strong>D-penicillamine<\/strong> (first-line) or trientine; zinc for maintenance. Liver transplant = curative.<\/p>\n\n        <div class=\"rv-sub\">Hepatic Encephalopathy \u2014 Precipitants<\/div>\n        <p><strong>GI bleeding = #1 precipitant<\/strong> (blood = protein load). Others: infection\/SBP, constipation, diuretic excess, sedatives\/opioids, TIPS, high protein diet. Management: treat precipitant &rarr; lactulose &rarr; rifaximin. <strong>Protein restriction is harmful<\/strong> &mdash; maintain 1.2&ndash;1.5 g\/kg\/day.<\/p>\n\n        <p><span class=\"rv-pill\">AST:ALT &gt;2:1 = alcohol<\/span> <span class=\"rv-pill\">SBP: PMN &gt;250, E. coli #1<\/span> <span class=\"rv-pill-teal\">Wilson's: young + liver + neuro + haemolysis<\/span> <span class=\"rv-pill-green\">Protein restriction in HE = harmful myth<\/span><\/p>\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 5 \u2014 PANCREATIC DISEASES\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 05 &middot; GIT Series<\/div>\n        <div class=\"rv-sec-title\">Pancreatic Diseases<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Acute Pancreatitis<\/div>\n        <p>Causes: <strong>GET SMASHED<\/strong> (Gallstones #1 overall; Alcohol #1 in males in India; Trauma; Steroids; Mumps; Autoimmune; Scorpion sting &mdash; <em>Mesobuthus tamulus<\/em>, India; Hyperlipidaemia\/hypercalcaemia; ERCP; Drugs). <strong>Ranson &ge;3 = severe<\/strong>. Atlanta 2012: mild \/ moderately severe \/ severe (persistent organ failure &gt;48 hr). Cornerstone: <strong>aggressive IV fluid resuscitation<\/strong> (Ringer's lactate preferred). Antibiotics: ONLY for confirmed infected necrosis. ERCP: ONLY for gallstone pancreatitis + cholangitis.<\/p>\n\n        <div class=\"rv-sub\">Local Complications \u2014 The Four Entities<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Entity<\/th><th>Timing<\/th><th>Wall<\/th><th>Contents<\/th><th>Treatment<\/th><\/tr>\n            <tr><td><strong>APFC<\/strong><\/td><td>&lt;4 weeks<\/td><td>None<\/td><td>Fluid<\/td><td>Observe (most resolve)<\/td><\/tr>\n            <tr><td><strong>Pseudocyst<\/strong><\/td><td>&gt;4 weeks<\/td><td>Fibrous (no epithelium)<\/td><td>Fluid only<\/td><td>Endoscopic drainage if symptomatic<\/td><\/tr>\n            <tr><td><strong>ANC<\/strong><\/td><td>&lt;4 weeks<\/td><td>None<\/td><td>Necrosis + fluid<\/td><td>Antibiotics if infected<\/td><\/tr>\n            <tr><td><strong>WON<\/strong><\/td><td>&gt;4 weeks<\/td><td>Well-defined<\/td><td>Solid necrotic debris<\/td><td>Step-up (drain &rarr; necrosectomy)<\/td><\/tr>\n          <\/table>\n        <\/div>\n        <p><strong>Cullen's sign:<\/strong> periumbilical bruising. <strong>Grey Turner's sign:<\/strong> flank bruising. Both = haemorrhagic pancreatitis. <strong>Hypocalcaemia:<\/strong> saponification (lipase releases FAs which bind Ca&sup2;&spades;).<\/p>\n\n        <div class=\"rv-sub\">Tropical Pancreatitis (FCPD)<\/div>\n        <p>Young, non-alcoholic, tropical background. <strong>Large intraductal calculi<\/strong> on plain X-ray. <strong>Ketosis-resistant diabetes<\/strong> (some glucagon preserved). Steatorrhoea = exocrine insufficiency. SPINK1 mutation common in India. Treatment: PERT (pancreatin with meals) + insulin.<\/p>\n\n        <div class=\"rv-sub\">Carcinoma of Pancreas<\/div>\n        <p><strong>Head:<\/strong> painless progressive jaundice, Courvoisier's sign (palpable non-tender GB = malignant obstruction, not stones), <strong>double duct sign<\/strong> (CBD + pancreatic duct dilation on MRCP), CA 19-9 for monitoring. <strong>Body\/tail:<\/strong> pain radiating to back relieved by leaning forward, late presentation, new-onset DM in elderly. Curative operation: <strong>Whipple's (pancreaticoduodenectomy)<\/strong>. Only ~20% resectable at diagnosis.<\/p>\n\n        <div class=\"rv-sub\">Endocrine Tumours<\/div>\n        <p><strong>Insulinoma:<\/strong> Whipple's triad (fasting hypoglycaemia + glucose &lt;45 mg\/dL + relief with glucose). <strong>Elevated C-peptide = endogenous insulin<\/strong>; suppressed C-peptide = exogenous injection. Treatment: surgical resection; diazoxide bridge. <strong>ZES (Zollinger-Ellison):<\/strong> gastrinoma &rarr; refractory atypical ulcers + diarrhoea; fasting gastrin &gt;1000 pg\/mL; secretin stimulation test (paradoxical rise). Always exclude <strong>MEN-1<\/strong> (3 Ps: parathyroid, pituitary, pancreas).<\/p>\n\n        <p><span class=\"rv-pill\">Scorpion sting: M. tamulus, India<\/span> <span class=\"rv-pill\">Antibiotics: only infected necrosis<\/span> <span class=\"rv-pill-teal\">FCPD: large calculi + ketosis-resistant DM<\/span> <span class=\"rv-pill-green\">Elevated C-peptide = endogenous insulin<\/span><\/p>\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 6 \u2014 BILIARY DISEASES\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 06 &middot; GIT Series<\/div>\n        <div class=\"rv-sec-title\">Biliary Diseases<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Gallstone Types<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Type<\/th><th>Cause<\/th><th>X-ray<\/th><th>Location<\/th><\/tr>\n            <tr><td><strong>Cholesterol<\/strong><\/td><td>5 Fs (Fat, Female, Fertile, Fair, Forty); OCP, rapid weight loss, Crohn's<\/td><td>Radiolucent (15% calcified)<\/td><td>Gallbladder<\/td><\/tr>\n            <tr><td><strong>Black pigment<\/strong><\/td><td>Haemolysis (sickle cell, spherocytosis, thalassaemia); cirrhosis<\/td><td>Radio-opaque<\/td><td>Gallbladder<\/td><\/tr>\n            <tr><td><strong>Brown pigment<\/strong><\/td><td>Infected bile (E. coli, Ascaris); common in Asia<\/td><td>Radiolucent<\/td><td>Bile ducts<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Acute Cholecystitis<\/div>\n        <p><strong>Murphy's sign:<\/strong> inspiratory arrest on deep RUQ palpation. <strong>Early laparoscopic cholecystectomy within 72 hours<\/strong> is preferred over interval. <strong>Acalculous cholecystitis:<\/strong> ICU patients, TPN, burns &mdash; no stones, higher mortality. <strong>Rigler's triad<\/strong> (gallstone ileus): pneumobilia + SBO + ectopic calcified stone on plain X-ray.<\/p>\n\n        <div class=\"rv-sub\">Charcot's Triad and Reynold's Pentad<\/div>\n        <p><strong>Charcot's triad:<\/strong> RUQ pain + fever + jaundice = CBD stone with ascending cholangitis. <strong>Reynold's pentad:<\/strong> Charcot's triad + altered consciousness + septic shock = Grade III severe acute cholangitis &rarr; emergency ERCP. Most common organism: <em>E. coli<\/em>. MRCP = gold standard non-invasive investigation for CBD stones.<\/p>\n\n        <div class=\"rv-sub\">Primary Sclerosing Cholangitis<\/div>\n        <p>MRCP: <strong>beads on a string<\/strong> (multifocal strictures alternating with dilatations). Association: <strong>UC in 70&ndash;80% of PSC patients<\/strong>. Most feared complication: <strong>cholangiocarcinoma (10&ndash;15% lifetime risk)<\/strong>. UDCA improves LFTs but does not alter prognosis. <strong>Liver transplantation<\/strong> = only treatment that improves survival. Always check IgG4 to exclude IgG4-related sclerosing cholangitis (steroid-responsive mimic).<\/p>\n\n        <p><span class=\"rv-pill\">Murphy's: inspiratory arrest, not tenderness alone<\/span> <span class=\"rv-pill\">Reynold's: Charcot's + confusion + shock<\/span> <span class=\"rv-pill-teal\">PSC + UC = cholangiocarcinoma risk<\/span><\/p>\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 7 \u2014 ONCOLOGY, VASCULAR & SURGERY\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 07 &middot; GIT Series<\/div>\n        <div class=\"rv-sec-title\">Completing the Series &mdash; Oncology, Vascular &amp; Surgery<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Hepatocellular Carcinoma<\/div>\n        <p><strong>Surveillance:<\/strong> 6-monthly USS (&plusmn; AFP) in all cirrhotic patients. <strong>Non-invasive diagnosis:<\/strong> arterial hyperenhancement + portal venous washout on dynamic CT\/MRI (LI-RADS 5). <strong>BCLC staging:<\/strong> 0\/A = resection or ablation (curative); B = TACE; C = sorafenib\/lenvatinib; D = palliative. <strong>Milan criteria<\/strong> for transplant: single &le;5 cm or up to 3 nodules &le;3 cm, no vascular invasion. <strong>Fibrolamellar HCC:<\/strong> young patient, no cirrhosis, normal AFP, lamellar fibrous bands on biopsy; best prognosis of all HCC variants. <strong>Sorafenib:<\/strong> multikinase inhibitor (RAF + VEGFR + PDGFR); BCLC stage C first-line (now atezolizumab + bevacizumab preferred in fit Child-Pugh A).<\/p>\n\n        <div class=\"rv-sub\">Anorectal Diseases \u2014 One-liner Table<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Condition<\/th><th>Key Feature<\/th><th>Treatment Pearl<\/th><\/tr>\n            <tr><td><strong>Haemorrhoids<\/strong><\/td><td>Grade II: spontaneous reduction; Grade III: manual; Grade IV: permanent<\/td><td>RBL for Grade II&ndash;III; haemorrhoidectomy for Grade III&ndash;IV<\/td><\/tr>\n            <tr><td><strong>Anal Fissure<\/strong><\/td><td>Posterior midline ~90%; IAS hypertonia perpetuates chronicity<\/td><td>GTN 0.2% first-line; LIS for refractory; botox second-line<\/td><\/tr>\n            <tr><td><strong>Fistula-in-ano<\/strong><\/td><td>Goodsall's rule: posterior external opening &rarr; posterior midline internal<\/td><td>Fistulotomy for low; seton for high (preserve sphincter)<\/td><\/tr>\n            <tr><td><strong>Anorectal abscess<\/strong><\/td><td>Perianal most common; ischiorectal: deep, no visible swelling<\/td><td>Incision and drainage \u2014 never antibiotics alone<\/td><\/tr>\n            <tr><td><strong>Fournier's gangrene<\/strong><\/td><td>Necrotising fasciitis of perineum; diabetes + immunosuppression<\/td><td>Emergency wide debridement + broad-spectrum antibiotics<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <!-- SVG: Forrest classification -->\n        <div class=\"rv-figure\">\n          <svg viewBox=\"0 0 660 185\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" style=\"width:100%;max-width:660px;display:block;margin:0 auto;font-family:'Source Serif 4',Georgia,serif\">\n            <rect width=\"660\" height=\"185\" fill=\"#FDFFFE\" rx=\"6\"\/>\n            <text x=\"330\" y=\"18\" text-anchor=\"middle\" fill=\"#1C2E2A\" font-size=\"12\" font-weight=\"700\">Forrest Classification \u2014 Peptic Ulcer Bleeding<\/text>\n\n            <!-- Column headers -->\n            <rect x=\"10\"  y=\"24\" width=\"70\"  height=\"20\" rx=\"3\" fill=\"#1A6B5A\"\/>\n            <rect x=\"86\"  y=\"24\" width=\"160\" height=\"20\" rx=\"3\" fill=\"#1A6B5A\"\/>\n            <rect x=\"252\" y=\"24\" width=\"120\" height=\"20\" rx=\"3\" fill=\"#1A6B5A\"\/>\n            <rect x=\"378\" y=\"24\" width=\"140\" height=\"20\" rx=\"3\" fill=\"#1A6B5A\"\/>\n            <rect x=\"524\" y=\"24\" width=\"126\" height=\"20\" rx=\"3\" fill=\"#1A6B5A\"\/>\n            <text x=\"45\"  y=\"38\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9.5\" font-weight=\"700\">Class<\/text>\n            <text x=\"166\" y=\"38\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9.5\" font-weight=\"700\">Description<\/text>\n            <text x=\"312\" y=\"38\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9.5\" font-weight=\"700\">Rebleed Risk<\/text>\n            <text x=\"448\" y=\"38\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9.5\" font-weight=\"700\">Action<\/text>\n            <text x=\"587\" y=\"38\" text-anchor=\"middle\" fill=\"#FDFFFE\" font-size=\"9.5\" font-weight=\"700\">Risk level<\/text>\n\n            <!-- Rows -->\n            <rect x=\"10\" y=\"46\" width=\"640\" height=\"20\" rx=\"1\" fill=\"#FDF0EB\"\/>\n            <text x=\"45\"  y=\"60\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">Ia<\/text>\n            <text x=\"166\" y=\"60\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Spurting arterial bleed<\/text>\n            <text x=\"312\" y=\"60\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">~90%<\/text>\n            <text x=\"448\" y=\"60\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Endoscopic Rx required<\/text>\n            <text x=\"587\" y=\"60\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"9\" font-weight=\"700\">High<\/text>\n\n            <rect x=\"10\" y=\"68\" width=\"640\" height=\"20\" rx=\"1\" fill=\"#EBF6F3\"\/>\n            <text x=\"45\"  y=\"82\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">Ib<\/text>\n            <text x=\"166\" y=\"82\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Oozing, no visible vessel<\/text>\n            <text x=\"312\" y=\"82\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"10\" font-weight=\"700\">~55%<\/text>\n            <text x=\"448\" y=\"82\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Endoscopic Rx required<\/text>\n            <text x=\"587\" y=\"82\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"9\" font-weight=\"700\">High<\/text>\n\n            <rect x=\"10\" y=\"90\" width=\"640\" height=\"20\" rx=\"1\" fill=\"#FDF0EB\"\/>\n            <text x=\"45\"  y=\"104\" text-anchor=\"middle\" fill=\"#C0603A\" font-size=\"10\" font-weight=\"700\">IIa<\/text>\n            <text x=\"166\" y=\"104\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Visible non-bleeding vessel<\/text>\n            <text x=\"312\" y=\"104\" text-anchor=\"middle\" fill=\"#C0603A\" font-size=\"10\" font-weight=\"700\">~50%<\/text>\n            <text x=\"448\" y=\"104\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Endoscopic Rx required<\/text>\n            <text x=\"587\" y=\"104\" text-anchor=\"middle\" fill=\"#C0603A\" font-size=\"9\" font-weight=\"700\">High<\/text>\n\n            <rect x=\"10\" y=\"112\" width=\"640\" height=\"20\" rx=\"1\" fill=\"#EBF6F3\"\/>\n            <text x=\"45\"  y=\"126\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">IIb<\/text>\n            <text x=\"166\" y=\"126\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Adherent clot<\/text>\n            <text x=\"312\" y=\"126\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"10\">~30%<\/text>\n            <text x=\"448\" y=\"126\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Consider Rx (irrigate clot)<\/text>\n            <text x=\"587\" y=\"126\" text-anchor=\"middle\" fill=\"#7A9A94\" font-size=\"9\">Intermediate<\/text>\n\n            <rect x=\"10\" y=\"134\" width=\"640\" height=\"20\" rx=\"1\" fill=\"#FDF0EB\"\/>\n            <text x=\"45\"  y=\"148\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"10\">IIc<\/text>\n            <text x=\"166\" y=\"148\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Flat pigmented spot<\/text>\n            <text x=\"312\" y=\"148\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"10\">~10%<\/text>\n            <text x=\"448\" y=\"148\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Medical management<\/text>\n            <text x=\"587\" y=\"148\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"9\">Low<\/text>\n\n            <rect x=\"10\" y=\"156\" width=\"640\" height=\"20\" rx=\"1\" fill=\"#EBF6F3\"\/>\n            <text x=\"45\"  y=\"170\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"10\">III<\/text>\n            <text x=\"166\" y=\"170\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Clean base<\/text>\n            <text x=\"312\" y=\"170\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"10\">&lt;5%<\/text>\n            <text x=\"448\" y=\"170\" text-anchor=\"middle\" fill=\"#3D5A54\" font-size=\"9\">Early discharge possible<\/text>\n            <text x=\"587\" y=\"170\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"9\">Low<\/text>\n          <\/svg>\n          <div class=\"rv-fig-cap\">Forrest classification of peptic ulcer bleeding stigmata. Classes Ia, Ib, and IIa require endoscopic intervention. Dual therapy (adrenaline + thermal or haemoclip) is superior to monotherapy.<\/div>\n        <\/div>\n\n        <div class=\"rv-sub\">Carcinoid Tumour<\/div>\n        <p>Carcinoid syndrome only with <strong>liver metastases<\/strong> (gut serotonin inactivated by first-pass hepatic metabolism). <strong>Right-sided<\/strong> cardiac disease (TR + PS) &mdash; left heart protected by pulmonary metabolism. Diagnosis: <strong>24-hr urinary 5-HIAA<\/strong>. Treatment: <strong>octreotide LAR<\/strong> (symptom control + antiproliferative). Appendiceal carcinoid: &lt;2 cm &rarr; appendicectomy; &gt;2 cm &rarr; right hemicolectomy.<\/p>\n\n        <div class=\"rv-sub\">Acute Mesenteric Ischaemia<\/div>\n        <p>Classic: <strong>pain out of proportion to physical findings<\/strong> in elderly patient with AF. SMA embolism = most common cause. <strong>Thumbprinting<\/strong> on plain X-ray = submucosal oedema (ischaemia but not yet infarcted). Pneumatosis intestinalis = transmural infarction (very poor prognosis). Investigation: <strong>CT angiography<\/strong>. Treatment: emergency surgical embolectomy &plusmn; bowel resection. Mortality &gt;60% if diagnosis delayed &gt;12&ndash;24 hours.<\/p>\n\n        <div class=\"rv-sub\">GI Bleeding \u2014 Quick Orientation<\/div>\n        <p><strong>UGIB:<\/strong> Rockall score (pre + post endoscopy); Glasgow-Blatchford score (predicts need for intervention). Forrest Ia\/Ib\/IIa = endoscopic treatment. Dual therapy superior to monotherapy. IV PPI before endoscopy. Erythromycin IV 30 min before endoscopy clears stomach. <strong>LGIB by age:<\/strong> young = IBD\/infective\/haemorrhoids; elderly = diverticular bleeding (#1 major LGIB) \/ angiodysplasia \/ CRC. Meckel's rule of 2s. Colonoscopy = first-line investigation after resuscitation.<\/p>\n\n        <p><span class=\"rv-pill\">Pain out of proportion + AF = mesenteric ischaemia<\/span> <span class=\"rv-pill\">Carcinoid heart: right-sided only<\/span> <span class=\"rv-pill-teal\">Forrest Ia\/Ib\/IIa: treat endoscopically<\/span> <span class=\"rv-pill-green\">Fibrolamellar: young, no cirrhosis, normal AFP<\/span><\/p>\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         TOPICS NOT COVERED \u2014 brief note\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">For Completeness<\/div>\n        <div class=\"rv-sec-title\">What This Series Does Not Cover<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n        <p>These seven rounds are thorough, not encyclopaedic. For an examination with the breadth of NEET-PG or CMS, the following GIT topics deserve attention beyond what is covered here: <strong>colorectal carcinoma<\/strong> in depth (Duke's\/TNM staging, Lynch syndrome, microsatellite instability, FOLFOX regimen); <strong>small bowel tumours<\/strong> including GIST (CD117\/c-kit, imatinib); <strong>gut motility disorders<\/strong> beyond achalasia (diffuse oesophageal spasm, gastroparesis); <strong>nutritional support<\/strong> and enteral versus parenteral feeding indications; and the <strong>paediatric GIT conditions<\/strong> &mdash; Hirschsprung's disease (absent ganglion cells, barium enema transition zone, Swenson pull-through), intussusception (ileocaecal, red-currant jelly stool, USS doughnut sign, air enema reduction), and hypertrophic pyloric stenosis (Ramstedt pyloromyotomy, hypochloraemic metabolic alkalosis).<\/p>\n        <p>These topics may appear in a future Paediatric Surgery or Surgery Morning Rounds series. They are noted here so that a candidate working through this GIT series knows precisely where its boundaries lie.<\/p>\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         CLOSING NOTE\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-closing\">\n      <div class=\"rv-closing-head\">A note at the end of the series<\/div>\n      <p>Forty cases. Seven rounds. Several hundred debrief paragraphs. If you have read this far, you have covered more GIT medicine and surgery than many candidates will encounter in any single resource &mdash; and you have done it through clinical problems rather than lists.<\/p>\n      <p>The examination, whether NEET-PG or CMS, is not the end point. It is the credential that opens the door to the work. The district hospital, the community health centre, the general OPD &mdash; these are where the real patients present: the jaundiced young woman in her third trimester, the elderly man whose abdomen is inexplicably soft despite his agony, the child with bloody diarrhoea whose antibiotics must be withheld. The cases in these rounds were written with that practice in mind, not with the examination hall as the only horizon.<\/p>\n      <p>There will be questions in the actual examination that this series did not anticipate. There will be vignettes phrased in ways that feel unfamiliar. That is expected and manageable &mdash; a candidate who understands mechanisms does not need to have seen every question before. The debrief notes in these rounds were written to build that kind of understanding: not what the answer is, but why it is the answer and what the alternatives would mean clinically.<\/p>\n      <p>Go well. The preparation you have done here is real, and it will serve you &mdash; in the examination room, and long after.<\/p>\n    <\/div>\n\n    <div style=\"margin-top:32px;text-align:center;font-size:0.80rem;color:#7A9A94;font-style:italic;line-height:1.6\">\n      GIT &amp; Hepatology Summative Revision &middot; atsixty.com &middot; Morning Rounds Series<br>\n      For clinical reasoning practice, return to the seven Morning Rounds quizzes linked in the series index.\n    <\/div>\n\n  <\/div>\n<\/div>\n\n\n<ul class=\"wp-block-latest-posts__list wp-block-latest-posts\"><li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/rheumatology-summative-revision-notes\/\">Rheumatology: Summative Revision Notes<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/rheumatology-mixed-high-yield\/\">Rheumatology Series: Mixed High-Yield Round<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/rheumatology-myopathies-sjogrens-scleroderma\/\">Myopathies, Sjogren's &amp; Scleroderma<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/rheumatology-vasculitides\/\">Vasculitides<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/crystal-arthropathies\/\">Crystal Arthropathies<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>Morning Rounds &middot; GIT Series GIT &amp; HepatologySummative Revision Notes Seven rounds &middot; 40 cases &middot; NEET-PG and UPSC CMS &middot; Core facts, tables, and diagrams Esophagus &amp; Stomach Intestinal Viral Hepatitis Liver Pancreas Biliary Oncology &amp; Surgery These notes summarise the seven Morning Rounds in the GIT series. They are written for rapid pre-exam&hellip;&nbsp;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18,76,74,24],"tags":[],"class_list":["post-36928","post","type-post","status-publish","format-standard","hentry","category-cms","category-git","category-morning-rounds","category-neet-pg"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>GIT &amp; Hepatology: Summative Revision Notes - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/cms\/git-hepatology-summative-revision-notes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"GIT &amp; Hepatology: Summative Revision Notes - atsixty\" \/>\n<meta property=\"og:description\" content=\"Morning Rounds &middot; GIT Series GIT &amp; HepatologySummative Revision Notes Seven rounds &middot; 40 cases &middot; NEET-PG and UPSC CMS &middot; Core facts, tables, and diagrams Esophagus &amp; Stomach Intestinal Viral Hepatitis Liver Pancreas Biliary Oncology &amp; Surgery These notes summarise the seven Morning Rounds in the GIT series. 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